P62. Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation

• Published in: Clinical neurophysiology 2015-08, Vol.126 (8), p.e124-e125
• Main Authors: Sollmann, N, Obermueller, T, Sabih, J, Bulubasova, L, Negwer, C, Moser, T, Ringel, F, Meyer, B, Krieg, S.M
• Format: Article
• Language: English
• Subjects: Neurology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2015.04.196

Objective Mapping of the motor cortex by navigated transcranial magnetic stimulation (nTMS) can be used for preoperative planning in brain tumor patients. Just recently, it has been proven to actually change outcomes by increasing the rate of gross total resection and by reducing the surgery-related rate of paresis. Yet, we also need data that shows if these changes also lead to a changed clinical course. Methods We prospectively enrolled 70 patients with supratentorial motor eloquently located high-grade gliomas (HGG) undergoing preoperative nTMS (2010–2014) and matched these patients with 70 HGG patients who did not undergo preoperative nTMS (2007–2010). Results The overall size of the craniotomy was 25.3 ± 9.7 cm2 (median 22.5 cm2 , range 12.0–61.6 cm2 ) for nTMS and 30.8 ± 13.2 cm2 (median 28.0 cm2 , range 4.6–65.7 cm2 ) for non-nTMS patients ( p = 0.0058). Median inpatient stay was 12 days for the nTMS and 14 days for the non-nTMS group (nTMS: CI 10.5–13.5 days; non-nTMS: CI 11.6–16.4 days; p = 0.0446). 60.0% of patients of the nTMS group and 54.3% of patients of the non-nTMS group were eligible for postoperative chemotherapy (OR 1.2630, CI 0.6458–2.4710, p = 0.4945), while 67.1% of nTMS patients and 48.6% of non-nTMS patients received radiotherapy (OR 2.1640, CI 1.0910–4.2910, p = 0.0261). There was a trend toward higher survival in the nTMS group (nTMS: 15.7 ± 10.9 months; non-nTMS: 11.9 ± 10.3 months; p = 0.1310). Moreover, 3, 6, and 9 month survival was significantly better in the nTMS group ( p = 0.0298, p = 0.0015, and p = 0.0167), while there was a trend in 12 month survival ( p = 0.0544). Conclusion The data illustrate that HGG patients benefit from preoperative nTMS motor mapping with regard to craniotomy size, duration of inpatient stay, and eligibility for adjuvant therapy. Even more important, a trend towards higher survival rates for the nTMS group compared to the non-nTMS group was revealed.