neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-1-130-136neurosurgery-1508Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWХирургия в сознании в нейроонкологии. Часть 2. Функциональное интраоперационное картированиеAwake surgery in neurooncology. Part 2. Functional intraoperative mappinghttps://orcid.org/0000-0002-7635-9701ДмитриевА. Ю.DmitrievA. Yu.

Александр Юрьевич Дмитриев 

129010 Москва, Большая Сухаревская пл., 3

127006 Москва,  ул. Долгоруковская, 4

 

Aleksandr Yuryevich Dmitriev 

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

dmitriev@neurosklif.ruhttps://orcid.org/0000-0001-5026-0060СинкинМ. В.SinkinM. V.

129010 Москва, Большая Сухаревская пл., 3

127006 Москва,  ул. Долгоруковская, 4

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

https://orcid.org/0000-0001-5938-9194СкальнаяА. А.SkalnayaA. A.

127006 Москва,  ул. Долгоруковская, 4

4 Dolgorukovskaya St., Moscow 127006

https://orcid.org/0000-0002-8263-1433СолодовА. А.SolodovA. A.

129010 Москва, Большая Сухаревская пл., 3

127006 Москва,  ул. Долгоруковская, 4

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

https://orcid.org/0000-0002-5847-9435ДашьянВ. Г.DashyanV. G. 

129010 Москва, Большая Сухаревская пл., 3

127006 Москва,  ул. Долгоруковская, 4

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения города Москвы»; ФГБОУ ВО «Российский университет медицины» Минздрава РоссииРоссияN.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow Healthcare Department; Russian University of Medicine, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Российский университет медицины» Минздрава РоссииРоссияRussian University of Medicine, Ministry of Health of RussiaRussian Federation202405042024261130‑136Copyright © Дмитриев А.Ю., Синкин М.В., Скальная А.А., Солодов А.А., Дашьян В.Г., 20242024Дмитриев А.Ю., Синкин М.В., Скальная А.А., Солодов А.А., Дашьян В.Г.Dmitriev A.Y., Sinkin M.V., Skalnaya A.A., Solodov A.A., Dashyan V.G.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/1508

Хирургию с пробуждением обычно применяют для сохранения речи у больного. С этой целью используют различные тесты, выбор которых зависит от расположения опухоли. У многоязычных пациентов вербальные центры обычно имеют различную локализацию. Картирование каждого из них необходимо для сохранения способности к общению. Для исследования зрения применяют тест с показом цветных точек или рисунков на экране монитора, разделенного на 4 части. Такое тестирование позволяет одновременно оценить функции зрения и речи.

Картирование моторной зоны у больных в сознании позволяет более комплексно оценить двигательную функцию, включая планирование движений, проприоцептивный контроль и равновесие. Электростимуляция чувствительного центра у пациентов в состоянии бодрствования дает возможность дифференцировки разных видов чувствительности.

Картирование и сохранение когнитивных функций, памяти, внимания и способности к калькуляции чисел повышают шанс сохранить профессиональные навыки и качество жизни после операции.

Awake surgery is usually used to save patient’s speech. Various tests are applied for this purpose, whish selection  depends on tumor location. In multilingual patients verbal centers usually have different position. Location of each of them is necessary to keep patient’s communication capabilities after operation.

To study vision, tests with presentations of color points or pictures on the screen divided on 4 parts are used. Such testing allows to estimate vision and speech simultaneously.

Mapping of motor area in awake patients allows to evaluate this function more comprehensively including motion planning, proprioceptive control and balance. Stimulation of sensory area in awake patients gives opportunity to differ various types of sensitivity.

Mapping and keeping of cognitive functions, memory, attention and ability of calculation increases chance to save professional skills and quality of life after operation.

хирургия в сознаниикраниотомия в сознаниихирургия с пробуждениемкартированиеэлектростимуляцияречьзрениекогнитивные функцииawake surgeryawake craniotomycortical mappingspeechvisioncognitive functionsReferencesOjemann G., Ojemann J., Lettich E., Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 1989;71(3): 316–26. DOI: 10.3171/jns.1989.71.3.0316Ojemann G., Ojemann J., Lettich E., Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 1989;71(3): 316–26. DOI: 10.3171/jns.1989.71.3.0316Nguyen H.S., Sundaram S.V., Mosier K.M., Cohen-Gadol A.A. A method to map the visual cortex during an awake craniotomy. J Neurosurg 2011;114(4):922–6. DOI: 10.3171/2010.11.JNS101293Nguyen H.S., Sundaram S.V., Mosier K.M., Cohen-Gadol A.A. A method to map the visual cortex during an awake craniotomy. J Neurosurg 2011;114(4):922–6. DOI: 10.3171/2010.11.JNS101293Racine C.A., Li J., Molinaro A.M. et al. Neurocognitive function in newly diagnosed low-grade glioma patients undergoing surgical resection with awake mapping techniques. Neurosurgery 2015;77(3):371–9; discussion 379. DOI: 10.1227/NEU.0000000000000779Racine C.A., Li J., Molinaro A.M. et al. Neurocognitive function in newly diagnosed low-grade glioma patients undergoing surgical resection with awake mapping techniques. Neurosurgery 2015;77(3):371–9; discussion 379. DOI: 10.1227/NEU.0000000000000779Duffau H. Awake surgery for nonlanguage mapping. Neurosurgery 2010;66(3):523–8; discussion 528–9. DOI: 10.1227/01.NEU.0000364996.97762.73Duffau H. Awake surgery for nonlanguage mapping. Neurosurgery 2010;66(3):523–8; discussion 528–9. DOI: 10.1227/01.NEU.0000364996.97762.73Hickok G., Poeppel D. Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language. Cognition 2004;92(1–2):67–99. DOI: 10.1016/j.cognition.2003.10.011Hickok G., Poeppel D. Dorsal and ventral streams: a framework for understanding aspects of the functional anatomy of language. Cognition 2004;92(1–2):67–99. DOI: 10.1016/j.cognition.2003.10.011Chang E.F., Raygor K.P., Berger M.S. Contemporary model of language organization: an overview for neurosurgeons. J Neurosurg 2015;122(2):250–61. DOI: 10.3171/2014.10.JNS132647Chang E.F., Raygor K.P., Berger M.S. Contemporary model of language organization: an overview for neurosurgeons. J Neurosurg 2015;122(2):250–61. DOI: 10.3171/2014.10.JNS132647Hickok G., Poeppel D. The cortical organization of speech processing. Nat Rev Neurosci 2007;8(5):393–402. DOI: 10.1038/nrn2113Hickok G., Poeppel D. The cortical organization of speech processing. Nat Rev Neurosci 2007;8(5):393–402. DOI: 10.1038/nrn2113Imaizumi S., Mori K., Kiritani S. et al. Vocal identification of speaker and emotion activates different brain regions. Neuroreport 1997;8(12):2809–12. DOI: 10.1097/00001756-199708180-00031Imaizumi S., Mori K., Kiritani S. et al. Vocal identification of speaker and emotion activates different brain regions. Neuroreport 1997;8(12):2809–12. DOI: 10.1097/00001756-199708180-00031Sefcikova V., Sporrer J.K., Ekert J.O. et al. High interrater variability in intraoperative language testing and interpretation in awake brain mapping among neurosurgeons or neuropsychologists: an emerging need for standardization. World Neurosurg 2020;141:e651–e60. DOI: 10.1016/j.wneu.2020.05.250Sefcikova V., Sporrer J.K., Ekert J.O. et al. High interrater variability in intraoperative language testing and interpretation in awake brain mapping among neurosurgeons or neuropsychologists: an emerging need for standardization. World Neurosurg 2020;141:e651–e60. DOI: 10.1016/j.wneu.2020.05.250Talacchi A., Santini B., Casartelli M. et al. Awake surgery between art and science. Part II: language and cognitive mapping. Funct Neurol 2013;28(3):223–39. DOI: 10.11138/FNeur/2013.28.3.223Talacchi A., Santini B., Casartelli M. et al. Awake surgery between art and science. Part II: language and cognitive mapping. Funct Neurol 2013;28(3):223–39. DOI: 10.11138/FNeur/2013.28.3.223Bello L., Gallucci M., Fava M. et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 2007;60(1):67–80; discussion 80–2. DOI: 10.1227/01.NEU.0000249206.58601.DEBello L., Gallucci M., Fava M. et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 2007;60(1):67–80; discussion 80–2. DOI: 10.1227/01.NEU.0000249206.58601.DESpena G., Nava A., Cassini F. et al. Preoperative and intraoperative brain mapping for the resection of eloquent-area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes. Acta Neurochir (Wien) 2010;152(11):1835–46. DOI: 10.1007/s00701-010-0764-9Spena G., Nava A., Cassini F. et al. Preoperative and intraoperative brain mapping for the resection of eloquent-area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes. Acta Neurochir (Wien) 2010;152(11):1835–46. DOI: 10.1007/s00701-010-0764-9Rofes A., Miceli G. Language mapping with verbs and sentences in awake surgery: a review. Neuropsychol Rev 2014;4(2):185–99. DOI: 10.1007/s11065-014-9258-5Rofes A., Miceli G. Language mapping with verbs and sentences in awake surgery: a review. Neuropsychol Rev 2014;4(2):185–99. DOI: 10.1007/s11065-014-9258-5Ohlerth A.K., Valentin A., Vergani F. et al. The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation. Acta Neurochir 2020;162(2):397–406. DOI: 10.1007/s00701-019-04159-xOhlerth A.K., Valentin A., Vergani F. et al. The verb and noun test for peri-operative testing (VAN-POP): standardized language tests for navigated transcranial magnetic stimulation and direct electrical stimulation. Acta Neurochir 2020;162(2):397–406. DOI: 10.1007/s00701-019-04159-xЖуков В.Ю., Горяйнов С.А., Буклина С.Б. и др. Интраоперационное картирование длинных ассоциативных трактов в хирургии глиом доминантной по речи лобной доли. Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко 2018;82(5):5–20. DOI: 10.17116/neiro2018820515Zhukov V.Yu., Goryaynov S.A., Buklina S.B. et al. Intraoperative mapping of long association fibers in surgery of gliomas of the speech-dominant frontal lobe. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2018;82(5):5–20. (In Russ.). DOI: 10.17116/neiro2018820515Garrett M.C., Pouratian N., Liau L.M. Use of language mapping to aid in resection of gliomas in eloquent brain regions. Neurosurg Clin N Am 2012;23(3):497–506. DOI: 10.1016/j.nec.2012.05.003Garrett M.C., Pouratian N., Liau L.M. Use of language mapping to aid in resection of gliomas in eloquent brain regions. Neurosurg Clin N Am 2012;23(3):497–506. DOI: 10.1016/j.nec.2012.05.003Trinh V.T., Fahim D.K., Shah K. et al. Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures. Neurosurgery 2013;72(2):160–9. DOI: 10.1227/NEU.0b013e31827b9a11Trinh V.T., Fahim D.K., Shah K. et al. Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures. Neurosurgery 2013;72(2):160–9. DOI: 10.1227/NEU.0b013e31827b9a11Giussani C., Roux F.E., Lubrano V. et al. Review of language organisation in bilingual patients: what can we learn from direct brain mapping? Acta Neurochir (Wien) 2007;149(11):1109–16; discussion 1116. DOI: 10.1007/s00701-007-1266-2Giussani C., Roux F.E., Lubrano V. et al. Review of language organisation in bilingual patients: what can we learn from direct brain mapping? Acta Neurochir (Wien) 2007;149(11):1109–16; discussion 1116. DOI: 10.1007/s00701-007-1266-2Walker J.A., Quiñones-Hinojosa A., Berger M.S. Intraoperative speech mapping in 17 bilingual patients undergoing resection of a mass lesion. Neurosurgery 2004;54(1):113–7; discussion 118. DOI: 10.1227/01.neu.0000097270.95721.3bWalker J.A., Quiñones-Hinojosa A., Berger M.S. Intraoperative speech mapping in 17 bilingual patients undergoing resection of a mass lesion. Neurosurgery 2004;54(1):113–7; discussion 118. DOI: 10.1227/01.neu.0000097270.95721.3bŠteňo A., Karlík M., Mendel P. et al. Navigated three-dimensional intraoperative ultrasound-guided awake resection of low-grade glioma partially infiltrating optic radiation. Acta Neurochir (Wien) 2012;154(7):1255–62. DOI: 10.1007/s00701-012-1357-6 21.Šteňo A., Karlík M., Mendel P. et al. Navigated three-dimensional intraoperative ultrasound-guided awake resection of low-grade glioma partially infiltrating optic radiation. Acta Neurochir (Wien) 2012;154(7):1255–62. DOI: 10.1007/s00701-012-1357-6 21.Gras-Combe G., Moritz-Gasser S., Herbet G., Duffau H. Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways. J Neurosurg 2012;117(3):466–73. DOI: 10.3171/2012.6.JNS111981Gras-Combe G., Moritz-Gasser S., Herbet G., Duffau H. Intraoperative subcortical electrical mapping of optic radiations in awake surgery for glioma involving visual pathways. J Neurosurg 2012;117(3):466–73. DOI: 10.3171/2012.6.JNS111981Brennum J., Engelmann C.M., Thomsen J.A., Skjøth-Rasmussen J. Glioma surgery with intraoperative mapping – balancing the oncofunctional choice. Acta Neurochir (Wien) 2018;160(5):1043–50. DOI: 10.1007/s00701-018-3521-0Brennum J., Engelmann C.M., Thomsen J.A., Skjøth-Rasmussen J. Glioma surgery with intraoperative mapping – balancing the oncofunctional choice. Acta Neurochir (Wien) 2018;160(5):1043–50. DOI: 10.1007/s00701-018-3521-0Satoer D., Visch-Brink E., Dirven C., Vincent A. Glioma surgery in eloquent areas: can we preserve cognition? Acta Neurochir 2016;158(1):35–50. DOI: 10.1007/s00701-015-2601-7Satoer D., Visch-Brink E., Dirven C., Vincent A. Glioma surgery in eloquent areas: can we preserve cognition? Acta Neurochir 2016;158(1):35–50. DOI: 10.1007/s00701-015-2601-7Chakravarthi S.S., Kassam A.B., Fukui M.B. et al. Awake surgical management of third ventricular tumors: a preliminary safety, feasibility, and clinical applications study. Oper Neurosurg (Hagerstown) 2019;17(2):208–26. DOI: 10.1093/ons/opy405Chakravarthi S.S., Kassam A.B., Fukui M.B. et al. Awake surgical management of third ventricular tumors: a preliminary safety, feasibility, and clinical applications study. Oper Neurosurg (Hagerstown) 2019;17(2):208–26. DOI: 10.1093/ons/opy405De Witte E., Satoer D., Colle H. et al. Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests. Acta Neurochir 2015;157(4):577–88. DOI: 10.1007/s00701-014-2317-0De Witte E., Satoer D., Colle H. et al. Subcortical language and non-language mapping in awake brain surgery: the use of multimodal tests. Acta Neurochir 2015;157(4):577–88. DOI: 10.1007/s00701-014-2317-0Duffau H. The challenge to remove diffuse low-grade gliomas while preserving brain functions. Acta Neurochir (Wien) 2012;154(4):569–74. DOI: 10.1007/s00701-012-1275-7Duffau H. The challenge to remove diffuse low-grade gliomas while preserving brain functions. Acta Neurochir (Wien) 2012;154(4):569–74. DOI: 10.1007/s00701-012-1275-7Wager M., Du Boisgueheneuc F., Pluchon C. et al. Intraoperative monitoring of an aspect of executive functions: administration of the Stroop test in 9 adult patients during awake surgery for resection of frontal glioma. Neurosurgery 2013;72(2 Suppl Operative):ons169–80; discussion ons180–1. DOI: 10.1227/NEU.0b013e31827bf1d6Wager M., Du Boisgueheneuc F., Pluchon C. et al. Intraoperative monitoring of an aspect of executive functions: administration of the Stroop test in 9 adult patients during awake surgery for resection of frontal glioma. Neurosurgery 2013;72(2 Suppl Operative):ons169–80; discussion ons180–1. DOI: 10.1227/NEU.0b013e31827bf1d6Puppa A.D., De Pellegrin S., d’Avella E. et al. Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor. J Neurosurg 2013;119(5):1107–11. DOI: 10.3171/2013.6.JNS122445Puppa A.D., De Pellegrin S., d’Avella E. et al. Right parietal cortex and calculation processing: intraoperative functional mapping of multiplication and addition in patients affected by a brain tumor. J Neurosurg 2013;119(5):1107–11. DOI: 10.3171/2013.6.JNS122445Puppa A.D., De Pellegrin S., Lazzarini A. et al. Subcortical mapping of calculation processing in the right parietal lobe. J Neurosurg 2015;122(5):1038–41. DOI: 10.3171/2014.10.JNS14261Puppa A.D., De Pellegrin S., Lazzarini A. et al. Subcortical mapping of calculation processing in the right parietal lobe. J Neurosurg 2015;122(5):1038–41. DOI: 10.3171/2014.10.JNS14261Bartolomeo P., Thiebaut de Schotten M., Duffau H. Mapping of visuospatial functions during brain surgery: a new tool to prevent unilateral spatial neglect. Neurosurgery 2007;61(6):E1340. DOI: 10.1227/01.neu.0000306126.46657.79Bartolomeo P., Thiebaut de Schotten M., Duffau H. Mapping of visuospatial functions during brain surgery: a new tool to prevent unilateral spatial neglect. Neurosurgery 2007;61(6):E1340. DOI: 10.1227/01.neu.0000306126.46657.79Duffau H., Mandonnet E. The “onco-functional balance” in surgery for diffuse low-grade glioma: integrating the extent of resection with quality of life. Acta Neurochir (Wien) 2013;155(6):951–7. DOI: 10.1007/s00701-013-1653-9Duffau H., Mandonnet E. The “onco-functional balance” in surgery for diffuse low-grade glioma: integrating the extent of resection with quality of life. Acta Neurochir (Wien) 2013;155(6):951–7. DOI: 10.1007/s00701-013-1653-9Zelitzki R., Korn A., Arial E. et al. Comparison of motor outcome in patients undergoing awake vs general anesthesia surgery for brain tumors locatedwithin or adjacent to the motor pathways. Neurosurgery 2019;85(3):E470–E6. DOI: 10.1093/neuros/nyz007Zelitzki R., Korn A., Arial E. et al. Comparison of motor outcome in patients undergoing awake vs general anesthesia surgery for brain tumors locatedwithin or adjacent to the motor pathways. Neurosurgery 2019;85(3):E470–E6. DOI: 10.1093/neuros/nyz007Khu K.J., Doglietto F., Radovanovic I. et al. Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. J Neurosurg 2010;112(5):1056–60. DOI: 10.3171/2009.6.JNS09716Khu K.J., Doglietto F., Radovanovic I. et al. Patients’ perceptions of awake and outpatient craniotomy for brain tumor: a qualitative study. J Neurosurg 2010;112(5):1056–60. DOI: 10.3171/2009.6.JNS09716Лубнин А.Ю., Синбухова Е.В., Куликов А.С., Кобяков Г.Л. Ощущения пациентов и их удовлетворенность при проведении краниотомии в сознании. Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко 2020;84(5):89–101. DOI: 10.17116/neiro20208405189Lubnin A.Yu., Sinbukhova E.V., Kulikov A.S., Kobyakov G.L. Sensations of patients and their satisfaction during awake craniotomy. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2020;84(5):89–101. (In Russ.). DOI: 10.17116/neiro20208405189Hansen E., Seemann M., Zech N. et al. Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 2013;155(8):1417–24. DOI: 10.1007/s00701-013-1801-2Hansen E., Seemann M., Zech N. et al. Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 2013;155(8):1417–24. DOI: 10.1007/s00701-013-1801-2Bayram A.K., Yan Q., Isitan C. et al. Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions. Epilepsy Behav 2021;118:107902. DOI: 10.1016/j.yebeh.2021.107902Bayram A.K., Yan Q., Isitan C. et al. Effect of anesthesia on electrocorticography for localization of epileptic focus: Literature review and future directions. Epilepsy Behav 2021;118:107902. DOI: 10.1016/j.yebeh.2021.107902

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