Preoperative Navigated Transcranial Magnetic Stimulation and Tractography to Guide Endoscopic Cystoventriculostomy: A Technical Note and Case Report

Hendrix P, Senger S, Griessenauer CJ, Simgen A, Linsler S, Oertel J (2018)

Publication Type: Journal article

Publication year: 2018

Journal

World Neurosurgery Elsevier

Book Volume: 109

Pages Range: 209-217

DOI: 10.1016/j.wneu.2017.09.185

Abstract

Objective To report a technique for endoscopic cystoventriculostomy guided by preoperative navigated transcranial magnetic stimulation (nTMS) and tractography in a patient with a large speech eloquent arachnoid cyst. Methods A 74-year old woman presented with a seizure and subsequent persistent anomic aphasia from a progressive left-sided parietal arachnoid cyst. An endoscopic cystoventriculostomy and endoscope-assisted ventricle catheter placement were performed. Surgery was guided by preoperative nTMS and tractography to avoid eloquent language, motor, and visual pathways. Results Preoperative nTMS motor and language mapping were used to guide tractography of motor and language white matter tracts. The ideal locations of entry point and cystoventriculostomy as well as trajectory for stent-placement were determined preoperatively with a pseudo-3-dimensional model visualizing eloquent language, motor, and visual cortical and subcortical information. The early postoperative course was uneventful. At her 3-month follow-up visit, her language impairments had completely recovered. Additionally, magnetic resonance imaging demonstrated complete collapse of the arachnoid cyst. Conclusion The combination of nTMS and tractography supports the identification of a safe trajectory for cystoventriculostomy in eloquent arachnoid cysts.

Authors with CRIS profile

Stefan Nikolaus Linsler

Involved external institutions

Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) Geisinger Health System US United States (USA) (US)

How to cite

APA:

Hendrix, P., Senger, S., Griessenauer, C.J., Simgen, A., Linsler, S., & Oertel, J. (2018). Preoperative Navigated Transcranial Magnetic Stimulation and Tractography to Guide Endoscopic Cystoventriculostomy: A Technical Note and Case Report. World Neurosurgery, 109, 209-217. https://doi.org/10.1016/j.wneu.2017.09.185

MLA:

Hendrix, Philipp, et al. "Preoperative Navigated Transcranial Magnetic Stimulation and Tractography to Guide Endoscopic Cystoventriculostomy: A Technical Note and Case Report." World Neurosurgery 109 (2018): 209-217.

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