Navigated transcranial magnetic stimulation for presurgical planning - Correlation with functional MRI

Purpose: This paper describes the potential of navigated transcranial magnetic stimulation to map the motor cortex in patients with mass lesions near the primary motor cortex by comparing the results of this technique to those of functional MRI. Material and Methods: Ten patients with mass lesions near the central sulcus were studied preoperatively using a figure-of-eight transcranial magnetic stimulator attached to a neuronavigation system to allow for direct visualization of the stimulated brain region. Subsequently, in all patients a blood oxygenation level dependent 2D multislice multishot T-2*-weighted gradient echo EPI sequence on a 1.5 T Philips Gyroscan during motor activation was performed. Results of both methods were coregistered and compared. Results: The distances between the peak parenchymal fMRI activation and the cortical area where TMS elicited the maximum MEPs ranged between 0 and 1.2 cm (mean 0.6 cm, SD 0.4 cm). Conclusion: We conclude that navigated TMS is a reliable alternative for localizing the motor-related areas in the human brain preoperatively and therefore may be a useful adjunct or, in selected patients, even a helpful alternative to functional MRI.