Stimulation intensity is nominally set to 100% of RMT, but can be lowered for tolerability. Most centers performing resections in language-eloquent tumors use direct cortical stimulation during awake surgery.Īfter an initial set-up process which aligns the patient head to a 3D of the patient’s MRI head scan, NBS is used to find the primary motor cortex and determine the patient’s resting motor threshold (RMT), typically from the hand muscle representation area in the right hemisphere.
Because patients with glioma benefit significantly from surgical treatment, these lesions should be resected with functional monitoring in order to avoid damage to the vital areas. However, many gliomas, are located in eloquent areas of the brain, including areas important for language or speech. In patients with high- or low-grade gliomas, macroscopically complete resection improves survival. However, since the entire mapping session is recorded, post-mapping video analysis can reveal even minor perturbations in normal speech production. Often, the patient is not aware of any interference or change, and it may be difficult for the operator to discern. When an area of the brain vital for speech or language is stimulated, rTMS can cause hesitation, loss of fluency or even the inability to speak. rTMS can be thought of as creating a temporary lesion-turning a specific cortical area "off" for a fraction of a second. rTMS temporarily disturbs normal brain function in the cortex underlying the coil. Speech mapping is a technique to locate the areas in the brain critically involved in language processing and speech production.
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