Surgical treatment of motor zone brain tumors

Dimertsev A.V., Zuev A.A.

Primary tumors of the central nervous system (CNS) account for about 2% of all human tumors. Ongoing epidemiological studies confirm an annual increase in the occurrence of both primary tumors and metastatic brain lesions, and, accordingly, the need for surgical treatment increases. Most often, malignant glial formations are located in the region of motor zones, requiring both surgery and adjuvant therapy. Deficiencies in motor functions directly reflect the functional status of the patient, which can adversely affect the selection of patients for chemo-radiation therapy. Preoperative preparation, including the study of the specifics of the spatial relationship of cortical motor zones, the corticospinal tract and the tumor, allows you to plan all stages of surgical treatment in advance, reduce the time of surgery, its volume, and, as a result reduce the risk of irreversible neurological disorders. Currently, there are various neuroimaging methods that allow assessing the size and configuration of volumetric formation in a three-dimensional format (MRI), localizing motor patterns on the surface of the cerebral cortex (fMRI, TMS, PET, MEG), assessing the state of the corticospinal tract (MR-tractography). However, these techniques are auxiliary and cannot be used separately. Intraoperatively, various combinations of neurophysiological monitoring methods, neuronavigation systems, ultrasound, intraoperative CT, MRI, metabolic navigation, etc., are used as neuroimaging. To date, there is no consensus on the volume of preoperative training, the technique of surgery of tumors of motor zones, intraoperative monitoring.

Materials and methods. Found and analyzed 51 articles on queries: brain tumor, brain mapping, extent of resection, functional mapping, fiber tracking, motor area tumor, gliomas, motor pathways with the maximum number of observations over the past 20 years, using PubMed, Cochrane library, MedLine and available search tools on the Internet.

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