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Proceedings SNO “LXII Congresso Nazionale SNO”
VENERDÌ, 29 SETTEMBRE

Abstract COMUNICAZIONI:
FASCIA V

Mapping cognition by navigated Transcranial Magnetic Stimulation
(nTMS): a single case of functional preoperative mapping
of language and calculation functions

C. BONAUDO *, B. GORI *, F. CAPELLI , A. PEDONE , A. GRIPPO , A. DELLA PUPPA 1
1
2
1
2
1
1 Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health,
University Hospital of Careggi, Florence, Italy
2 Neurophysiopathology, University Hospital Careggi, Florence, Italy
* Equally contributed to write the paper

❒ ❒ BACKGROUND. The primary neurosurgical goal to treat marginal and angular gyri, and fronto-temporal regions. The
oncological patients is the ‘onco-functional’ balance, latter mapped the third segment of the superior longitudinal
achieving a maximal safe resection, with preservation of fasciculus. The craniotomy included two nTMS-positive
the eloquent areas. calculation points, matching DES-positive calculation
The integration of advanced neuroimaging techniques to spots, whilst no nTMS language positive points were ex-
understand the ‘functional’ brain architecture and the in- posed. We illustrate the first case of language and calcula-
creasing use of navigated Transcranial Magnetic tion mapping by presurgical nTMS and intraoperative DES.
Stimulation (nTMS) allow a non-invasive characterization The comparison with the gold standard DES is limited by
of cortical functional anatomy. Increasing literature is the degree of brain parenchyma exposed by the craniotomy.
demonstrating presurgical nTMS reliability to map cortical Additionally, it allows tracing white matter fibers related to
regions involved in motor and language organization, but language and calculation. Finally, nTMS has proved to be a
still localization of eloquent cortical areas for calculation feasible method to map cognitive processes prior to surgery
processing is not identified. to guide a ‘patient-tailored’ surgical strategy.
❒ ❒ MATERIALS AND METHODS. In this work we present a ❒ ❒ CONCLUSIONS. In this work, we finally provide prelimi-
single case of a 42-years-old right-handed female patient nary data about the use of nTMS for language and calcula-
harboring a left fronto-opercular lesion, whose presurgical tion presurgical mapping, demonstrating that it is feasible,
planning was performed with nTMS and nTMS-derived- reliable, and can be used to create a ‘functional’ tractogra-
fiber tracking, including language and calculation func- phy. Unlike intraoperative DES, nTMS mapping is not in-
tion. An awake surgical procedure using DES was chosen. vasive and it is not limited by the degree of cerebral
She was operated at the Neurosurgical Department of the parenchyma, exposed by the craniotomy. Certainly, more
University Hospital of Careggi, Florence. data is required to develop the best protocol for mapping
❒ ❒ RESULTS. nTMS identified five language-specific points, language areas, as well as to implement the study of other
two corresponding to the arcuate fasciculus, and two clus- cognitive functions, such as calculation, guiding a ‘patient-
ters of calculation-positive spots were identified in supra- tailored’, ‘connectome-based’ surgical strategy.

Corrispondenza: Dr.ssa Camilla Bonaudo, SOD di Neurochirurgia, AOU Careggi, largo G.A. Brambilla 3, 50134 Firenze (FI), e-mail:
camilla.bonaudo@unifi.it
LXII Congresso Nazionale SNO, 27-30 settembre 2023, Firenze.
Atti a cura di Pasquale Palumbo e Bruno Zanotti.
Copyright © 2023 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-138-3

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