RESUMO
The aim of the study is to assess the possibilities of the combined approach to using multimodal MRI, neuronavigation, and awake craniotomy in resecting tumors of eloquent areas. Materials and Methods: The results of 30 successive awake surgical interventions performed in 2017-2019 years in patients with tumors of eloquent areas have been analyzed. The main selection criterion for this type of operations was the location of the tumor in the projection or in the immediate proximity to the cortical centers of speech and motion. To minimize the damage, patients underwent functional MRI and DTI tractography at the prehospital stage to identify cortical regions and white matter tracts involved in the motor and language functions; immediately before the operation the acquired data was loaded into the navigation StealthStation S7 (Medtronic, USA) to plan and monitor surgery stages; during the surgery, direct cortical and subcortical stimulation was performed to identify the motor and speech centers (asleep-awake-asleep technique) with neurolinguistic testing. Karnofsky performance status, assessment of the patient's neurological status, frequency of epileptic seizures before and after the operation, the extent of the tumor resection, and the data analysis after the linguistic testing were used to determine the patients' condition and surgery outcomes. Results: Improvement of the general state after the operation has been noted in 30% of patients compared to the preoperative condition, no neurological deficit dynamics has been observed in 33% of patients. Postoperative multimodal MRI showed that total tumor removal was achieved in 37% of cases, subtotal in 40%, partial removal resection in 23% of cases. Conclusion: The combined approach to the brain tumor resection using multimodal MRI, neuronavigation, and awake craniotomy with motor and language areas mapping allows neurosurgeons to minimize the risk of persistent neurological deficit occurrence and provides the possibility to perform maximal resection possible preserving the patients' functional status. The presented methodology is reproducible, permitting one to expand the options of surgical treatment when lesions are localized in eloquent areas.
Assuntos
Neoplasias Encefálicas , Neuronavegação , Humanos , Neuronavegação/métodos , Vigília/fisiologia , Mapeamento Encefálico/métodos , Craniotomia/métodos , Imageamento por Ressonância Magnética , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/patologia , IdiomaRESUMO
We examined postoperative material from 28 patients aged 39-61 years with gliomas of different degrees of anaplasia (the diagnosis was histologically verified according to the WHO classification of CNS tumors) who had not previously received antitumor treatment. In glioma tissue, the glucose concentration was significantly higher than in the brain tissue of subjects dead from traumas (control), while lactate concentration did not differ from that in the control group or was lower. Hexokinase activity demonstrated a tendency to an increase in grade I and significant elevation in grades II and III, while in grade IV gliomas, this parameter did not differ from the control. Activities of the pentose-phosphate pathway enzymes glucose-6-phosphate dehydrogenase and transketolase increased with increasing of tumor anaplasia. Activity of glycogen synthase 3ß kinase was significantly higher than in the control group. IDH1 mutation was discovered in 40% cases, the MGMT promoter methylation was detected in more than 50%, the Ki-67 level increased with increasing tumor anaplasia. The most significant correlations with glioma markers were detected for glucose-6-phosphate dehydrogenase and glycogen synthase 3ß kinase. Activities of the studied enzymes of carbohydrate metabolism significantly correlated with Ki-67 marker.
Assuntos
Química Encefálica/fisiologia , Neoplasias Encefálicas/patologia , Glioma/genética , Glioma/patologia , Glucosefosfato Desidrogenase/metabolismo , Glicogênio Sintase Quinase 3 beta/metabolismo , Adulto , Anaplasia/patologia , Biomarcadores Tumorais/genética , Neoplasias Encefálicas/genética , Metabolismo dos Carboidratos/genética , Metabolismo dos Carboidratos/fisiologia , Metilação de DNA/genética , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Glucose/análise , Hexoquinase/metabolismo , Humanos , Isocitrato Desidrogenase/genética , Ácido Láctico/análise , Pessoa de Meia-Idade , Regiões Promotoras Genéticas/genética , Transcetolase/metabolismo , Proteínas Supressoras de Tumor/genéticaRESUMO
The presence of mutations in the gene encoding isocitrate dehydrogenase (IDH1), parameters of pro- and antioxidant activity in glioma tumor tissue, and their correlation were studied using bioinformatic analysis using STRING, IntAct, BioGrid, UniProt, SwissProt databases. The rate of detection of IDH1 gene mutations varied in different degree of anaplasia, being maximum in grade III gliomas. The intensity of free radical oxidation and activities of superoxide dismutase and catalase in the tumor tissue were significantly higher than in the control. The dependence of these parameters on the degree of anaplasia was shown. Mutations in IDH1 are associated with a decrease in antioxidant activity in the tissues of gliomas, which is critically important for the initial diagnosis, the choice of treatment options, and prediction of patient survival.
