Send to

Choose Destination
Acta Neurochir (Wien). 2017 Jul;159(7):1187-1195. doi: 10.1007/s00701-017-3187-z. Epub 2017 Apr 29.

Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report.

Author information

Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität Ismaninger Str. 22, 81675, Munich, Germany.
BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland.
Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland.
Nexstim Plc, Elimäenkatu 9 B, 00510, Helsinki, Finland.
Department of Biomedical Engineering and Computational Science, Aalto University, Espoo, Finland.
Center of Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Neurosurgery Inselspital, Bern University Hospital University of Berne, 3010, Berne, Switzerland.
Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, Neurosurgery, University of Helsinki, P.O. Box 266, Topeliuksenkatu 5, 00260, Helsinki, Finland.
Department of Clinical Neurophysiology (R2:01), Karolinska University Hospital, 17176, Solna, Stockholm, Sweden.
Epilepsy Unit, Department of Pediatric Neurology, Helsinki University Central Hospital, Lastenlinnantie 2 PL 280, HUS, 00029, Helsinki, Finland.
Department of Neurological Surgery, University of California, 505 Parnassus Ave, Moffitt, San Francisco, CA, 94143, USA.
Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Augustenburger Platz 1, 13353, Berlin, Germany.



Navigated transcranial magnetic stimulation (nTMS) is increasingly used for preoperative mapping of motor function, and clinical evidence for its benefit for brain tumor patients is accumulating. In respect to language mapping with repetitive nTMS, literature reports have yielded variable results, and it is currently not routinely performed for presurgical language localization. The aim of this project is to define a common protocol for nTMS motor and language mapping to standardize its neurosurgical application and increase its clinical value.


The nTMS workshop group, consisting of highly experienced nTMS users with experience of more than 1500 preoperative nTMS examinations, met in Helsinki in January 2016 for thorough discussions of current evidence and personal experiences with the goal to recommend a standardized protocol for neurosurgical applications.


nTMS motor mapping is a reliable and clinically validated tool to identify functional areas belonging to both normal and lesioned primary motor cortex. In contrast, this is less clear for language-eloquent cortical areas identified by nTMS. The user group agreed on a core protocol, which enables comparison of results between centers and has an excellent safety profile. Recommendations for nTMS motor and language mapping protocols and their optimal clinical integration are presented here.


At present, the expert panel recommends nTMS motor mapping in routine neurosurgical practice, as it has a sufficient level of evidence supporting its reliability. The panel recommends that nTMS language mapping be used in the framework of clinical studies to continue refinement of its protocol and increase reliability.


Brain tumor; Epilepsy surgery; Language; Motor; Preoperative mapping; Transcranial magnetic stimulation

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center