Recent decades have substantiated the understanding that the function of language relies on an elaborate network of not only cortical but also subcortical structures of the human brain. Therefore, efforts have been made in the neurosurgical field to delineate and preserve the synergy of both cortical language hubs and subcortical white matter tracts on a patient-tailored basis. Preferably, this mapping of function is achieved during the preoperative phase, thereby aiding meticulous presurgical planning. In this chapter, we present the techniques enabling this preoperative functional delineation of language: the combination of cortical stimulation mapping with navigated transcranial magnetic stimulation (nTMS) and tractography of white matter bundles for language. We commence in the first part with a stepwise description of nTMS language mapping and an overview of tractography approaches through region of interest placement and the merging of the two methods. In the second part, we depict the applicability of this combined approach by outlining the theory of language and the anatomy behind the intricate language system that these methods aim to preserve. Lastly, we present an illustrative case in order to depict the implementation in the individual. Through discussing the foundational principles of tractography and the cutting-edge applications of nTMS in language mapping, this chapter elucidates how these technologies can maximize surgical outcomes while preserving human language capacity.

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Combining nTMS and Tractography for Language Mapping: An Integrated Paradigm for Neurosurgical Planning

  • Ann-Katrin Ohlerth,
  • Jose Pedro Lavrador,
  • Francesco Vergani,
  • Stephanie J. Forkel

摘要

Recent decades have substantiated the understanding that the function of language relies on an elaborate network of not only cortical but also subcortical structures of the human brain. Therefore, efforts have been made in the neurosurgical field to delineate and preserve the synergy of both cortical language hubs and subcortical white matter tracts on a patient-tailored basis. Preferably, this mapping of function is achieved during the preoperative phase, thereby aiding meticulous presurgical planning. In this chapter, we present the techniques enabling this preoperative functional delineation of language: the combination of cortical stimulation mapping with navigated transcranial magnetic stimulation (nTMS) and tractography of white matter bundles for language. We commence in the first part with a stepwise description of nTMS language mapping and an overview of tractography approaches through region of interest placement and the merging of the two methods. In the second part, we depict the applicability of this combined approach by outlining the theory of language and the anatomy behind the intricate language system that these methods aim to preserve. Lastly, we present an illustrative case in order to depict the implementation in the individual. Through discussing the foundational principles of tractography and the cutting-edge applications of nTMS in language mapping, this chapter elucidates how these technologies can maximize surgical outcomes while preserving human language capacity.