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Satoshi Takahashi, Peter Vajkoczy and Thomas Picht

imminent deterioration of the patient's motor status. 17 Altogether, these 7 unique capabilities of nTMS enable neurosurgeons to improve rolandic tumor resection through advanced planning and better postoperative evaluation of the surgery. Conclusions Navigated transcranial magnetic stimulation is the only mapping modality so far that is capable of stimulating the brain and recording the output in a noninvasive and painless way. Its accuracy for delineation of the motor cortex is comparable to that of DES. However, DES cannot be replaced by a noninvasive method

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Jan Coburger, Jari Karhu, Markus Bittl and Nikolai J. Hopf

. References 1 Coburger J , Musahl C , Weissbach C , Bittl M : Navigated transcranial magnetic stimulation-guided resection of a left parietal tumor: case report . Minim Invasive Neurosurg 54 : 38 – 40 , 2011 2 Deshpande G , Kerssens C , Sebel PS , Hu X : Altered local coherence in the default mode network due to sevoflurane anesthesia . Brain Res 1318 : 110 – 121 , 2010 3 Fietzek UM , Heinen F , Berweck S , Maute S , Hufschmidt A , Schulte-Mönting J , : Development of the corticospinal system and hand motor function

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Tizian Rosenstock, Ulrike Grittner, Güliz Acker, Vera Schwarzer, Nataliia Kulchytska, Peter Vajkoczy and Thomas Picht

Intraoperative neurophysiological monitoring (IOM) such as direct cortical and subcortical stimulation has been established to increase safety during the resection of rolandic brain tumors. 7 , 13 Yet even when IOM is routinely available, preoperative risk assessment is essential to allow for optimal patient counseling and treatment planning. Navigated transcranial magnetic stimulation (nTMS) has been extensively validated as a reliable tool for exactly analyzing the spatial relation between brain tumors and primary motor areas in a noninvasive fashion. 17 , 23 , 24 , 32 It

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Giovanni Raffa, Maria Catena Quattropani and Antonino Germanò

intrinsic tumors, 65 as well as many posterior fossa 75 and spinal neoplasms. 67 , 68 In the last decade a new mixed technique merging advanced imaging and electrophysiology, namely navigated transcranial magnetic stimulation (nTMS), has progressively gained favor among the neurosurgical community for studying and understanding brain functional organization. 45 , 53 nTMS provides a reliable combination of advanced imaging with the direct electrophysiological evaluation of neural activity, thereby representing a new approach for a noninvasive preoperative

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Nico Sollmann, Anna Kelm, Sebastian Ille, Axel Schröder, Claus Zimmer, Florian Ringel, Bernhard Meyer and Sandro M. Krieg

common options in clinical routine, functional MRI (fMRI) and magnetoencephalography (MEG) have been applied successfully. 16 , 35 , 39 , 40 , 43 , 44 In addition, navigated transcranial magnetic stimulation (nTMS) has been introduced recently as a novel technique for preoperative language mapping in patients with brain tumors. 42 , 56 , 63 By using a magnetic coil, magnetic pulses can be delivered over preselected areas of the scalp of a patient, and these pulses can be spatially related to the respective patient’s individual cortical anatomy, thanks to an

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Nico Sollmann, Alessia Fratini, Haosu Zhang, Claus Zimmer, Bernhard Meyer and Sandro M. Krieg

cortical and subcortical direct electrical stimulation (DES). 13 , 22 , 28 , 35 For resection of language-eloquent brain lesions, the techniques are commonly combined with awake surgery. 14 , 15 , 43 , 44 A novel, increasingly applied technique is represented by navigated transcranial magnetic stimulation (nTMS), which allows for preoperative language mapping. 19 , 33 Language mapping by nTMS has been recently combined with diffusion tensor imaging fiber tracking (DTI FT), which enables tractography of various subcortical language-related pathways purely based on

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Tizian Rosenstock, Thomas Picht, Heike Schneider, Peter Vajkoczy and Ulrich-Wilhelm Thomale

preoperative navigated transcranial magnetic stimulation compared to repeated intraoperative DCS mapping in awake craniotomy . BMC Neurosci . 2014 ; 15 : 20 . 2 Tarapore PE , Picht T , Bulubas L , Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients . Clin Neurophysiol . 2016 ; 127 ( 3 ): 1895 – 1900 . 3 Picht T , Schmidt S , Brandt S , Preoperative functional mapping for rolandic brain tumor surgery: comparison of navigated transcranial magnetic stimulation to direct cortical stimulation . Neurosurgery

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Nico Sollmann, Thomas Picht, Jyrki P. Mäkelä, Bernhard Meyer, Florian Ringel and Sandro M. Krieg

Lefaucheur JP , Brugières P , Ménard-Lefaucheur I , Wendling S , Pommier M , Bellivier F : The value of navigation-guided rTMS for the treatment of depression: an illustrative case . Neurophysiol Clin 37 : 265 – 271 , 2007 17 Lioumis P , Zhdanov A , Mäkelä N , Lehtinen H , Wilenius J , Neuvonen T , : A novel approach for documenting naming errors induced by navigated transcranial magnetic stimulation . J Neurosci Methods 204 : 349 – 354 , 2012 18 Ojemann G , Ojemann J , Lettich E , Berger M : Cortical language

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Giovanni Raffa, Thomas Picht, Antonino Scibilia, Judith Rösler, Johannes Rein, Alfredo Conti, Giuseppe Ricciardo, Salvatore Massimiliano Cardali, Peter Vajkoczy and Antonino Germanò

of postoperative motor deficits has been reported to range from 7.1% to 24.7%, 3 , 7 , 22 , 23 and it is particularly high when a clear cleavage plane with M1 and the underlying corticospinal tract (CST) is not identifiable and the tumor infiltrates the surrounding brain. 11 , 45 Therefore, during surgery for rolandic meningiomas all available pre- and intraoperative technologies should be employed to reduce the risk of postoperative motor deficits. Preoperative navigated transcranial magnetic stimulation (nTMS) has been introduced for the planning of brain tumor

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Neal Conway, Noémie Wildschuetz, Tobias Moser, Lucia Bulubas, Nico Sollmann, Noriko Tanigawa, Bernhard Meyer and Sandro M. Krieg

Neurol Neurosurg Psychiatry 72 : 511 – 516 , 2002 11909913 11 Duffau H , Karachi C , Gatignol P , Capelle L , Grossman RG , Roberts DW , : Transient Foix-Chavany-Marie syndrome after surgical resection of a right insulo-opercular low-grade glioma: case report . Neurosurgery 53 : 426 – 431 , 2003 12925262 10.1227/01.NEU.0000073990.94180.54 12 Forster MT , Hattingen E , Senft C , Gasser T , Seifert V , Szelényi A : Navigated transcranial magnetic stimulation and functional magnetic resonance imaging: advanced adjuncts in