Surgical Approaches to Mesencephalic (Midbrain) Tumors

The midbrain acts as a junction between the brain, lower part of the brainstem, and spinal cord. It functions as a relay station for major white matter tracts (e.g., corticospinal tracts) as well as the origin of two cranial nerve nuclei. Tumors that originate in or involve the midbrain pose a significant challenge, and their treatment usually involves several disciplines including neurosurgery and neurooncology. Surgery for midbrain tumors demands a high surgical technique and multidisciplinary approach in the operating room (e.g., neuromonitoring) and outside of it as well. The surgical approach is tailored for each and every case, taking into account the complex anatomy, specific location of the long tracts using advanced imaging, as well as the adjacent neurovascular structures that surround the surgical location. In recent years, there has been a growing interest and understanding of the molecular and genetic parameters of tumors that invade the midbrain, which, with time, will allow us to tailor more specific treatments for these patients.