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  • "It assures me that what I am going to be doing that day or the next day is going to be as safe as possible, and create the greatest advantage to helping that patient without risking deficit."

    Mitchel Berger, M.D.
    Chairman of the Department of Neurological Surgery, Director of the Brain Tumor Surgery Program, University of California, San Francisco

Navigated Brain Stimulation (NBS) by Nexstim is the only CE marked and FDA cleared noninvasive solution to presurgical mapping of the motor cortex. The NBS System 5 adds navigation to transcranial magnetic stimulation (nTMS), creating a precise map of the eloquent cortex superimposed on a patient specific MRI. NBS accurately locates the stimulating electric field (E-field) in the cortex, with the proven accuracy of direct cortical stimulation (DCS)1.

The patient’s motor responses are clearly marked as pegs color coded as a heat scale. Each mapping session can be stored to precisely replicate any session at a later date. The NBS 5’s mapping results can be exported via DICOM to planning systems or directly into the neuronavigator. In the OR, NBS maps help optimal placement of DCS electrodes and facilitates surgical guidance.

In a recent study of 250 consecutive patients, presurgical mapping with NBS enabled a more aggressive surgical strategy in more the 75% of the cases. The same study using navigated TMS (nTMS) disproved suspected involvement of the primary motor cortex in over 25% of the cases, expanding surgical indication by 14.8%. The study concluded that the integration of nTMS into the surgical workflow crucially improves pre-operative planning, patient counseling, and surgical procedures, leading to longer progression-free survival rates and better neurological outcomes by expanding the indications and extent of resection.3

 

The Nexstim NBS System is indicated for noninvasive mapping of the primary motor cortex of the brain to its cortical gyrus. The NBS System provides information that may be used in the assessment of the primary motor cortex for pre-procedural planning.

Nexstim NexSpeech®, when used together with the NBS System, is indicated for noninvasive localization of cortical areas that do not contain essential speech function. NexSpeech® provides information that may be used in pre-surgical planning in patients undergoing brain surgery. Intraoperatively, the localization information provided by NexSpeech® is intended to be verified by direct cortical stimulation.

The Nexstim NBS System and NBS System with NexSpeech® are not intended to be used during a surgical procedure. The NBS System and NBS System with NexSpeech are intended to be used by trained clinical professionals.

References:

1 Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging,navigated transcranial magnetic stimulation, and direct cortical stimulation By: Phiroz E. Tarapore, M.D., Mitchel S. Berger, M.D., et. al Journal of Neurosurgery. 2012 Aug;117(2):354-62. doi: 10.3171/2012.5.JNS112124

2 Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions By: Krieg SM, Ringel F, el. al Neuro-Oncology. 2014 Feb 9.

3 Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations By: Frey D, P Vajkoczy, T Picht, et. al Neuro-Oncology. 2014 Jun 12. pii: nou110.

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