Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study

被引:42
作者
Kantelhardt, Sven Rainer [1 ]
Fadini, Tommaso [2 ]
Finke, Markus [4 ]
Kallenberg, Kai [3 ,5 ]
Siemerkus, Jakob [5 ]
Bockermann, Volker [1 ]
Matthaeus, Lars [4 ]
Paulus, Walter [2 ]
Schweikard, Achim [4 ]
Rohde, Veit [1 ]
Giese, Alf [1 ]
机构
[1] Univ Gottingen, Dept Neurosurg, D-37075 Gottingen, Germany
[2] Univ Gottingen, Dept Clin Neurophysiol, D-37075 Gottingen, Germany
[3] Univ Gottingen, Dept Neuroradiol, D-37075 Gottingen, Germany
[4] Med Univ Lubeck, Inst Robot & Cognit Syst, D-23538 Lubeck, Germany
[5] Univ Gottingen, MR Res Neurol & Psychiat, D-37075 Gottingen, Germany
关键词
Functional MRI; Transcranial magnetic stimulation; Motor cortex; Brain mapping; Robotized neuronavigation; Electrical cortex stimulation; CORTICAL STIMULATION; COIL PLACEMENT; SPEECH ARREST; BRAIN-TUMORS; LOCALIZATION; TMS; REPRESENTATION; ORIENTATION; SUPPRESSION; VALIDATION;
D O I
10.1007/s00701-009-0565-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Shape and exact location of motor cortical areas varies among individuals. The exact knowledge of these locations is crucial for planning of neurosurgical procedures. In this study, we have used robot-assisted image-guided transcranial magnetic stimulation (Ri-TMS) to elicit MEP response recorded for individual muscles and reconstruct functional motor maps of the primary motor cortex. One healthy volunteer and five patients with intracranial tumors neighboring the precentral gyrus were selected for this pilot study. Conventional MRI and fMRI were obtained. Transcranial magnetic stimulation was performed using a MagPro X100 stimulator and a standard figure-of-eight coil positioned by an Adept Viper s850 robot. The fMRI activation/Ri-TMS response pattern were compared. In two cases, Ri-TMS was additionally compared to intraoperative direct electrical cortical stimulation. Maximal MEP response of the m. abductor digiti minimi was located in an area corresponding to the "hand knob" of the precentral gyrus for both hemispheres. Repeated Ri-TMS measurements showed a high reproducibility. Simultaneous registration of the MEP response for m. brachioradialis, m. abductor pollicis brevis, and m. abductor digiti minimi demonstrated individual peak areas of maximal MEP response for the individual muscle groups. Ri-TMS mapping was compared to the corresponding fMRI studies. The areas of maximal MEP response localized within the "finger tapping" activated areas by fMRI in all six individuals. Ri-TMS is suitable for high resolution non-invasive preoperative somatotopic mapping of the motor cortex. Ri-TMS may help in the planning of neurosurgical procedures and may be directly used in navigation systems.
引用
收藏
页码:333 / 343
页数:11
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