Application of Navigated Transcranial Magnetic Stimulation (nTMS) to Study the Visual–Spatial Network and Prevent Neglect in Brain Tumour Surgery
Year: 2024
Type: article
Study design: Clinical Trial
Abstract: Objective: Navigated Transcranial Magnetic Stimulation (nTMS) has been little used to study Visuo-spatial (VS) circuits so far. Our work studies: I) VS functions in neurosurgical oncological patients by using repetitive nTMS (rnTMS); II) the possible subcortical circuits underneath. III) the correspondence between nTMS and Direct Cortical Stimulation (DCS) during awake procedures. Methods: We designed a monocentric prospective study, adopting a protocol to use rnTMS for preoperative planning, including VS functions for lesions potentially involving the VS network, including neurosurgical awake and asleep procedures. nTMS-based-DTI tractography allowed visualization of subcortical circuits. Statistical analyses on n TMS/DCS points were performed. Clinical results were collected pre- and postoperatively. Results: Finally, 27 patients with primitive intra-axial brain lesions were enrolled between April 2023-March 2024. Specific tests and an experimental integrated VS test (VISA) were used. The clinical evaluation (at 5±7, 30±10, 90±10 days after surgery) documented 33% of patients with ne-glect in the left hemisphere four days after surgery, and during 3-months-follow-up preservation of visuospatial function/clinical recovery [90.62% in MMSE, 98.86% in Bell Test, 80% in Clock test, 98% in OCS test]. The surgical strategy was modulated according to nTMS map. Subcortical bun-dles were traced to identify those most involved in these functions: SFLII>SLFII>SLFI. Comparison of nTMS and DCS points in awake surgery (n=10 patients) documented: Sensitivity (Se)=12%, Specificity (Sp)=91.21%, Positive Predictive Value (PPV)=42%, Negative Predictive Value (NPV)=66%. Accuracy ~63.7%. Conclusions: Based on our preliminary results, nTMS is advantageous to study cognitive func-tions, minimising neurological impairment. Further analyses are needed to validate our data.
Source: Cancers
Authors: Camilla Bonaudo, Elisa Castaldi, Agnese Pedone, Federico Capelli, Shani Enderage Don, Edoardo Pieropan, Andrea Bianchi, Marika Gobbo, Giuseppe Maduli, Francesca Fedi, Fabrizio Baldanzi, Simone Troiano, Antonio Maiorelli, Giovanni Muscas, Francesca Battista, Luca Campagnaro, Serena De Pellegrin, Andrea Amadori, Enrico Fainardi, Riccardo Carrai, Antonello Grippo, Alessandro Della Puppa
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,296
OpenAlex ID: W4405643568