Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a nTMS-tractography study

IF 3.6 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Neurophysiology Pub Date : 2025-08-30 DOI:10.1016/j.clinph.2025.2110995

Josephine Jung , Kapil Rajwani , Ana Mirallave-Pescador , Sally Ann Price , Sabina Patel , Jahard Aliaga-Arias , Hilary Wren , Richard Gullan , Ranjeev Bhangoo , Keyoumars Ashkan , Francesco Vergani , José Pedro Lavrador

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引用次数: 0

Abstract

Objective

Cortical speech mapping using navigated Transcranial Magnetic Stimulation (nTMS) has a variable positive predictive value (PPV) when compared with intraoperative direct electrical stimulation.

Methods

This is a single centre prospective study of all patients undergoing pre-operative nTMS and tractography (frontal aslant tract (FAT) and arcuate fasciculus (AF)) for awake surgery between October 2018 and November 2023. We reviewed operative notes for speech arrest, collected data on demographics, histopathology and pre-/post-operative language assessment.

Results

57 patients were included (27 female, 30 male) with a mean age of 46 years. 89.5 % were right-handed. 59.6 % of patients had surgery for isocitrate dehydrogenase (IDH)-mutant glioma (n = 34). Intra-operative speech arrest was located at opIFG (n = 32), vPrG (n = 19), pMFG (n = 5) and mPoG (n = 1). In 87.7 % of cases (n = 50) intra-operative speech arrest was colocated with nTMS and tractography. This was statistically significant especially in tumours involving opIFG (n = 21) and improved accuracy of locating intra-operative speech arrest when compared with using nTMS or tractography alone (p < 0.01). This was also true for IDH-wildtype tumours (triple colocation n = 14, other modalities n = 6, p < 0.05).

Conclusions

Preoperative cortical-subcortical integration is paramount for the prediction of intra-operative speech arrest.

Significance

nTMS-FAT-AF trilocation is a useful tool in predicting intra-operative speech arrest.

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功能皮质映射和结构皮质下解剖预测术中言语骤停：一项ntms神经束造影研究

目的与术中直接电刺激相比，导航经颅磁刺激（nTMS）的脑皮层语音定位具有可变阳性预测值（PPV）。方法本研究是一项单中心前瞻性研究，研究对象为2018年10月至2023年11月接受清醒手术的所有术前nTMS和神经束造影（额斜束（FAT）和弓状束（AF））的患者。我们回顾了言语阻滞的手术记录，收集了人口统计学、组织病理学和术前/术后语言评估的数据。结果共纳入57例患者，其中女性27例，男性30例，平均年龄46岁。89.5%是右撇子。59.6%的患者因异柠檬酸脱氢酶（IDH）突变胶质瘤接受手术治疗（n = 34）。术中言语停止位于opIFG (n = 32), vPrG (n = 19), pMFG （n = 5）和mPoG （n = 1）。在87.7%的病例（50例）术中言语停止同时使用nTMS和声带造影。这在涉及opIFG的肿瘤中具有统计学意义（n = 21），并且与单独使用nTMS或牵引道造影相比，术中定位言语骤停的准确性提高（p < 0.01）。对于idh野生型肿瘤也是如此（三重共置n = 14，其他模式n = 6, p < 0.05）。结论术中皮层-皮层下整合对预测术中言语骤停具有重要意义。意义ms - fat - af三定位是预测术中言语骤停的有效工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurophysiology 医学-临床神经学

CiteScore

8.70

自引率

6.40%

发文量

932

审稿时长

59 days

期刊介绍： As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology. Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.