Abstract：
OBJECTIVE: The objective of this prospective, single-centre case series was to investigate feasibility, clinical outcomes, and neural correlates of non-invasive Neuromodulation-Induced Cortical Prehabilitation (NICP) before brain tumor surgery. Previous studies have shown that gross total resection is paramount to increase life expectancy but is counterbalanced by the need of preserving critical functional areas. NICP aims at expanding functional margins for extensive tumor resection without functional sequelae. Invasive NICP (intracranial neuromodulation) was effective but characterized by elevated costs and high rate of adverse events. Non-invasive NICP (transcranial neuromodulation) may represent a more feasible alternative. Nonetheless, up to this point, non-invasive NICP has been examined in only two case reports, yielding inconclusive findings.
METHODS: Treatment sessions consisted of non-invasive neuromodulation, to transiently deactivate critical areas adjacent to the lesion, coupled with intensive functional training, to activate alternative nodes within the same functional network. Patients were evaluated pre-NICP, post-NICP, and at follow-up post-surgery.
RESULTS: Ten patients performed the intervention. Feasibility criteria were met (retention, adherence, safety, and patient\'s satisfaction). Clinical outcomes showed overall stability and improvements in motor and executive function from pre- to post-NICP, and at follow-up. Relevant plasticity changes (increase in the distance between tumor and critical area) were observed when the neuromodulation target was guided by functional neuroimaging data.
CONCLUSIONS: This is the first case series demonstrating feasibility of non-invasive NICP. Neural correlates indicate that neuroimaging-guided target selection may represent a valid strategy to leverage neuroplastic changes before neurosurgery. Further investigations are needed to confirm such preliminary findings.
METHODS: Treatment sessions consisted of non-invasive neuromodulation, to transiently deactivate critical areas adjacent to the lesion, coupled with intensive functional training, to activate alternative nodes within the same functional network. Patients were evaluated pre-NICP, post-NICP, and at follow-up post-surgery.
RESULTS: Ten patients performed the intervention. Feasibility criteria were met (retention, adherence, safety, and patient\'s satisfaction). Clinical outcomes showed overall stability and improvements in motor and executive function from pre- to post-NICP, and at follow-up. Relevant plasticity changes (increase in the distance between tumor and critical area) were observed when the neuromodulation target was guided by functional neuroimaging data.
CONCLUSIONS: This is the first case series demonstrating feasibility of non-invasive NICP. Neural correlates indicate that neuroimaging-guided target selection may represent a valid strategy to leverage neuroplastic changes before neurosurgery. Further investigations are needed to confirm such preliminary findings.
摘要：
目标：这个前瞻性的目标，单中心病例系列是为了调查可行性，临床结果，脑肿瘤手术前非侵入性神经调节诱导的皮质前康复（NICP）的神经相关性。先前的研究表明，总切除对增加预期寿命至关重要，但由于保留关键功能区域的需要而抵消。NICP旨在扩大功能边界，以进行广泛的肿瘤切除，而没有功能后遗症。侵入性NICP（颅内神经调节）是有效的，但其特点是成本升高和不良事件发生率高。非侵入性NICP（经颅神经调节）可能代表更可行的替代方案。尽管如此，到目前为止，非侵入性NICP仅在两份病例报告中进行了检查，产生不确定的发现。
方法：治疗包括非侵入性神经调节，暂时停用病变附近的关键区域，加上强化的功能训练，激活同一功能网络中的替代节点。患者在NICP前进行了评估，NICP后，以及术后随访。
结果：10名患者进行了干预。符合可行性标准(保留，坚持,安全,和患者的满意度)。临床结果显示，从NICP之前到之后，运动和执行功能的总体稳定性和改善。在后续。当神经调节目标由功能神经影像学数据指导时，观察到相关的可塑性变化（肿瘤与临界区域之间的距离增加）。
结论：这是第一个证明非侵入性NICP可行性的病例系列。神经相关性表明，神经影像学引导的目标选择可能代表了在神经外科手术前利用神经可塑性变化的有效策略。需要进一步调查以确认这些初步发现。
方法：治疗包括非侵入性神经调节，暂时停用病变附近的关键区域，加上强化的功能训练，激活同一功能网络中的替代节点。患者在NICP前进行了评估，NICP后，以及术后随访。
结果：10名患者进行了干预。符合可行性标准(保留，坚持,安全,和患者的满意度)。临床结果显示，从NICP之前到之后，运动和执行功能的总体稳定性和改善。在后续。当神经调节目标由功能神经影像学数据指导时，观察到相关的可塑性变化（肿瘤与临界区域之间的距离增加）。
结论：这是第一个证明非侵入性NICP可行性的病例系列。神经相关性表明，神经影像学引导的目标选择可能代表了在神经外科手术前利用神经可塑性变化的有效策略。需要进一步调查以确认这些初步发现。
