neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-2-61-69neurosurgery-1529Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEХирургическое лечение низкозлокачественных глиом функционально значимых зон головного мозга у детей: обзор литературы и клинические наблюденияSurgical treatment of gangliogliomas in functional areas of the brain in child: a literature review and clinical caseshttps://orcid.org/0000-0001-8719-0342НизолинД. В.NizolinD. V.

Дмитрий Владимирович Низолин 

197341 Санкт-Петербург, ул. Аккуратова, 2

Dmitry  V. Nizolin 

2 Akkuratova St., St. Petersburg 197341

dlarinskij@mail.ruhttps://orcid.org/0000-0002-6219-7270КимА. В.KimA. V.

197341 Санкт-Петербург, ул. Аккуратова, 2

 

2 Akkuratova St., St. Petersburg 197341

ЗуеваЮ. А.ZuevaYu. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

ШмелеваО. О.ShmelevaO. O.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

МасловН. Е.MaslovN. E.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

ЕфимцевА. Ю.EfimtsevA. Yu.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

НазаралиеваЭ. Т.NazaralievaE. T.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0003-0350-0249СамочерныхК. А.SamochernykhK. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияV.A. Almazov National Medical Research Center, Ministry of Health of RussiaRussian Federation2024070620242626169Copyright © Низолин Д.В., Ким А.В., Зуева Ю.А., Шмелева О.О., Маслов Н.Е., Ефимцев А.Ю., Назаралиева Э.Т., Самочерных К.А., 20242024Низолин Д.В., Ким А.В., Зуева Ю.А., Шмелева О.О., Маслов Н.Е., Ефимцев А.Ю., Назаралиева Э.Т., Самочерных К.А.Nizolin D.V., Kim A.V., Zueva Y.A., Shmeleva O.O., Maslov N.E., Efimtsev A.Y., Nazaralieva E.T., Samochernykh K.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/1529

Хирургическое лечение опухолей, расположенных вблизи функционально значимых зон, подразумевает использование таких технологий, как краниотомия в сознании, кортикальная и субкортикальная стимуляция. Задача этих и других технологий – достижение максимального объема резекции опухоли без ухудшения функционального статуса пациента. Применение вышеупомянутых технологий у взрослых пациентов хорошо изучено, чего нельзя сказать в отношении педиатрических пациентов.

Цель работы – представить 2 клинических случая успешного лечения педиатрических пациентов с низкозлокачественными глиомами функционально значимых зон головного мозга и обзор литературы по данной проблеме.

В клинических наблюдениях выявлено поражение функционально значимых зон: сенсорной речевой коры и кортикоспинального тракта соответственно. Поражение речевой коры в первом представленном наблюдении подтверждено также данными функциональной магнитно‑резонансной томографии. В первом случае проведена операция с пробуждением, использованием кортикального и субкортикального картирования, во втором – с иcпользованием субкортикального картирования и метаболической навигации. И в том и в другом случае достигнуто тотальное удаление опухоли при удовлетворительном функциональном исходе.

Достижение оптимального баланса функционального исхода и степени радикальности удаления низкозлокачественных опухолей функционально значимых зон возможно при использовании комплексного подхода, основанного на анализе разномодальных данных.

Surgical treatment of tumors located near functional areas involves the use of technologies such as awake craniotomy, cortical and subcortical stimulation. The introduction of these and other technologies makes it possible to achieve maximum resection of the tumor without compromising the functional status of the patient. The use of this technologies has been well studied in adults, but this not about pediatric patients.

Aim of the work is to present two clinical cases of successful treatment of low‑grade gliomas of functional areas of the brain in children and literature review.

In clinical cases, damage of functionally significant areas were noted: the sensory speech cortex and the corticospinal tract. The involving speech cortex in the first case was also confirmed by functional magnetic resonance imaging. In the first case, an operation was performed with awake craniotomy, using cortical and subcortical mapping, in the second, using subcortical mapping and metabolic navigation. Total tumor resection was achieved in both clinical cases with a good functional outcome.

Achieving an optimal balance of functional outcome and the degree of radical removal of low‑grade tumors of functional areas is possible using an integrated approach based on the analysis of multimodal data.

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