PMC6744739_01
Navigated transcranial magnetic stimulation motor mapping session. (a) Patient in a relaxing condition, with eyes open and superior limbs supported by pillows. (b) We centered a 5 x 5 cm2 grid on the lesion. (c) Result was a very close relation between anterior aspect of the lesion and the hand region of the primary motor cortex.
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F1
Our nTMS routine consists of a patient seated comfortably in a chair with headrest [Figure 1a]. Subjects are examined in a relaxing condition, with eyes open and superior limbs supported as previously described [Figure 1a]. To perform mapping, we centered a 5 x 5 cm2 grid on the lesion and started the stimulation of 110% RMT [Figure 1b]. The result showed a very close relationship between the AP aspect of the lesion and the primary motor cortex hand area [Figure 1c].
Navigated transcranial magnetic stimulation motor mapping final result. Any motor evoked potential amplitude >50 microvolts (peak-to-peak) were considered positive and exported to digital imaging and communications in medicine format as a white spot. (a) Axial head computed tomography showing the white spots near from lesion area. (b) Sagittal head computed tomography showing the relationship of motor sites and lesion. Again, we can observe close proximity.
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F2
Positive locations were colored with white [Figure 2a and b].
Surgical steps of open brain lesion removal using computed tomography-guided navigated transcranial magnetic stimulation. (a) Localizing craniotomy site guided by neuronavigation system. (b) Neuronavigation system image could precisely localize lesion. (c) After durotomy, we exposed the eloquent cortex and lesion site. Asterisk represents a cortical vein on central sulcus between motor and somatosensory cortex. (d) Final aspect after complete lesion removal as seen in arrowhead.
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F3
During surgery, we used a neuronavigation system to localize the lesion and perform a small craniotomy [Figure 3a and b]. Then, we could precisely locate and remove completely the lesion [Figure 3c and d].
Comparison between preoperative and postoperative head computed tomography. (a) Axial head computed tomography showing the white spots near from lesion area. (b) Postoperative axial head computed tomography with a hypodense image exhibiting a complete lesion resection.
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F4
After the procedure, a postoperative head CT was performed and compared with the preoperative images [Figure 4a and 4b].