Postoperative navigated transcranial magnetic stimulation [Neurosurgery Wiki]

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====== Postoperative navigated transcranial magnetic stimulation ======

To know whether [[motor deficit]]s after [[tumor surgery]] are [[transient]] is reassuring for the patient and crucial for planning [[rehabilitation]] and [[adjuvant]] treatment. 
Seidel et al., analyzed the value of postoperative MRI [[navigated transcranial magnetic stimulation]] ([[nTMS]]) compared to intraoperative [[MEP]] monitoring in predicting recovery of motor function.

Retrospective series of nTMS [[mapping]]s within 14 days after surgery for [[supratentorial tumor]]s (09/2014-05/2018). All patients with motor deficits of [[Medical Research Council Scale for Muscle Strength]] (MRCS) 0-4- were included.

We performed nTMS mapping on average 3.8 days after surgery and recorded nTMS MEP in 11 of 13 patients. Motor strength recovered to at least MRCS 4 within one month if postoperative nTMS elicited MEPs (positive predictive value 90.9%). If nTMS did not elicit MEPs, the patient did not recover (negative predictive value 100%). Intraoperative MEP and postoperative nTMS were equally predictive for long-term motor recovery. In cases of intraoperative MEP alteration/signal loss, but a positive postoperative nTMS mapping, 2/3 patients demonstrated a good motor recovery.

nTMS may predict long-term motor recovery of patients suffering from severe motor deficits directly after resection of tumors located in motor eloquent areas.

In cases of intraoperative MEP alterations, postoperative nTMS may clarify the potential for motor recovery
((Seidel K, Häni L, Lutz K, Zbinden C, Redmann A, Consuegra A, Raabe A, Schucht 
P. Postoperative navigated transcranial magnetic stimulation to predict motor
recovery after surgery of tumors in motor eloquent areas. Clin Neurophysiol. 2019
Apr 5;130(6):952-959. doi: 10.1016/j.clinph.2019.03.015. [Epub ahead of print]
PubMed PMID: 30981901.
)).