PMC8814635_01
Case 1. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, AF in purple, IFOF in turquoise, ILF in yellow, and CF in light blue. Panels (E, F) Overlap of tracking and postoperative T1-weighted imaging after elastic fusion with the resection cavity marked in red.
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Preoperative nTMS mapping at baseline revealed language-positive nTMS spots for ON mostly in the frontal and the parietal lobe with one spot in proximity to the lesion ( Figure 1A ). Subsequent fiber tracking for ON included the AF, ILF, IFOF, CF and CNT ( Figure 1C ). Language-positive points for AN were more scarce and overlapped nearly entirely with ON points, resulting in a similar white matter visualization of the AF, IFOF, CF and CNT ( Figures 1B, D ). CNT ( Figures 1E, F ). Case 1 was discharged on the sixth postoperative day.
PMC8814635_02
Case 2. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, IFOF in turquoise, and ILF in yellow. Panels (E, F) Overlap of tracking and postoperative T1-weighted imaging after elastic fusion with the resection cavity marked in red.
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Figures 2A, C ). For AN, nTMS mapping revealed language-positive spots in the middle and superior frontal gyrus, the superior and middle temporal gyrus, some parietal points and the poG, as well leading to visualization of the CNT, ILF and IFOF ( Figures 2B,
PMC8814635_03
Case 3. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, AF in purple, SLF in pink, IFOF in turquoise, ILF in yellow, and CF in light blue. Panels (E, F) Overlap of tracking and postoperative T1-weighted imaging after elastic with the resection cavity marked in red.
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Preoperative nTMS mapping at baseline revealed language-positive spots for ON in the superior frontal regions, as well as some parietal and superior temporal areas, resulting in visualization of a white matter network comprising the AF, ILF, CNT and CF ( Figures 3A, C ). These led to white matter visualization of the AF, SLF, IFOF and CF ( Figures 3B, D ). MRI scanning demonstrated that the resection cavity did not overlap or approach the fiber tracts implicated in either ON nor AN ( Figures 3E, F ).
PMC8814635_04
Case 4. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, AF in purple, SLF in pink, and ILF in yellow. Panels (E, F) Overlap of tracking and postoperative T1-weighted imaging after elastic fusion with the resection cavity marked in red.
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Preoperative nTMS mapping at baseline with ON revealed only a few parietal, middle frontal and one temporal cortical language-positive spots, leading to white matter visualization of the AF, SLF, ILF and CNT ( Figures 4A, C ). During AN under nTMS mapping, middle frontal and several parietal cortical regions were uncovered, resulting in a similar white matter visualization of the AF, SLF, ILF and CNT ( Figures 4B, D ). Postoperative MRI scanning confirmed that the resection cavity left most of the white matter network unaffected, but was in proximity of the ILF, especially for AN ( Figures 4E, F ).
PMC8814635_05
Case 5. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, AF in purple, ILF in yellow, Frontal Aslant Tract in pink, and CF in light blue. Panels (E, F) Overlap of tracking and postoperative T1-weighted imaging after elastic fusion with the resection cavity marked in red.
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Tract ( Figures 5A, C ). The nTMS mapping with AN led to many semantic errors and showed a similarly distributed network to ON with a high number of frontal areas and a white matter visualization of the AF, ILF, CNT, CF and Frontal Aslant Tract ( Figures 5B, D ). Tract in both the ON and the AN network with all other language tracts arching posteriorly away from the resection cavity ( Figures 5E, F ).
PMC8814635_06
Case 6. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in in direction-coded, here dark blue, AF in purple, SLF in pink, ILF in yellow, and CF in light blue. Panels (E, F) Screenshot of intraoperative positive cortical sites with tags 1-3 on the middle and posterior STG and tag 4 on the posterior MTG for ON, and tags 11-13 on the middle and posterior STG for AN. Panels (G, H) Overlap of tracking and postoperative T1-weighted imaging after elastic fusion with the resection cavity marked in red.
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AF, ILF, CNT and some parts of the CF ( Figures 6A, C ). AN resulted in many semantic errors and in an overall larger error rate with more frontal and temporal cortical sites and visualization of the AF, SLF, CNT, and CF, but no ventral stream tracts ( Figures 6B, D ). In the exposed middle and posterior temporal area, intraoperative DES led to errors in the STG in both tasks ( Figures 6E, F : ON errors in tags 1-4; AN errors in tags 11-13), as predicted by nTMS mapping with AN. Postoperative MRI scans confirmed the overlap of the cavity and the ON network's AF and ILF and the AN network's AF and CF ( Figures 6G, H ).
PMC8814635_07
Case 7. Left panels show ON results, right panels AN results. Panels (A, B) nTMS stimulation sites that induced errors; no response and hesitations in orange, semantic errors in yellow and performance errors in blue. Panels (C, D) Fiber tracking results including the lesion, nTMS cortical endpoints in orange and color-coded tracts with CNT in direction-coded, here dark blue, AF in purple, SLF in pink, ILF in yellow, and CF in light blue. Panels (E, F) Screenshot of intraoperative positive cortical sites with tag 1 PoG for ON, and tags 11 + 12 on PoG and the middle STG for AN. Panels (G, H) Overlap of tracking and postoperative T1-weighted imaging after elastic with the resection cavity marked in red.
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AF, SLF, CNT and CF ( Figures 7A, C ). Apart from these regions, nTMS mapping with AN showed language-positive cortical areas in the parietal and temporal lobe and revealed semantic errors in all 3 lobes, leading to subcortical visualization of the AF, ILF, CNT and CF ( Figures 7B, D ). Intraoperative DES led to errors in ON in the middle postcentral gyrus ( Figure 7E : tag 1). STG that repeatedly led to naming errors under stimulation only for AN ( Figure 7F : tag 11 + 12) and as predicted by nTMS mapping with AN. Subsequent resection avoided these language-positive cortical areas and was extended into the insular lobe. Postoperative MRI scans showed that the white matter network of ON had been spared entirely and was not in proximity of the cavity, while the AN network's ILF was in close proximity to the resected tissue ( Figures 7G, H ).