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Roger Rotta, Sudhakar Tummala, Sean Guillory, Sujit Prabhu, Ganesh Rao, Nicholas Levine, Dima Suki, Frederick Lang, Jeffrey Weinberg, Raymond Sawaya, NC-14
SPEECH MAPS GENERATED BY nTMS AND CORRELATION WITH DIRECT INTRAOPERATIVE ELECTRICAL STIMULATION, Neuro-Oncology, Volume 16, Issue suppl_5, November 2014, Page v137, https://doi.org/10.1093/neuonc/nou263.14Close - Share Icon Share
Abstract
INTRODUCTION: IOM of language pathways is the gold standard for the safe resection of gliomas; navigated TMS has been shown to be useful in generating speech maps prior surgery. This study test the clinical utility of nTMS for mapping language and its concordance with intraoperative stimulation. METHODS: We describe 12 patients with gliomas adjacent to language areas. All cases were performed with nTMS, DES for language mapping. We analyzed, positive and negative sites preoperatively and intraoperatively, and correlated them to the extent of resection and a 1-mo follow-up. RESULTS: Navigated TMS positive maps, was achieved in 11 (92%), and 8 (80%) of cases had language errors during DES. 3527 site were stimulated during nTMS mapping, 225 (7%) was positive, 77 (34%) speech arrest, 78 (35%) performance errors and 70 (31%) semantic errors. TP correlation was achieved in 8 (67%) of cases, TN correlation 1 (8%) and FP correlation was achieved in 1 (8%) of cases. In TP cases, GTR was achieved in 6 (75%) of cases and after 1-mo follow-up 1 (14%) case developed new deficit and improvement was seen in 1(14%) case. In the only case of TN correlation, GTR resection was achieved, without deficits after 1-mo follow-up. CONCLUSION: nTMS correlated well with DES in generated language mapping, with a rate of TP according 67% and the only case with negative response in nTMS was TN. We have shown that nTMS has a high rate of concordance with DES; nTMS has 100% sensitivity, and 50% specificity when compared with DES. PPV at 89% and NPV 100%. The majority of positive sites were achieved in Broca's area and Wernicke's area. Additionally, if the nTMS reveal speech arrest distant from surgical exposure, this may be an additional utility for nTMS in explaining apparent negative mapping results in intraoperative stimulation.
