Estimulação magnética transcraniana navegada em pacientes com tumores cerebrais adjacentes à área motora: planejamento pré-operatório e avaliação do prognóstico motor

• Ano de defesa: 2019
• Autor(a) principal: Pinto, Pedro Henrique da Costa Ferreira
• Orientador(a): Nigri, Flávio
• Banca de defesa: Medeiros, Ana Heloisa de , Simões, Elington Lannes , Sousa, Marcus Andre Acioly de , Madeira, Eugenio Pacelle Queiroz
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências Médicas
• Departamento: Centro Biomédico::Faculdade de Ciências Médicas
• País: BR
• Palavras-chave em Português: Estimulação magnética cerebral; Mapeamento cerebral; Cérebro Tumores Cirurgia; Cérebro Tumores Cirurgia Complicações e sequelas; Força muscular; Estimulação magnética transcraniana navegada; Mapeamento motor; Tumor cerebral; Prognóstico motor; Planejamento pré-operatório
• Palavras-chave em Inglês: Navigated transcranial magnetic stimulation; Motor mapping; Brain tumor; Motor outcome; Preoperative planning
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::MEDICINA::CIRURGIA::NEUROCIRURGIA
• Link de acesso: http://www.bdtd.uerj.br/handle/1/8551

Currently, navigated transcranial magnetic stimulation (nTMS) has several applications in the field of neurosurgery and neuro-oncology. In spite of the currently fast-paced development of nTMS in neurosurgical patients, it is a relatively recent method, with its applications and workflow still facing the process of adaptation, with only a few cases published in literature. With the purpose of expanding current knowledge about the role of nTMS in neurosurgery and neuro-oncology, patients with brain tumors adjacent to the motor area submitted to motor mapping with nTMS were studied. The effects of the preoperative mapping of the motor area by nTMS on the neurosurgeon's decision regarding surgical strategy and the use of nTMS as a tool for assessing motor outcome were analyzed. Fourteen patients who underwent neurosurgeon evaluation for preoperative planning with nTMS were studied. Of the 14 patients submitted to preoperative motor mapping, 9 were evaluated for the use of nTMS in the motor outcome.The preoperative planning of neurosurgeons who had access to motor mapping with nTMS differed from those who did not have this data avaliable. The preoperative planning of most neurosurgeons has changed in some way after knowledge of the motor area mapping with nTMS. In this study, the lower the distance between the hotspot and the tumor, the higher the power score found on patient s physical examination in the 1st and 3rd postoperative weeks. The presence of motor evoked potential at the 1st and 3rd postoperative weeks correlated with a better motor outcome in the contralateral upper limb. In conclusion, nTMS was useful as a tool in the preoperative planning and evaluation of the motor outcome of patients with brain tumors adjacent to the motor area. More studies are necessary to assess its real importance in patients with brain tumors near from motor area.