Fundamentals of Brain Tumor Surgery in Eloquent Areas

Abstract

Central nervous system tumors are a major cause of morbidity and mortality. The main pathology involved is brain metastases, followed by intrinsic gliomas. In nearly all cases, surgery is the initial and most important measure to change natural course of disease. In brain metastases and meningiomas, gross total resection is also precluded, and usually more achievable, because of biological behavior of tumor and extrinsic presentation. Generally these tumors push or compress eloquent areas, but spare them. In intrinsic tumors, complete resection is often difficult, once tumor is invasive and may even be within eloquent cortex. When tumors occur in eloquent areas such as sensorial, motor and language cortex, there is the need for taking several measures to avoid worsening of symptoms after surgery. Especially in lesions involving language cortex, an awake craniotomy may be performed to assess intraoperatively language functions.

Resumo

Tumores no Sistema nervosa central são a maior causa de morbimortalidade. A principal patologia é metástase do cérebro, seguida de gliomas intrínsecos. Em quase todos os casos, cirurgia é a primeira e mais importante medida para impedir a evolução da doença. Em metástase do cérebro e meningiomas, ressecção brutal total é igualmente excluída e geralmente mais factível, devido ao comportamento biológico do tumor e apresentação extrínseca. Normalmente, estes tumores empurram ou comprimem áreas eloquentes, mas o separam. Em tumores intrínsecos, a ressecção completa é difícil, uma vez que o tumor é invasivo e pode até mesmo estar dentro córtex. Quando tumores ocorrem em áreas eloquentes, como a sensorial, a motora e o córtex de linguagem, há a necessidade de tomar diversas medidas para evitar piora dos sintomas pós-cirúrgicos. Particularmente em lesões envolvendo o córtex da linguagem, uma craniotomia desperta deve ser realizada para acesso funções linguísticas de forma intraoperativa.

Keywords

brain cortex - brain tumor - surgery

Palavras-chave

córtex cerebral - tumor cerebral - cirurgia

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