Navigated transcranial magnetic stimulation for preoperative language mapping in a patient with a left frontoopercular glioblastoma

Case report

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Up to now, navigated transcranial magnetic stimulation (nTMS) has been used for motor mapping in the vicinity of rolandic brain lesions. Recently, nTMS has also been suggested to be useful in mapping human language areas.

The authors describe the case of a left-handed patient with a left-side glioblastoma within the opercular inferior frontal gyrus who presented with severe motor aphasia. Preoperative functional MRI (fMRI) indicated speech dominance of the right hemisphere and did not show any language-related activation in the vicinity of the tumor. Navigated TMS, however, showed a significantly higher rate of induced speech arrests for the left than for the right. Left-side direct cortical stimulation induced clear speech arrests during awake surgery.

This case suggests that nTMS may be useful for preoperative speech mapping in tumors affecting the anatomy, vasculature, and brain oxygen levels and therefore impairing fMRI reliability.

Abbreviations used in this paper:DCS = direct cortical stimulation; fMRI = functional MRI; GBM = glioblastoma; nTMS = navigated transcranial magnetic stimulation; RMT = resting motor threshold; rTMS = repetitive TMS.
Article Information

Contributor Notes

Address correspondence to: Sandro M. Krieg, M.D., Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany. email: Sandro.Krieg@lrz.tum.de.Please include this information when citing this paper: published online October 26, 2012; DOI: 10.3171/2012.9.JNS121053.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Bello LGambini ACastellano ACarrabba GAcerbi FFava E: Motor and language DTI Fiber Tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage 39:3693822008

    • Search Google Scholar
    • Export Citation
  • 2

    Corina DPLoudermilk BCDetwiler LMartin RFBrinkley JFOjemann G: Analysis of naming errors during cortical stimulation mapping: implications for models of language representation. Brain Lang 115:1011122010

    • Search Google Scholar
    • Export Citation
  • 3

    Epstein CM: Transcranial magnetic stimulation: language function. J Clin Neurophysiol 15:3253321998

  • 4

    Epstein CMLah JJMeador KWeissman JDGaitan LEDihenia B: Optimum stimulus parameters for lateralized suppression of speech with magnetic brain stimulation. Neurology 47:159015931996

    • Search Google Scholar
    • Export Citation
  • 5

    FitzGerald DBCosgrove GRRonner SJiang HBuchbinder BRBelliveau JW: Location of language in the cortex: a comparison between functional MR imaging and electrocortical stimulation. AJNR Am J Neuroradiol 18:152915391997

    • Search Google Scholar
    • Export Citation
  • 6

    Forster MTHattingen ESenft CGasser TSeifert VSzelényi A: Navigated transcranial magnetic stimulation and functional magnetic resonance imaging: advanced adjuncts in preoperative planning for central region tumors. Neurosurgery 68:131713252011

    • Search Google Scholar
    • Export Citation
  • 7

    Giussani CRoux FEOjemann JSganzerla EPPirillo DPapagno C: Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies. Neurosurgery 66:1131202010

    • Search Google Scholar
    • Export Citation
  • 8

    Ilmoniemi RJRuohonen JKarhu J: Transcranial magnetic stimulation—a new tool for functional imaging of the brain. Crit Rev Biomed Eng 27:2412841999

    • Search Google Scholar
    • Export Citation
  • 9

    Kohn SEGoodglass H: Picture-naming in aphasia. Brain Lang 24:2662831985

  • 10

    Krieg SMShiban EBuchmann NGempt JFoerschler AMeyer B: Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. Clinical article. J Neurosurg 116:99410012012

    • Search Google Scholar
    • Export Citation
  • 11

    Krieg SMShiban EDroese DGempt JBuchmann NPape H: Predictive value and safety of intraoperative neurophysiological monitoring with motor evoked potentials in glioma surgery. Neurosurgery 70:106010712012

    • Search Google Scholar
    • Export Citation
  • 12

    Krings TBuchbinder BRButler WEChiappa KHJiang HJRosen BR: Stereotactic transcranial magnetic stimulation: correlation with direct electrical cortical stimulation. Neurosurgery 41:131913261997

    • Search Google Scholar
    • Export Citation
  • 13

    Krings TChiappa KHFoltys HReinges MHCosgrove GRThron A: Introducing navigated transcranial magnetic stimulation as a refined brain mapping methodology. Neurosurg Rev 24:1711792001

    • Search Google Scholar
    • Export Citation
  • 14

    Krishnan RRaabe AHattingen ESzelényi AYahya HHermann E: Functional magnetic resonance imaging-integrated neuronavigation: correlation between lesion-to-motor cortex distance and outcome. Neurosurgery 55:9049152004

    • Search Google Scholar
    • Export Citation
  • 15

    Laws ER JrTaylor WFClifton MBOkazaki H: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61:6656731984

    • Search Google Scholar
    • Export Citation
  • 16

    Lefaucheur JPBrugières PMénard-Lefaucheur IWendling SPommier MBellivier F: The value of navigation-guided rTMS for the treatment of depression: an illustrative case. Neurophysiol Clin 37:2652712007

    • Search Google Scholar
    • Export Citation
  • 17

    Lioumis PZhdanov AMäkelä NLehtinen HWilenius JNeuvonen T: A novel approach for documenting naming errors induced by navigated transcranial magnetic stimulation. J Neurosci Methods 204:3493542012

    • Search Google Scholar
    • Export Citation
  • 18

    Ojemann GOjemann JLettich EBerger M: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:3163261989

    • Search Google Scholar
    • Export Citation
  • 19

    Ojemann GAWhitaker HA: Language localization and variability. Brain Lang 6:2392601978

  • 20

    Ojemann JGBuckner RLAkbudak ESnyder AZOllinger JMMcKinstry RC: Functional MRI studies of wordstem completion: reliability across laboratories and comparison to blood flow imaging with PET. Hum Brain Mapp 6:2032151998

    • Search Google Scholar
    • Export Citation
  • 21

    Ojemann JGNeil JMMacLeod AMSilbergeld DLDacey RG JrPetersen SE: Increased functional vascular response in the region of a glioma. J Cereb Blood Flow Metab 18:1481531998

    • Search Google Scholar
    • Export Citation
  • 22

    Pascual-Leone AGates JRDhuna A: Induction of speech arrest and counting errors with rapid-rate transcranial magnetic stimulation. Neurology 41:6977021991

    • Search Google Scholar
    • Export Citation
  • 23

    Picht TMularski SKuehn BVajkoczy PKombos TSuess O: Navigated transcranial magnetic stimulation for preoperative functional diagnostics in brain tumor surgery. Neurosurgery 65:6 Suppl93992009

    • Search Google Scholar
    • Export Citation
  • 24

    Picht TSchmidt SBrandt SFrey DHannula HNeuvonen T: Preoperative functional mapping for rolandic brain tumor surgery: comparison of navigated transcranial magnetic stimulation to direct cortical stimulation. Neurosurgery 69:5815882011

    • Search Google Scholar
    • Export Citation
  • 25

    Roux FEBoulanouar KLotterie JAMejdoubi MLeSage JPBerry I: Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation. Neurosurgery 52:133513472003

    • Search Google Scholar
    • Export Citation
  • 26

    Ruohonen JIlmoniemi RJ: Modeling of the stimulating field generation in TMS. Electroencephalogr Clin Neurophysiol Suppl 51:30401999

    • Search Google Scholar
    • Export Citation
  • 27

    Ruohonen JKarhu J: Navigated transcranial magnetic stimulation. Neurophysiol Clin 40:7172010

  • 28

    Sacko OLauwers-Cances VBrauge DSesay MBrenner ARoux FE: Awake craniotomy vs surgery under general anesthesia for resection of supratentorial lesions. Neurosurgery 68:119211992011

    • Search Google Scholar
    • Export Citation
  • 29

    Sanai NBerger MS: Mapping the horizon: techniques to optimize tumor resection before and during surgery. Clin Neurosurg 55:14192008

    • Search Google Scholar
    • Export Citation
  • 30

    Sanai NMirzadeh ZBerger MS: Functional outcome after language mapping for glioma resection. N Engl J Med 358:18272008

  • 31

    Sparing RMottaghy FMHungs MBrügmann MFoltys HHuber W: Repetitive transcranial magnetic stimulation effects on language function depend on the stimulation parameters. J Clin Neurophysiol 18:3263302001

    • Search Google Scholar
    • Export Citation
  • 32

    Stummer WReulen HJMeinel TPichlmeier USchumacher WTonn JC: Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62:5645762008

    • Search Google Scholar
    • Export Citation
  • 33

    Ulmer JLHacein-Bey LMathews VPMueller WMDeYoe EAProst RW: Lesion-induced pseudo-dominance at functional magnetic resonance imaging: implications for preoperative assessments. Neurosurgery 55:5695812004

    • Search Google Scholar
    • Export Citation
  • 34

    Ulmer JLKrouwer HGMueller WMUgurel MSKocak MMark LP: Pseudo-reorganization of language cortical function at fMR imaging: a consequence of tumor-induced neurovascular uncoupling. AJNR Am J Neuroradiol 24:2132172003

    • Search Google Scholar
    • Export Citation
  • 35

    Wassermann EMBlaxton TAHoffman EABerry CDOletsky HPascual-Leone A: Repetitive transcranial magnetic stimulation of the dominant hemisphere can disrupt visual naming in temporal lobe epilepsy patients. Neuropsychologia 37:5375441999

    • Search Google Scholar
    • Export Citation
  • 36

    Yetkin FZMueller WMMorris GLMcAuliffe TLUlmer JLCox RW: Functional MR activation correlated with intraoperative cortical mapping. AJNR Am J Neuroradiol 18:131113151997

    • Search Google Scholar
    • Export Citation
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