The impact of presurgical planning based on navigated transcranial magnetic stimulation on surgery of rolandic meningiomas
EANS Academy. Germanò A. 09/27/19; 276016; EP04030
Prof. Antonino Germanò
Prof. Antonino Germanò

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Backgroud: Surgery of convexity meningiomas is usually considered a low-risk procedure, but the risk of postoperative motor deficits can be higher (7.1 - 24.7%) for lesions located in the rolandic region, especially when an arachnoidal cleavage plane is not identifiable. We analyzed the role of navigated transcranial magnetic stimulation (nTMS) for planning resection of rolandic meningiomas, and for predicting the presence/lack of an intraoperative arachnoidal cleavage plane and the motor outcome.
Methods: We collected clinical data from patients with rolandic meningiomas who received preoperative nTMS mapping of the motor cortex (M1) and nTMS-based DTI fiber tracking of the corticospinal tract before surgery at two European neurosurgical departments. Surgeons' self-reported evaluation of the impact of nTMS-based planning on surgery was analyzed. Moreover, the nTMS mapping accuracy was compared with intraoperative neurophysiological mapping (IONM). Lastly, we assessed the role of nTMS and other pre- and intraoperative parameters for predicting the patients' motor outcome and the presence/lack of an arachnoidal cleavage plane.
Results: Forty-seven patients were enrolled. The nTMS-based planning was useful in 89.3% of cases, and modified surgical strategy in 42.5%. The nTMS-based planning and IONM were concordant in 94.2% of cases. New permanent motor deficits occurred in 8.5% of cases (4 out of 47). A higher resting motor threshold (RMT) as well as the lack of an intraoperative cleavage plane were the only independent predictors of a poor motor outcome (p=0.04 and p=0.02, respectively). Moreover, a higher RMT and perilesional edema also predicted the lack of an arachnoidal cleavage plane (p=0.01 and p=0.03).
Conclusion: nTMS-based motor mapping is a useful tool for presurgical planning in rolandic meningiomas, especially when a clear cleavage plane with M1 is not present. Moreover, the RMT can predict the presence/lack of an intraoperative cleavage as well as the motor outcome, thereby helping to preoperatively identify high-risk patients.
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