СОВРЕМЕННЫЕ ПРИНЦИПЫ МАКСИМАЛЬНО БЕЗОПАСНОЙ РЕЗЕКЦИИ ДИФФУЗНЫХ ГЛИОМ В ФУНКЦИОНАЛЬНО ЗНАЧИМЫХ ЗОНАХ ГОЛОВНОГО МОЗГА: ИНТЕГРАЦИЯ НЕЙРОНАВИГАЦИИ, ИНТРАОПЕРАЦИОННОГО КАРТИРОВАНИЯ И ФЛУОРЕСЦЕНТНОГО КОНТРОЛЯ

Abstract

Background. Diffuse gliomas are heterogeneous primary central nervous system tumors characterized by infiltrative growth, involvement of neuronal networks, and variable biological aggressiveness. Surgical management of gliomas located in eloquent brain regions requires balancing maximal tumor removal with preservation of neurological and neurocognitive functions. Advances in functional neuronavigation, diffusion tractography, direct electrical stimulation, intraoperative magnetic resonance imaging, and fluorescence guidance have substantially improved individualized surgical planning.

Materials and Methods. A narrative analytical review of international clinical guidelines, randomized trials, systematic reviews, and meta-analyses was conducted. Particular attention was paid to extent of resection, intraoperative functional mapping, advanced neuroimaging, and postoperative neurological outcomes.

Results. The clinical applications and limitations of direct electrical stimulation, diffusion tensor tractography, intraoperative magnetic resonance imaging, ultrasound navigation, and 5-aminolevulinic acid fluorescence were analyzed. An original conceptual framework, ONCO-FUNCTION, was developed to integrate surgical radicality, eloquent pathway preservation, and real-time intraoperative decision-making.

Conclusion. Maximal safe resection of diffuse gliomas requires individualized integration of anatomical imaging and functional mapping. Multimodal surgical guidance may improve the balance between tumor removal and neurological preservation, while prospective validation is needed to establish the effectiveness of the proposed conceptual framework.