Preoperative rTMS language mapping in speech eloquent brain lesions resected under general anesthesia: a pair-matched cohort study.

Preoperative rTMS language mapping in speech eloquent brain lesions resected under general anesthesia: a pair-matched cohort study.

World Neurosurg. 2017 Jan 18;:

Authors: Hendrix P, Senger S, Simgen A, Griessenauer CJ, Oertel J

Abstract
OBJECTIVE: The value of preoperative rTMS language mapping for function preservation in surgery of speech eloquent lesions under general anesthesia remains to be determined.
METHODS: The authors prospectively enrolled 20 consecutive right-handed patients with a malignant, left-sided perisylvian language eloquent brain tumor. All patients were subjected to surgical resection under general anesthesia guided by preoperative rTMS language mapping (rTMS group, 2014 - 2016). A matched-pair analysis with 20 patients that also underwent surgical resection under general anesthesia in the pre-rTMS era (pre-rTMS group, 2009 - 2013) was performed. Language performance status was ranked from grade 0 to grade 3 (none, mild, medium, severe).
RESULTS: Rates of gross total resection, of tumor residual, and of complications were equal in both groups. Duration of surgery (p = 0.039) and inpatient stay (p = 0.001) were significantly shorter in the rTMS group. Preoperatively, 14 patients in the rTMS and 13 patients in the pre-rTMS group suffered from language deficits (p = 0.380). One week after surgery, 8/14 patients (57.1 %) in the rTMS group but only 1/13 patients (7.7 %) in the pre-rTMS group experienced improvement of language performance status (p = 0.013). At six weeks follow-up, language performance status was significantly better in the rTMS group (p = 0.048). However, at three months follow-up, the rTMS- and pre-rTMS groups showed an equal language performance status.
CONCLUSION: Implementation of preoperative rTMS language mapping seems to provide a favorable early language outcome in patients undergoing surgical resection of language eloquent lesions under general anesthesia.

PMID: 28109861 [PubMed - as supplied by publisher]

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