• Philipp Hendrix, Sebastian Senger, Andreas Simgen, Christoph J Griessenauer, and Joachim Oertel.
• Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany. Electronic address: hendrix.philipp@gmail.com.
• World Neurosurg. 2017 Apr 1; 100: 425-433.

ObjectiveThe value of preoperative repetitive transcranial magnetic stimulation (rTMS) language mapping for function preservation in surgery of speech-eloquent lesions under general anesthesia remains to be determined.MethodsWe prospectively enrolled 20 consecutive right-handed patients with a malignant, left-sided perisylvian language-eloquent brain tumor. All patients were subjected to surgical resection under general anesthesia guided by preoperative rTMS language mapping (rTMS group, 2014-2016). A matched-pair analysis with 20 patients who also underwent surgical resection under general anesthesia in the pre-rTMS era (pre-rTMS group, 2009-2013) was performed. Language performance status was ranked from grade 0 to grade 3 (none, mild, medium, severe).ResultsRates of gross total resection, tumor residual, and complications were equal in both groups. Duration of surgery (P = 0.039) and inpatient stay (P = 0.001) were significantly shorter in the rTMS group. Preoperatively, 14 patients in the rTMS and 13 patients in the pre-rTMS group had language deficits (P = 0.380). One week after surgery, 8/14 patients (57.1%) in the rTMS group but only 1/13 patients (7.7%) in the pre-rTMS group experienced improvement of language performance status (P = 0.013). At 6 weeks follow-up, language performance status was significantly better in the rTMS group (P = 0.048). However, at 3 months follow-up, the rTMS and pre-rTMS groups showed an equal language performance status.ConclusionsImplementation of preoperative rTMS language mapping seems to provide a favorable early language outcome in patients undergoing surgical resection of language-eloquent lesions under general anesthesia.Copyright © 2017 Elsevier Inc. All rights reserved.

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