neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2022-24-3-90-99neurosurgery-1241Research ArticleЛЕКЦИЯLECTUREХирургическое лечение опухолей дополнительной моторной областиSurgical treatment of tumors of the supplementary motor areahttps://orcid.org/0000-0001-8107-3065АлексеевИ. М.AlekseevI. M.

Алексеев Иван Максимович.

105203 Москва, ул. Нижняя Первомайская, 70.

Ivan M. Alekseev.

70 Nizhnyaya Pervomayskaya St., Moscow 105203.

alexeev.im@yandex.ruhttps://orcid.org/0000-0003-2974-1462ЗуевА. А.ZuevA. A.

105203 Москва, ул. Нижняя Первомайская, 70.

70 Nizhnyaya Pervomayskaya St., Moscow 105203.

ФГБУ «Национальный медико-хирургический центр им. Н. И. Пирогова» Минздрава РоссииРоссияN.I. Pirogov National Medical and Surgical Center, Ministry of Health of RussiaRussian Federation2022051020222439099Copyright © Алексеев И.М., Зуев А.А., 20222022Алексеев И.М., Зуев А.А.Alekseev I.M., Zuev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1241Введение

Введение. Дополнительная моторная область - участок медиальной части лобной коры головного мозга, расположенный в пределах межполушарной щели кпереди от первичной моторной коры, - традиционно считается вторичной моторной корой и наименее изученным моторным регионом. Ранее ее классифицировали только как высший двигательный центр (положение в иерархии между префронтальной и первичной моторной корой). Однако сегодня достоверно установлены ее мультифункциональный статус и участие во множестве когнитивных процессов. Изучение дополнительной моторной области долгое время ограничивалось лишь фундаментальными нейровизуализационными и электрофизиологическими исследованиями, но практическая сторона вопроса и клиническое значение данного региона часто оставались вне интереса исследователей.  Цель исследования - представить анатомо-функциональные особенности дополнительной моторной области, клиническую симптоматику при ее поражении, проанализировать все имеющиеся сегодня данные и аспекты хирургического лечения опухолей этого региона. 

Материалы и методы

Материалы и методы. Поиск в научных базах данных (PubMed и др.) привел к выбору и анализу 62 литературных источников. В основном обзор посвящен аспектам и факторам риска хирургического лечения патологий, локализованных в данном регионе. 

Результаты

Результаты. Дополнительная моторная область по своим анатомо-функциональным характеристикам гетерогенна, в ней выделяют два отдельных субрегиона. Помимо изначально описанной двигательной функции исследуемой области, ее роль также достоверно установлена в функционировании рабочей памяти, языковых, перцептивных, когнитивных процессах и др. Большое число функций этой области связано с многочисленными нейронными связями. Например, относительно недавно описан лобный косой пучок, связывающий медиальную часть верхней лобной извилины с оперкулярной частью нижней лобной извилины: предполагается, что данный тракт, по всей видимости, связан с осуществлением языковой функции в доминантном полушарии и функции рабочей памяти - в недоминантном.  При поражении дополнительной моторной области может возникать различная неврологическая двигательная и речевая симптоматика, в частности, так называемый синдром дополнительной моторной области, который характеризуется развитием у пациентов акинетического мутизма и в большинстве случаев полностью обратим в течение нескольких дней или месяцев. Среди всех патологий в исследуемой зоне наиболее часто встречаются опухоли, особенно глиомы разной степени злокачественности, которые также могут проявляться различными клиническими симптомами в пред- и послеоперационном периодах. 

Заключение

Заключение. Критически важно тщательное предоперационное планирование, информирование пациента о пространственно-временной картине прогнозируемых послеоперационных клинических нарушений и сроках реабилитации. Рекомендуется использовать методы интраоперационной нейронавигации, а также интраоперационный нейрофизиологический мониторинг. Необходимо дальнейшее изучение этого региона и особенностей его хирургии для стандартизации подходов к лечению патологий. 

Background

Background. The supplementary motor area is a part of the medial frontal cortex, that is located just anterior to the primary motor cortex entirely within the interhemispheric fissure. This area belongs traditionally to the secondary motor cortex and perhaps it is the least studied motor region of the brain. While functions and symptoms of a damage to the primary motor and the premotor cortex areas have been well known and described for a long time, study of the supplementary motor area has been limited to fundamental neuroimaging and electrophysiological researches, and a practical side of the issue and clinical significance of this region remained outside the interest of researchers.

Aim

Aim. To present the anatomical and functional features of the supplementary motor area, the clinical symptoms of its lesion, to analyze all the data available today and aspects of surgical treatment of tumors in this region.

Materials and methods

Materials and methods. A search in scientific databases (PubMed, etc.) led to the selection and analysis of sixty-two literary sources. The review is mainly devoted to the aspects and risk factors of surgical treatment of pathologies localized in this region.

Results

Results. According to its anatomical and functional characteristics, the supplementary motor area is a heterogeneous region - it has two separate subregions in it. In addition to the motor function of the supplementary motor area, its role has also been reliably established in the implementation of working memory processes, language, perceptual, cognitive and other functions. Such a number of functions performed by the supplementary motor area is associated with numerous neural connections of this area. For example, the frontal aslant tract has been described recently, and it connects medial part of the superior frontal gyrus with the pars opercularis of the inferior frontal gyrus. This tract, apparently, is associated with the implementation of language function in the dominant hemisphere and function of working memory in the non-dominant hemisphere.

When the supplementary motor area is affected, various neurological motor and speech symptoms can occur, in particular, the supplementary motor area syndrome, which is characterized by the development of akinetic mutism in patients and, in most cases, is completely reversible within a few days or months. Among all pathologies in this area, tumors are most common, especially gliomas, which can also manifest themselves with various clinical symptoms both in the preoperative and postoperative periods.

Conclusion

Conclusion. Critically important preoperative planning, informing the patient about the spatio-temporal picture of the predicted postoperative clinical disorders and the timing of rehabilitation are critically important. It is recommended to use methods of intraoperative neuronavigation, as well as intraoperative neurophysiological monitoring. It is necessary to further study the supplementary motor area and the peculiarities of its surgery in order to standardize approaches to the treatment of pathologies.

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The authors declare that there are no conflicts of interest present.