Approximately 26,070 primary malignant and 53,200 nonmalignant brain tumors will be diagnosed in the United States in 2017, with an estimated 16,947 deaths in the United States in 2017 attributable to primary malignant brain and central nervous system tumors. Surgery is typically the treatment of choice for most brain tumors, with a goal to remove as much of the tumor as possible while preserving the patient’s neurological function. The specific neurological risks of brain surgery are related to the location of the tumor and can include memory problems, speech difficulty, paralysis, and abnormal balance or coordination.

Description of Technology: Navigated transcranial magnetic stimulation (nTMS) is a noninvasive functional mapping technique that utilizes magnetic stimulation to generate electrical current in the cerebral cortex. Motor cortex mapping is conducted by stimulating different regions of the brain and measuring the modulatory effect via surface electrodes placed over desired muscles. Alternatively, in language and speech mapping, the patient names objects displayed every few seconds on a computer monitor during magnetic stimulation. The surgeon uses the nTMS mapping results presurgically for treatment planning and intraoperatively, in conjunction with direct cortical stimulation, for surgical guidance.

Patient Population: nTMS is indicated for noninvasive mapping of the primary motor cortex to provide information that may be used for preprocedural planning.

Clinical Alternatives: Other noninvasive presurgical mapping modalities include functional magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, magnetoencephalography, and diffusion tensor imaging.

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