Effect of navigated transcranial magnetic stimulation for glioma surgery outcomes: a systematic review and meta-analysis
Zhipeng Xu, Jinrong Wang, Wenming Wang, Hua LiuAbstract
Objectives
Gliomas are the most common primary brain tumors in adults, often linked to poor prognosis despite advances in treatment. Navigated transcranial magnetic stimulation (nTMS) is a non-invasive preoperative mapping technique that may improve glioma surgery outcomes by enhancing tumor resection and preserving neurological function. This meta-analysis evaluates the impact of nTMS on glioma resection outcomes.
Methods
A literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science up to September 2024 for cohort or case-control studies comparing nTMS-guided surgery with conventional planning, with or without subcortical fibre-guided tractography (SFG) and intra-operative neurophysiological monitoring (IONM). Data on extent of resection, motor function, quality of life (Karnofsky Performance Status), and complications were extracted. Statistical analysis was performed using RevMan 5.3. This study was registered at PROSPERO (registration number CRD42025641788).
Results
Five studies with 736 patients were included. The nTMS group showed significantly higher rates of gross total resection (GTR) and lower rates of subtotal resection (STR) compared to the non-nTMS group. No significant differences were found in postoperative motor function or quality of life. Two studies comparing nTMS + SFG + IONM with IONM alone demonstrated higher GTR rates (absolute increase 12–18 %) and reduced permanent motor paresis (3–6 % vs. 9–14 %); one reached statistical significance for neurological outcomes.
Conclusions
Pre-operative nTMS significantly improves the anatomical radicality of glioma resection without increasing early neurological morbidity. Integration of nTMS with SFG-based tractography and IONM may confer additional functional protection, highlighting the value of a multimodal mapping strategy for tumors abutting motor-eloquent cortex. Further studies are needed to confirm these findings.