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Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading
- Source :
- Neurosurgery. 88:183-192
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background Diffuse gliomas have an increased biological aggressiveness across the World Health Organization (WHO) grading system. The implications of glioma grading on the primary motor cortex (M1)-corticospinal tract (CST) excitability is unknown. Objective To assess the excitability of the motor pathway with navigated transcranial magnetic stimulation (nTMS). Methods Retrospective cohort study of patients admitted for surgery with diffuse gliomas within motor eloquent areas. Demographic, clinical, and nTMS-related variables were collected. The Cortical Excitability Score (CES 0 to 2 according to the number of abnormal interhemispheric resting motor threshold (RMT) ratios) was calculated for patients where bilateral upper and lower limb mapping was performed. Results A total of 45 patients were included: 9 patients had a low-grade glioma and 36 patients had a high-grade glioma. The unadjusted analysis revealed an increase in the latency of the motor evoked potential of the lower limb with an increase of the WHO grade (P = .038). The adjusted analysis confirmed this finding (P = .013) and showed a relation between the increase in the WHO and a decreased RMT (P = .037) of the motor evoked responses in the lower limb. When CES was calculated, an increase in the score was related with an increase in the WHO grade (unadjusted analysis-P = .0001; adjusted analysis-P = .001) and in isocitrate dehydrogenase (IDH) wild-type tumors (unadjusted analysis-P = .020). Conclusion An increase in the WHO grading system and IDH wild-type tumors are associated with an abnormal excitability of the motor eloquent areas in patients with diffuse gliomas.
- Subjects :
- medicine.medical_specialty
Neoplasm Grading
business.industry
medicine.medical_treatment
medicine.disease
Transcranial magnetic stimulation
03 medical and health sciences
Diffuse Glioma
0302 clinical medicine
medicine.anatomical_structure
030220 oncology & carcinogenesis
Internal medicine
Glioma
Corticospinal tract
medicine
Cardiology
Surgery
Neurology (clinical)
Primary motor cortex
Evoked potential
business
030217 neurology & neurosurgery
Motor cortex
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 88
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....f7729334a3798bd0b09a2620b9d7b6c6