• Giovanni Raffa, Alfredo Conti, Antonino Scibilia, Carmela Sindorio, Maria Catena Quattropani, Massimiliano Visocchi, Antonino Germanò, and Francesco Tomasello.
• Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy. mark83g@alice.it.
• Acta Neurochir. Suppl. 2017 Jan 1; 124: 251-261.

BackgroundSurgery of low-grade gliomas (LGGs) in eloquent areas still presents a challenge. New technologies have been introduced to enable the performance of "functional", customized preoperative planning aimed at maximal resection, while reducing the risk of postoperative deficits. We describe our experience in the surgery of LGGs in eloquent areas using preoperative planning based on navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography.MethodsSixteen patients underwent preoperative planning, using nTMS and nTMS-based DTI tractography. Motor and language functions were mapped. Preoperative data allowed for tailoring of the surgical strategy. The impact of these modalities on surgical planning was evaluated. Influence on functional outcome was analyzed in comparison with results in a historical control group.ResultsIn 12 patients (75 %), nTMS added useful information on functional anatomy and surgical risks. Surgical strategy was modified in 9 of 16 cases (56 %). The nTMS "functional approach" provided a good outcome at discharge, with a decrease in postoperative motor and/or language deficits, as compared with controls (6 vs. 44 %; p = 0.03).ConclusionsThe functional preoperative mapping of speech and motor pathways based on nTMS and DTI tractography provided useful information, allowing us to plan the best surgical strategy for radical resection; this resulted in improved postoperative neurological results.

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