Loss of Subcortical Language Pathways Correlates with Surgery-Related
   Aphasia in Patients with Brain Tumor: An Investigation via Repetitive
   Navigated Transcranial Magnetic Stimulation-Based Diffusion Tensor
   Imaging Fiber Tracking

Negwer, Chiara; Beurskens, Eva; Sollmann, Nico; Maurer, Stefanie; Ille, Sebastian; Giglhuber, Katrin; Kirschke, Jan S.; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M.

doi:10.1016/j.wneu.2017.12.163

2018

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Dokumenttyp:: Article
Autor(en):: Negwer, Chiara; Beurskens, Eva; Sollmann, Nico; Maurer, Stefanie; Ille, Sebastian; Giglhuber, Katrin; Kirschke, Jan S.; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M.
Titel:: Loss of Subcortical Language Pathways Correlates with Surgery-Related Aphasia in Patients with Brain Tumor: An Investigation via Repetitive Navigated Transcranial Magnetic Stimulation-Based Diffusion Tensor Imaging Fiber Tracking
Abstract:: BACKGROUND: Within language function research, there is a shift of focus from cortical specialization to a more hodotopical view including subcortical fiber tracts in functional and oncologic considerations. Diffusion tensor imaging fiber tracking (DTI FT) is well established to visualize subcortical fiber tracts. Recently, a new technique has been developed using cortical regions mapped via repetitive navigated transcranial magnetic stimulation (rTMS) as seed regions. This study investigates if rTMS-based DTI FT for language pathways is also feasible postoperatively and whether preoperative versus postoperative fiber changes correlate with changes and severity of the patients' aphasia grades. METHODS: rTMS-based DTI FT was performed preoperatively and postoperatively in 24 patients with left hemispheric perisylvian tumors. Language pathways were analyzed individually preoperatively and postoperatively with 5 different settings of minimum fiber length and fractional anisotropy. Transient aphasia was defined as any new or worse language impairment caused by surgery that resolved within the regular 3-month follow-up interval. Because postoperative aphasia does not allow rTMS language mapping, preoperative rTMS data were used throughout. RESULTS: Patients with transient aphasia postoperatively had a significant reduction in fiber count compared with patients without deficit (321.5 +/- 242.8 fibers vs. 518.0 +/- 435.2 fibers; P = 0.01). Furthermore, in this patient group, the arcuate fascicle was lost postoperatively twice as often compared with patients with no deficit after surgery (52% vs. 26%; P < 0.01). CONCLUSIONS: This study shows that rTMS-based DTI FT is feasible for postoperative examination of language pathways. Moreover, changes in preoperative versus postoperative fibers correlate well with the grade of aphasia.
Zeitschriftentitel:: World Neurosurg
Jahr:: 2018
Band / Volume:: 111
Seitenangaben Beitrag:: E806-E818
Volltext / DOI:: doi:10.1016/j.wneu.2017.12.163
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/29309976
Print-ISSN:: 1878-8750
TUM Einrichtung:: Fachgebiet Neuroradiologie (Prof. Zimmer); Neurochirurgische Klinik und Poliklinik
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