癫痫通常与低级别神经胶质瘤 (LGG) 相关，影响患者的健康。虽然切除是主要治疗方法，但 27%-55% 的病例术后仍会出现癫痫发作。作者旨在评估 LGG 的皮层电图 (ECoG) 和导航经颅磁刺激 (nTMS) 定制的上总切除 (ETT-SpTR) 在控制癫痫发作、保留神经功能和提高治疗效果方面的作用。作者回顾性分析了一个前瞻性入组队列接受切除手术的 LGG 患者中，脑电图（EEG）显示癫痫发作并伴有发作期/发作间期活动。作者在术前进行了 nTMS 来识别功能性皮质区域。 ECoG 用于指导切除高危癫痫皮质区域 (HREA)。患者被分为两组：I 组（对照组），仅接受大体全切除，而 II 组患者接受 ECoG (ETT-SpTR) 识别的 HREA 切除。切除避免了 nTMS 上识别的功能性区域，并通过皮质映射进行检查。使用 Engel 分类评估术后癫痫发作结果。纳入了 2023 年 1 月至 7 月期间接受 LGG 切除术的 15 名患者。在 24 个已识别的 nTMS 阳性点中，没有一个被纳入切除范围。总体而言，73.3% 的患者 (11/15) 术中 ECoG 呈阳性，随访时 II 组 (85.7% Engel IA 级) 的结果优于 I 组 (25% Engel IA 级) (p = 0.02， OR 0.5 [95% CI 0.035-7.10]，RR 0.19 [95% CI 0.03-1.2]）。 II 组的癫痫发作控制明显更好，两组术后短暂性神经功能缺损没有显着差异 (p = 0.45)。随访期间未观察到永久性神经功能缺损。统计分析显示两组之间存在显着差异（p < 0.05）。这项初步研究肯定了 TMS 对癫痫患者术后神经状态和安全性的预测价值。术中 ECoG 有效识别瘤周 HREA。 ETT-SpTR 显着改善了癫痫结果，保留了功能，而没有永久性的神经功能恶化。额外切除的目标是颞叶、额叶和顶叶的 HREA。

Epilepsy is commonly associated with low-grade gliomas (LGGs), impacting patients' well-being. While resection is the primary treatment, seizures can persist postoperatively in 27%-55% of cases. The authors aimed to evaluate an electrocorticography (ECoG) and navigated transcranial magnetic stimulation (nTMS)-tailored supratotal resection (ETT-SpTR) for LGG in controlling seizures, preserving neurological function, and enhancing treatment effectiveness.The authors retrospectively analyzed a prospectively enrolled cohort of patients with LGG presenting with epileptic seizures with ictal/interictal activity on electroencephalography (EEG) who underwent resective surgery. The authors performed preoperative nTMS to identify functional cortical areas. ECoG was used to guide the removal of the high-risk epilepsy cortical areas (HREAs). Patients were divided into two groups: group I, the control group, underwent gross-total resection alone, whereas group II patients underwent removal of HREAs identified by ECoG (ETT-SpTR). Resection avoided functionally eloquent areas as identified on nTMS, checked with cortical mapping. Postoperative seizure outcome was assessed using the Engel classification.Fifteen patients who underwent LGG resection between January and July 2023 were included. Among 24 identified nTMS-positive points, none were included in the resection. Overall, 73.3% of patients (11/15) showed positive intraoperative ECoG, with better outcomes in group II (85.7% Engel class IA) than in group I (25% Engel class IA) at the follow-up (p = 0.02, OR 0.5 [95% CI 0.035-7.10], RR 0.19 [95% CI 0.03-1.2]). Seizure control was significantly better in group II, with no notable differences in postoperative transient neurological deficits between the two groups (p = 0.45). No permanent neurological deficits were observed during follow-up. Statistical analysis revealed significant differences between the two groups (p < 0.05).This preliminary study affirms the predictive value of TMS for postoperative neurological status and safety in epileptic patients. Intraoperative ECoG effectively identified peritumoral HREAs. ETT-SpTR significantly improved epileptic outcomes, preserving functions without permanent neurological worsening. Additional resection targets the HREAs in the temporal, frontal, and parietal lobes.