Use of repetitive transcranial magnetic stimulation and 2D ultrasound in resection of low-grade glioma at motor strip area in resource limited setting

Eloquent area glioma surgery is technically demanding. Identification and preservation of the functional area determines the long term outcome. Here we discuss the use of transcranial magnetic stimulation (TMS) and 2D ultrasound (2DUSG) in resection of low grade glioma (LGG) located at motor strip area. In five patients where the LGG was located close to motor area were evaluated with TMS in the preoperative period and the functional area is marked. This information is used for planning the craniotomy. A 2DUSG is used to detect the margin of resection. Complete excision was feasible in two and partial resection in three without any added deficit. TMS is an useful tool for localizing motor area in the pre operative period for patients with tumor located close to the motor area. Additionally 2DUSG provides real time imaging to safeguard the eloquent brain area. Combination of these two offers low cost, easily available method for resecting eloquent area brain tumors in resource limited areas.