Nexstim nTMS pre-surgical mapping: left frontal diffuse lower grade glioma in ambidextrous patient скачать в хорошем качестве

Nexstim nTMS pre-surgical mapping: left frontal diffuse lower grade glioma in ambidextrous patient

Awake or asleep? That is the question. And it’s an important question related to our current understanding of the eloquent brain and supratentorial tumours, where anatomic assumptions relating to movement and language function may represent increased risk during surgery. It’s also particularly important for ambidextrous patients. This patient was referred to us for non-invasive brain mapping to determine language lateralisation and/or localisation after fMRI results indicated bilateralization of language function. Would surgery be awake or asleep? During the session, Ryan Hamer determined very minor instances of language inhibition at the left ipsilesional hemisphere, most likely associated with muscle stimulation and natural hesitancy during object naming tasks when compared to the patient’s baseline. The right contralesional hemisphere tells a completely different story, with true arrest and disturbances of speech clustered towards classical and less-than-expected eloquent cortical regions. The answer to the question? Asleep craniotomy with motor mapping. This is the standard of care for functional mapping during perirolandic brain tumour surgery, which permits the objective detection & quantification of motor function frequently associated with greater resection rates and outcomes (though not all mapping is created equal, more on this later). Nexstim then takes us to another level by non-invasively mapping the brain before surgery to establish clinically-relevant white matter pathways from nTMS data. This kind of functional tractography via Brainlab Elements represents a new frontier of pre-surgical risk stratification and planning, rendering fiber tracking as more than just a ‘pretty picture’. It works simply because nTMS shares a very close electrophysiologic profile with direct cortical stimulation. The future is functional, and Neuroclast can take you there. -- For this particular procedure: nTMS-based corticospinal tracts were also generated with Medtronic Stealth for intraoperative use, and ZEISS Medical Technology microscope vision was seamlessly captured via our inomed ISIS electrophysioloigical mapping technology.