在过去的十年中,导航经颅磁刺激(nTMS)已发展成为一种可靠的非侵入性临床和科学工具。具体来说,它已经经历了几项验证临床试验,证明与术中直接电刺激(DES)高度一致,这为在患有运动性颅内肿瘤的患者中增加运动标测目的的应用铺平了道路。基于该技术的临床用例,在本文中,我们回顾了运动映射和推导模型(风险分层和预测,基于nTMS的光纤跟踪,改善临床结果,和功能可塑性的评估),并为nTMS定量映射的适用性提供收集的证据集。此外,我们提供基于证据的演示,以确保运动测绘程序的方法学可行性和准确性。我们证明了nTMS的刺激强度(SI)的选择和刺激的空间密度是准确应用运动映射的关键因素,同时也展示了对运动图的影响。我们得出的结论是,虽然nTMS电机映射的应用在过去十年中得到了令人印象深刻的传播,应用的协议和参数仍然存在差异,可以进行优化,以实现可靠的定量映射。
Navigated transcranial magnetic stimulation (nTMS) has developed into a reliable non-invasive clinical and scientific tool over the past decade. Specifically, it has undergone several validating clinical trials that demonstrated high agreement with intraoperative direct electrical stimulation (DES), which paved the way for increasing application for the purpose of motor mapping in patients harboring motor-eloquent intracranial neoplasms. Based on this clinical use case of the technique, in this article we
review the evidence for the feasibility of motor mapping and derived models (risk stratification and prediction, nTMS-based fiber tracking, improvement of clinical outcome, and assessment of functional plasticity), and provide collected sets of evidence for the applicability of quantitative mapping with nTMS. In addition, we provide evidence-based demonstrations on factors that ensure methodological feasibility and accuracy of the motor mapping procedure. We demonstrate that selection of the stimulation intensity (SI) for nTMS and spatial density of stimuli are crucial factors for applying motor mapping accurately, while also demonstrating the effect on the motor maps. We conclude that while the application of nTMS motor mapping has been impressively spread over the past decade, there are still variations in the applied protocols and parameters, which could be optimized for the purpose of reliable quantitative mapping.