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Review
. 2022 Jun 16:18:1219-1235.
doi: 10.2147/NDT.S359855. eCollection 2022.

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Lucas Jose Vaz Schiavao  1   2 , Iuri Neville Ribeiro  1   2 , Cintya Yukie Hayashi  1 , Eberval Gadelha Figueiredo  1 , Andre Russowsky Brunoni  1 , Manoel Jacobsen Teixeira  1 , Gabriel Pokorny  3 , Wellingson Silva Paiva  1
Affiliations
Review

Assessing the Capabilities of Transcranial Magnetic Stimulation (TMS) to Aid in the Removal of Brain Tumors Affecting the Motor Cortex: A Systematic Review

Lucas Jose Vaz Schiavao et al. Neuropsychiatr Dis Treat. .

Abstract

Introduction: The brain tumor is frequently related to severe motor impairment and impacts the quality of life. The corticospinal tract can sometimes be affected depending on the type and size of the neoplasm, so different tools can evaluate motor function and connections. It is essential to organize surgical procedures and plan the approach. Functional motor status is mapped before, during, and after surgery. Studying corticospinal tract status can help map the functional areas, predict postoperative outcomes, and help the decision, reducing neurological deficits, aiming to preserve functional networks, using the concepts of white matters localization and fibbers connections. Nowadays, there are new techniques that provide functional information regarding the motor cortex, such as transcranial magnetic stimulation (TMS), direct cortical stimulation (DCS), and navigated TMS (nTMS). These tools can be used to plan a customized surgical strategy and the role of motor evoked potentials (MEPs) is well described during intra-operative, using intraoperative neuromonitoring. MEPs can help to localize primary motor areas and delineate the cut-off point of resection in real-time, using direct stimulation. In the post-operative, the MEP has increased your function as a predictive marker of permanent or transitory neurological lesion marker.

Methods: Systematic review performed in MEDLINE via PUBMED, EMBASE, and SCOPUS databases regarding the post-operative assessment of MEP in patients with brain tumors. The search strategy included the following terms: (("Evoked Potentials, Motor"[Mesh]) AND "Neoplasms"[Mesh]) AND "Transcranial Magnetic Stimulation"[Mesh] AND "Brain Tumor"[Mesh]), the analysis followed the PRISMA guidelines for systematic reviews, the review spanned until 06/04/2021, inclusion criteria were studies presenting confirmed diagnosis of brain tumor (primary or metastatic), patients >18 y/o, using TMS, Navigated TMS, and/or Evoked Potentials as tools in preoperative planning or at the intra-operative helping the evaluation of the neurological status of the motor cortex, articles published in peer-reviewed journals, and written in English or Portuguese.

Results: A total of 38 studies were selected for this review, of which 14 investigated the potential of nTMS to predict the occurrence of motor deficits, while 25 of the articles investigated the capabilities of the nTMS technique in performing pre/intraoperative neuro mapping of the motor cortex.

Conclusion: Further studies regarding motor function assessment are needed and standardized protocols for MEPs also need to be defined.

Keywords: brain tumors; motor cortex mapping; neurophysiology; systematic review; transcranial magnetic resonance.

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Conflict of interest statement

None of the authors states any conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
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References

    1. Sanai N, Berger MS. Intraoperative stimulation techniques for functional pathway preservation and glioma resection. Neurosurg Focus. 2010;28(2):E1. doi:10.3171/2009.12.FOCUS09266 - DOI - PubMed
    1. Krivosheya D, Prabhu SS, Weinberg JS, Sawaya R. Technical principles in glioma surgery and preoperative considerations. J Neurooncol. 2016;130(2):243–252. doi:10.1007/s11060-016-2171-4 - DOI - PubMed
    1. Hervey-Jumper SL, Berger MS. Role of surgical resection in low- and high-grade gliomas. Curr Treat Options Neurol. 2014;16(4):1–19. doi:10.1007/s11940-014-0284-7 - DOI - PubMed
    1. Tarapore PE, Tate MC, Findlay AM, et al. Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. J Neurosurg. 2012;117(2):354. doi:10.3171/2012.5.JNS112124 - DOI - PMC - PubMed
    1. Julkunen P, Säisänen L, Danner N, et al. Comparison of navigated and non-navigated transcranial magnetic stimulation for motor cortex mapping, motor threshold and motor evoked potentials. Neuroimage. 2009;44(3):790–795. doi:10.1016/j.neuroimage.2008.09.040 - DOI - PubMed

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