1
|
Velchev V, Burev S, Ferdinandov D, Popov D, Vasileva P, Petrova S, Petrov PP, Hyusein RR, Penchev P. Awake Craniotomy for a Frontal Astrocytoma: A Case Report. Cureus 2024; 16:e59667. [PMID: 38836145 PMCID: PMC11149057 DOI: 10.7759/cureus.59667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
Awake craniotomy is a surgical procedure that has been gaining significance over the past decades. Neuronavigation is an intraoperative technology that locates tumors and monitors the brain cortex during awake craniotomy. The presence of cerebral low-grade gliomas in the frontal lobe creates a risk of affecting vital centers of the brain cortex during surgery. We present a clinical case of a 42-year-old male patient who entered the neurosurgery clinic with a clinical manifestation of headache for two months. MRI showed evidence of the recurrence of a left frontal glioma. Differential diagnoses of frontal gliomas include metastases, abscesses, and cysts. The pathophysiologic background of the disease is the mutation of neuroglial cells, which leads to an abnormal and uncontrollable proliferation. Under sleep-awake anesthesia, operative treatment was performed through left frontal awake craniotomy under neuronavigation. As a result, a total excision was achieved. Motor functions of the right limbs and speech have been preserved. The patient was mobilized on the day after the intervention. Surgery-related complications were not observed. The patient had relief from the symptoms and was discharged on the fifth day. Awake craniotomy combined with neuronavigation was the most efficient and the least harmful method for the excision of the tumor. For low-grade gliomas localized in the frontal area of the encephalon, awake craniotomy is the only secure option for surgery.
Collapse
Affiliation(s)
| | - Stefan Burev
- Department of Neurological Surgery, University Hospital "St. Ivan Rilski", Sofia, BGR
| | - Dilyan Ferdinandov
- Department of Neurological Surgery, University Hospital "St. Ivan Rilski", Sofia, BGR
| | - Deyan Popov
- Department of Neurological Surgery, University Hospital "St. Ivan Rilski", Sofia, BGR
| | - Petra Vasileva
- Department of Neurological Surgery, University Hospital "St. Ivan Rilski", Sofia, BGR
| | - Stela Petrova
- Department of General and Clinical Pathology, University Multi-profile Hospital for Active Treatment and Emergency Medicine (UMHATEM) - Pirogov, Sofia, BGR
| | - Petar-Preslav Petrov
- Department of Anatomy, Histology, and Embryology, Medical University of Plovdiv, Plovdiv, BGR
| | - Remzi R Hyusein
- Faculty of Medicine, Medical University of Sofia, Sofia, BGR
| | - Plamen Penchev
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
| |
Collapse
|
2
|
Sollmann N, Zhang H, Kloth C, Zimmer C, Wiestler B, Rosskopf J, Kreiser K, Schmitz B, Beer M, Krieg SM. Modern preoperative imaging and functional mapping in patients with intracranial glioma. ROFO-FORTSCHR RONTG 2023; 195:989-1000. [PMID: 37224867 DOI: 10.1055/a-2083-8717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Magnetic resonance imaging (MRI) in therapy-naïve intracranial glioma is paramount for neuro-oncological diagnostics, and it provides images that are helpful for surgery planning and intraoperative guidance during tumor resection, including assessment of the involvement of functionally eloquent brain structures. This study reviews emerging MRI techniques to depict structural information, diffusion characteristics, perfusion alterations, and metabolism changes for advanced neuro-oncological imaging. In addition, it reflects current methods to map brain function close to a tumor, including functional MRI and navigated transcranial magnetic stimulation with derived function-based tractography of subcortical white matter pathways. We conclude that modern preoperative MRI in neuro-oncology offers a multitude of possibilities tailored to clinical needs, and advancements in scanner technology (e. g., parallel imaging for acceleration of acquisitions) make multi-sequence protocols increasingly feasible. Specifically, advanced MRI using a multi-sequence protocol enables noninvasive, image-based tumor grading and phenotyping in patients with glioma. Furthermore, the add-on use of preoperatively acquired MRI data in combination with functional mapping and tractography facilitates risk stratification and helps to avoid perioperative functional decline by providing individual information about the spatial location of functionally eloquent tissue in relation to the tumor mass. KEY POINTS:: · Advanced preoperative MRI allows for image-based tumor grading and phenotyping in glioma.. · Multi-sequence MRI protocols nowadays make it possible to assess various tumor characteristics (incl. perfusion, diffusion, and metabolism).. · Presurgical MRI in glioma is increasingly combined with functional mapping to identify and enclose individual functional areas.. · Advancements in scanner technology (e. g., parallel imaging) facilitate increasing application of dedicated multi-sequence imaging protocols.. CITATION FORMAT: · Sollmann N, Zhang H, Kloth C et al. Modern preoperative imaging and functional mapping in patients with intracranial glioma. Fortschr Röntgenstr 2023; 195: 989 - 1000.
Collapse
Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, United States
| | - Haosu Zhang
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Neuroradiology, Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Bernd Schmitz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Sandro M Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| |
Collapse
|
3
|
Habib A, Jovanovich N, Hoppe M, Hameed NF, Edwards L, Zinn P. Navigated 3D ultrasound-guided resection of high-grade gliomas: A case series and review. Surg Neurol Int 2022; 13:356. [PMID: 36128115 PMCID: PMC9479605 DOI: 10.25259/sni_469_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background: The crux in high-grade glioma surgery remains maximizing resection without affecting eloquent brain areas. Toward this, a myriad of adjunct tools and techniques has been employed to enhance surgical safety and efficacy. Despite intraoperative MRI and advanced neuronavigational techniques, as well as augmented reality, to date, the only true real-time visualization tool remains the ultrasound (US). Neuroultrasonography is a cost-efficient imaging modality that offers instant, real-time information about the changing anatomical landscape intraoperatively. Recent advances in technology now allow for the integration of intraoperative US with neuronavigation. Case Description: In this report, we present the resection technique for three cases of high-grade gliomas (two glioblastomas and one anaplastic astrocytoma). The patient presented with a variable clinical spectrum. All three cases have been performed using the Brainlab® neuronavigation system (BrainLAB, Munich, Germany) and the bk5000 US Machine® (BK Medical, Analogic Corporation, Peabody, Massachusetts, USA). Conclusion: Gross total resection was achieved in all three cases. The use of 3D navigated US was a reliable adjunct surgical tool in achieving favorable resection outcomes in these patients.
Collapse
|
4
|
Sloan AE. Commentary: A Novel 5-Aminolevulinic Acid-Enabled Surgical Loupe System—A Consecutive Brain Tumor Series of 11 Cases. Oper Neurosurg (Hagerstown) 2022; 22:e287-e288. [PMID: 35867099 PMCID: PMC9514739 DOI: 10.1227/ons.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andrew E Sloan
- University Hospitals-Cleveland Medical Center & Seidman Cancer Center, Department of Neurosurgery, Cleveland, Ohio, USA; and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
5
|
El Ganainy SO, Cijsouw T, Ali MA, Schoch S, Hanafy AS. Stereotaxic-assisted gene therapy in Alzheimer's and Parkinson's diseases: therapeutic potentials and clinical frontiers. Expert Rev Neurother 2022; 22:319-335. [PMID: 35319338 DOI: 10.1080/14737175.2022.2056446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Alzheimer's disease (AD) and Parkinson's disease (PD) are neurodegenerative disorders causing cognitive deficits and motor difficulties in the elderly. Conventional treatments are mainly symptomatic with little ability to halt disease progression. Gene therapies to correct or silence genetic mutations predisposing to AD or PD are currently being developed in preclinical studies and clinical trials, relying mostly on systemic delivery, which reduces their effectiveness. Imaging-guided stereotaxic procedures are used to locally deliver therapeutic cargos to well-defined brain sites, hence raising the question whether stereotaxic-assisted gene therapy has therapeutic potentials. AREAS COVERED The authors summarize the studies that investigated the use of gene therapy in PD and AD in animal and clinical studies over the past five years, with a special emphasis on the combinatorial potential with stereotaxic delivery. The advantages, limitations and futuristic challenges of this technique are discussed. EXPERT OPINION Robotic stereotaxis combined with intraoperative imaging has revolutionized brain surgeries. While gene therapies are bringing huge innovations to the medical field and new hope to AD and PD patients and medical professionals, the efficient and targeted delivery of such therapies is a bottleneck. We propose that careful application of stereotaxic delivery of gene therapies can improve PD and AD management. [Figure: see text].
Collapse
Affiliation(s)
- Samar O El Ganainy
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Tony Cijsouw
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
| | - Mennatallah A Ali
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Susanne Schoch
- Institute of Neuropathology, Section for Translational Epilepsy Research, Medical Faculty, University of Bonn, Bonn, Germany
| | | |
Collapse
|
6
|
Villemure-Poliquin N, Chrétien M, Leclerc JE. Navigation and non-navigation CT scan of the sinuses: comparison of the effective doses of radiation in children and adults. J Otolaryngol Head Neck Surg 2021; 50:66. [PMID: 34798901 PMCID: PMC8605512 DOI: 10.1186/s40463-021-00541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advent of 3D navigation imaging has opened new borders to the endoscopic surgical approaches of naso-sinusal inflammatory and neoplastic disease. This technology has gained in popularity among otolaryngologists for endoscopic sinus and skull base surgeries in both adults and children. However, the increased tissue radiation required for data acquisition associated with 3D navigation protocols CT scans is a source of concern because of its potential health hazards. We aimed to compare the effective doses of radiation between 3D navigation protocols and standard protocols for sinus computed tomography (CT) scans for both the adult and pediatric population. METHODS We performed a retrospective cohort study through electronic chart review of patients undergoing sinus CT scans (standard and 3D navigation protocols) from May 2019 to December 2019 using a Siemens Drive (VA62A) CT scanner. The effective dose of radiation was calculated in mSv for all exams. Average irradiation doses were compared using a Student's T-Test or a Kruskall-Wallis test when appropriate. RESULTS A total of 115 CT scans were selected for analysis, of which 47 were standard protocols and 68 were 3D navigation protocols CT scans. Among these, 31 exams were performed on children and 84 exams on adults. For the total population, mean effective dose in the non-navigation CT scans was 0.37 mSv (SD: 0.16, N = 47) and mean effective dose in the 3D navigation sinus CT group was 2.33 mSv (SD: 0.45, N = 68). The mean difference between the two groups was statistically significant 1.97 mSv (CI 95% - 2.1 to - 1.83; P < 0.0001). There was a sixfold increase in radiation with utilization of 3D navigation protocols. The ratio was identical when the pediatric as well as the adult subset of patients were analyzed. CONCLUSION In our center, utilization of 3D navigation sinus CT protocols significantly increases radiation exposure. Otolaryngologists should be aware of this significant increase and should attempt to decrease the radiation exposure of their patients by limiting unnecessary scan orders and by evaluating 3D acquisition protocols locally with radiation physicists. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Noémie Villemure-Poliquin
- Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Faculté de Médecine, Université Laval, Québec, QC, Canada.
| | - Mario Chrétien
- Service de Physique Médicale et de Radioprotection, CHU de Québec - Université Laval, Pavillon Enfant-Jésus, 1401 18e Rue, Québec, G1J 1Z4, Canada
| | - Jacques E Leclerc
- Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Faculté de Médecine, Université Laval, Québec, QC, Canada
| |
Collapse
|
7
|
Soffar H, Alsawy MF. Assessment of necessity of neuronavigation in localization of calvarial extra-axial lesions in the setting of limited resources. Chin Neurosurg J 2021; 7:35. [PMID: 34334132 PMCID: PMC8327415 DOI: 10.1186/s41016-021-00253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 06/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Neuronavigation is a very beneficial tool in modern neurosurgical practice. However, the neuronavigation is not available in most of the hospitals in our country raising the question about its importance in localizing the calvarial extra-axial lesions and to what extent it is safe to operate without it. Methods We studied twenty patients with calvarial extra-axial lesions who underwent surgical interventions. All lesions were preoperatively located with both neuronavigation and the usual linear measurements. Both methods were compared regarding the time consumed to localize the tumor and the accuracy of each method to anticipate the actual center of the tumor. Results The mean error of distance between the planned center of the tumor and the actual was 6.50 ± 1.762 mm in conventional method, whereas the error was 3.85 ± 1.309 mm in IGS method. Much more time was consumed during the neuronavigation method including booting, registration, and positioning. A statistically significant difference was found between the mean time passed in the conventional method and IGS method (2.05 ± 0.826, 24.90 ± 1.334, respectively), P-value < 0.001. Conclusion In the setting of limited resources, the linear measurement localization method seems to have an accepted accuracy in the localization of calvarial extra-axial lesions and it saves more time than neuronavigation method.
Collapse
Affiliation(s)
- Hussein Soffar
- Neurosurgery Department, Kasr Alainy Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo, Egypt
| | - Mohamed F Alsawy
- Neurosurgery Department, Kasr Alainy Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo, Egypt.
| |
Collapse
|
8
|
Skyrman S, Lai M, Edström E, Burström G, Förander P, Homan R, Kor F, Holthuizen R, Hendriks BHW, Persson O, Elmi-Terander A. Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 2021; 51:E7. [PMID: 34333469 DOI: 10.3171/2021.5.focus20813] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room-based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16-104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87-233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135-400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.
Collapse
Affiliation(s)
- Simon Skyrman
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Lai
- 2Philips Research, High Tech Campus 34, Eindhoven.,3Eindhoven University of Technology (TU/e), Eindhoven
| | - Erik Edström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Burström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Förander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Flip Kor
- 5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Benno H W Hendriks
- 2Philips Research, High Tech Campus 34, Eindhoven.,5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Oscar Persson
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Chen YW, Hanak BW, Yang TC, Wilson TA, Hsia JM, Walsh HE, Shih HC, Nagatomo KJ. Computer-assisted surgery in medical and dental applications. Expert Rev Med Devices 2021; 18:669-696. [PMID: 33539198 DOI: 10.1080/17434440.2021.1886075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Computer-assisted surgery (CAS) is a broad surgical methodology that utilizes computer technology to both plan and execute surgical intervention. CAS is widespread in both medicine and dentistry as it allows for minimally invasive and precise surgical procedures. Key innovations in volumetric imaging, virtual surgical planning software, instrument tracking, and robotics have assisted in facilitating the transfer of surgical plans to precise execution of surgical procedures. CAS has long been used in certain medical specialties including neurosurgery, cardiology, orthopedic surgery, otolaryngology, and interventional radiology, and has since expanded to oral and maxillofacial application, particularly for computer-assisted implant surgery. AREAS COVERED This review provides an updated overview of the most current research for CAS in medicine and dentistry, with a focus on neurosurgery and dental implant surgery. The MEDLINE electronic database was searched and relevant original and review articles from 2005 to 2020 were included. EXPERT OPINION Recent literature suggests that CAS performs favorably in both neurosurgical and dental implant applications. Computer-guided surgical navigation is well entrenched as standard of care in neurosurgery. Whereas static computer-assisted implant surgery has become established in dentistry, dynamic computer-assisted navigation is newly poised to trend upward in dental implant surgery.
Collapse
Affiliation(s)
- Yen-Wei Chen
- Department of Restorative Dentistry, University of Washington School of Dentistry Seattle,98195, WA, USA
| | - Brian W Hanak
- Department of Neurosurgery, Loma Linda University Health Loma Linda, 92354, CA, USA
| | - Tzu-Chian Yang
- Department of Restorative Dentistry, University of Washington School of Dentistry Seattle,98195, WA, USA
| | - Taylor A Wilson
- Department of Neurosurgery, Loma Linda University Health Loma Linda, 92354, CA, USA
| | - Jenovie M Hsia
- Department of Restorative Dentistry, University of Washington School of Dentistry Seattle,98195, WA, USA
| | - Hollie E Walsh
- Department of Restorative Dentistry, University of Washington School of Dentistry Seattle,98195, WA, USA
| | - Huai-Che Shih
- Department of Restorative Dentistry, University of Washington School of Dentistry Seattle,98195, WA, USA
| | - Kanako J Nagatomo
- Department of Periodontics, University of Washington School of Dentistry Seattle,98195 WA,USA
| |
Collapse
|
10
|
Reuter G, Moïse M, Roll W, Martin D, Lombard A, Scholtes F, Stummer W, Suero Molina E. Conventional and advanced imaging throughout the cycle of care of gliomas. Neurosurg Rev 2021; 44:2493-2509. [PMID: 33411093 DOI: 10.1007/s10143-020-01448-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Although imaging of gliomas has evolved tremendously over the last decades, published techniques and protocols are not always implemented into clinical practice. Furthermore, most of the published literature focuses on specific timepoints in glioma management. This article reviews the current literature on conventional and advanced imaging techniques and chronologically outlines their practical relevance for the clinical management of gliomas throughout the cycle of care. Relevant articles were located through the Pubmed/Medline database and included in this review. Interpretation of conventional and advanced imaging techniques is crucial along the entire process of glioma care, from diagnosis to follow-up. In addition to the described currently existing techniques, we expect deep learning or machine learning approaches to assist each step of glioma management through tumor segmentation, radiogenomics, prognostication, and characterization of pseudoprogression. Thorough knowledge of the specific performance, possibilities, and limitations of each imaging modality is key for their adequate use in glioma management.
Collapse
Affiliation(s)
- Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium. .,GIGA-CRC In-vivo Imaging Center, ULiege, Liège, Belgium.
| | - Martin Moïse
- Department of Radiology, University Hospital of Liège, Liège, Belgium
| | - Wolfgang Roll
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - Didier Martin
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Arnaud Lombard
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Félix Scholtes
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.,Department of Neuroanatomy, University of Liège, Liège, Belgium
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| |
Collapse
|
11
|
Gavdush AA, Chernomyrdin NV, Komandin GA, Dolganova IN, Nikitin PV, Musina GR, Katyba GM, Kucheryavenko AS, Reshetov IV, Potapov AA, Tuchin VV, Zaytsev KI. Terahertz dielectric spectroscopy of human brain gliomas and intact tissues ex vivo: double-Debye and double-overdamped-oscillator models of dielectric response. BIOMEDICAL OPTICS EXPRESS 2021; 12:69-83. [PMID: 33659071 PMCID: PMC7899500 DOI: 10.1364/boe.411025] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 05/07/2023]
Abstract
Terahertz (THz) technology offers novel opportunities in the intraoperative neurodiagnosis. Recently, the significant progress was achieved in the study of brain gliomas and intact tissues, highlighting a potential for THz technology in the intraoperative delineation of tumor margins. However, a lack of physical models describing the THz dielectric permittivity of healthy and pathological brain tissues restrains the further progress in this field. In the present work, the ex vivo THz dielectric response of human brain tissues was analyzed using relaxation models of complex dielectric permittivity. Dielectric response of tissues was parametrized by a pair of the Debye relaxators and a pair of the overdamped-oscillators - namely, the double-Debye (DD) and double-overdamped-oscillator (DO) models. Both models accurately reproduce the experimental curves for the intact tissues and the WHO Grades I-IV gliomas. While the DD model is more common for THz biophotonics, the DO model is more physically rigorous, since it satisfies the sum rule. In this way, the DO model and the sum rule were, then, applied to estimate the content of water in intact tissues and gliomas ex vivo. The observed results agreed well with the earlier-reported data, justifying water as a main endogenous label of brain tumors in the THz range. The developed models can be used to describe completely the THz-wave - human brain tissues interactions in the frameworks of classical electrodynamics, being quite important for further research and developments in THz neurodiagnosis of tumors.
Collapse
Affiliation(s)
- A A Gavdush
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - N V Chernomyrdin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - G A Komandin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - I N Dolganova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - P V Nikitin
- P.K. Anokhin Institute of Normal Physiology, Moscow, Russia
| | - G R Musina
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - G M Katyba
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - A S Kucheryavenko
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - I V Reshetov
- Institute for Cluster Oncology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A A Potapov
- Burdenko Neurosurgery Institute, Moscow, Russia
| | - V V Tuchin
- Saratov State University, Saratov, Russia
- Institute of Precision Mechanics and Control of the Russian Academy of Sciences, Saratov, Russia
- National Research Tomsk State University, Tomsk, Russia
| | - K I Zaytsev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| |
Collapse
|
12
|
Choi SW, Gerhardson TI, Duclos SE, Surowiec RK, Scheven UM, Galban S, Lee FT, Greve JM, Balter JM, Hall TL, Xu Z. Stereotactic Transcranial Focused Ultrasound Targeting System for Murine Brain Models. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:154-163. [PMID: 32746229 PMCID: PMC7814337 DOI: 10.1109/tuffc.2020.3012303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An inexpensive, accurate focused ultrasound stereotactic targeting method guided by pretreatment magnetic resonance imaging (MRI) images for murine brain models is presented. An uncertainty of each sub-component of the stereotactic system was analyzed. The entire system was calibrated using clot phantoms. The targeting accuracy of the system was demonstrated with an in vivo mouse glioblastoma (GBM) model. The accuracy was quantified by the absolute distance difference between the prescribed and ablated points visible on the pre treatment and posttreatment MR images, respectively. A precalibration phantom study ( N = 6 ) resulted in an error of 0.32 ± 0.31, 0.72 ± 0.16, and 1.06 ± 0.38 mm in axial, lateral, and elevational axes, respectively. A postcalibration phantom study ( N = 8 ) demonstrated a residual error of 0.09 ± 0.01, 0.15 ± 0.09, and 0.47 ± 0.18 mm in axial, lateral, and elevational axes, respectively. The calibrated system showed significantly reduced ( ) error of 0.20 ± 0.21, 0.34 ± 0.24, and 0.28 ± 0.21 mm in axial, lateral, and elevational axes, respectively, in the in vivo GBM tumor-bearing mice ( N = 10 ).
Collapse
|
13
|
Hu LS, Brat DJ, Bloch O, Ramkissoon S, Lesser GJ. The Practical Application of Emerging Technologies Influencing the Diagnosis and Care of Patients With Primary Brain Tumors. Am Soc Clin Oncol Educ Book 2020; 40:1-12. [PMID: 32324425 DOI: 10.1200/edbk_280955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past decade, a variety of new and innovative technologies has led to important advances in the diagnosis and management of patients with primary malignant brain tumors. New approaches to surgical navigation and tumor localization, advanced imaging to define tumor biology and treatment response, and the widespread adoption of a molecularly defined integrated diagnostic paradigm that complements traditional histopathologic diagnosis continue to impact the day-to-day care of these patients. In the neuro-oncology clinic, discussions with patients about the role of tumor treating fields (TTFields) and the incorporation of next-generation sequencing (NGS) data into therapeutic decision-making are now a standard practice. This article summarizes newer applications of technology influencing the pathologic, neuroimaging, neurosurgical, and medical management of patients with malignant primary brain tumors.
Collapse
Affiliation(s)
- Leland S Hu
- Neuroradiology Section, Department of Radiology, Mayo Clinic, Phoenix, AZ
| | - Daniel J Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Orin Bloch
- Department of Neurologic Surgery, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Shakti Ramkissoon
- Foundation Medicine, Inc., Morrisville, NC.,Comprehensive Cancer Center, Wake Forest Baptist Health, Winston-Salem, NC.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Glenn J Lesser
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston-Salem, NC
| |
Collapse
|
14
|
Wilson TA, Huang L, Ramanathan D, Lopez-Gonzalez M, Pillai P, De Los Reyes K, Kumal M, Boling W. Review of Atypical and Anaplastic Meningiomas: Classification, Molecular Biology, and Management. Front Oncol 2020; 10:565582. [PMID: 33330036 PMCID: PMC7714950 DOI: 10.3389/fonc.2020.565582] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Although the majority of meningiomas are slow-growing and benign, atypical and anaplastic meningiomas behave aggressively with a penchant for recurrence. Standard of care includes surgical resection followed by adjuvant radiation in anaplastic and partially resected atypical meningiomas; however, the role of adjuvant radiation for incompletely resected atypical meningiomas remains debated. Despite maximum treatment, atypical, and anaplastic meningiomas have a strong proclivity for recurrence. Accumulating mutations over time, recurrent tumors behave more aggressively and often become refractory or no longer amenable to further surgical resection or radiation. Chemotherapy and other medical therapies are available as salvage treatment once standard options are exhausted; however, efficacy of these agents remains limited. This review discusses the risk factors, classification, and molecular biology of meningiomas as well as the current management strategies, novel therapeutic approaches, and future directions for managing atypical and anaplastic meningiomas.
Collapse
Affiliation(s)
| | - Lei Huang
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Promod Pillai
- Loma Linda University, Loma Linda, CA, United States
| | | | | | - Warren Boling
- Loma Linda University, Loma Linda, CA, United States
| |
Collapse
|
15
|
Kiesel B, Thomé CM, Weiss T, Jakola AS, Darlix A, Pellerino A, Furtner J, Kerschbaumer J, Freyschlag CF, Wick W, Preusser M, Widhalm G, Berghoff AS. Perioperative imaging in patients treated with resection of brain metastases: a survey by the European Association of Neuro-Oncology (EANO) Youngsters committee. BMC Cancer 2020; 20:410. [PMID: 32398144 PMCID: PMC7216695 DOI: 10.1186/s12885-020-06897-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/23/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neurosurgical resection represents an important treatment option in the modern, multimodal therapy approach of brain metastases (BM). Guidelines for perioperative imaging exist for primary brain tumors to guide postsurgical treatment. Optimal perioperative imaging of BM patients is so far a matter of debate as no structured guidelines exist. METHODS A comprehensive questionnaire about perioperative imaging was designed by the European Association of Neuro-Oncology (EANO) Youngsters Committee. The survey was distributed to physicians via the EANO network to perform a descriptive overview on the current habits and their variability on perioperative imaging. Chi square test was used for dichotomous variables. RESULTS One hundred twenty physicians worldwide responded to the survey. MRI was the preferred preoperative imaging method (93.3%). Overall 106/120 (88.3%) physicians performed postsurgical imaging routinely including MRI alone (62/120 [51.7%]), postoperative CT (29/120 [24.2%]) and MRI + CT (15/120 [12.5%]). No correlation of postsurgical MRI utilization in academic vs. non-academic hospitals (58/89 [65.2%] vs. 19/31 [61.3%], p = 0.698) was found. Early postoperative MRI within ≤72 h after resection is obtained by 60.8% of the participants. The most frequent reason for postsurgical imaging was to evaluate the extent of tumor resection (73/120 [60.8%]). In case of residual tumor, 32/120 (26.7%) participants indicated to adjust radiotherapy, 34/120 (28.3%) to consider re-surgery to achieve complete resection and 8/120 (6.7%) to evaluate both. CONCLUSIONS MRI was the preferred imaging method in the preoperative setting. In the postoperative course, imaging modalities and timing showed high variability. International guidelines for perioperative imaging with special focus on postoperative MRI to assess residual tumor are warranted to optimize standardized management and adjuvant treatment decisions for BM patients.
Collapse
Affiliation(s)
- Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Carina M Thomé
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Weiss
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amélie Darlix
- Department of Medical Oncology, Institut Régional Du Cancer Montpellier, University of Montpellier, Montpellier, France
| | - Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Julia Furtner
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | | | | | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic & National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany
| | - Matthias Preusser
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. .,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
16
|
Silva D, Belsuzarri T, Barnett GH. Image-guided surgery for meningioma. HANDBOOK OF CLINICAL NEUROLOGY 2020; 170:201-207. [PMID: 32586491 DOI: 10.1016/b978-0-12-822198-3.00040-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Image-guided surgery (IGS-neuronavigation) has revolutionized the field of neurosurgery over the past few decades. Although commonly used for the diagnosis and resection of intracranial gliomas and metastases, IGS is also useful for meningioma surgery, particularly for accessing deep tumors, creating an optimal craniotomy for superficial lesions, and for showing the location of critical neurovascular structures deep to the tumor in skull base surgery. An additional bonus in meningioma surgery is that so-called brain shift is minimal or nonexistent, allowing for ongoing accurate navigation during the surgical procedure.
Collapse
Affiliation(s)
- Danilo Silva
- Department of Neurosurgery, Phelps Hospital, Northwell Health, New York, NY, United States
| | - Telmo Belsuzarri
- Department of Neurosurgery, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Gene H Barnett
- Department of Neurological Surgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
17
|
Surgery of Cerebral Cavernous Angiomas With Navigational Support. J Craniofac Surg 2019; 30:e697-e700. [PMID: 31689737 DOI: 10.1097/scs.0000000000005600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Accurate localization and removal of deep-seated cavernomas through a less invasive approach is still a challenge. The aim of this study is to compare the efficacy of neuronavigation and ultrasound in guiding surgery for resection of deep-seated cavernomas by transsulcal microsurgical approach. METHODS A total of 38 consecutive patients who suffered from deep-seated cavernomas underwent surgery via a transsulcal microsurgical approach in our hospital between September 2016 and March 2018. Patients were randomly divided into 2 groups (20 cases in neuronavigation group and 18 cases in ultrasound group). The clinical features, character of images, and surgical outcome were analyzed. RESULTS There was no significant difference between the 2 groups in diameter (16.6 ± 2.7 mm versus 19.6 ± 2.0 mm, P > 0.05) and depth (19.2 ± 2.4 mm versus 22.0 ± 4.6 mm, P > 0.05) of lesions. The ultrasound group had a similar tumor resection rate (100% versus 80%, P = 0.11) and shorter operation time (119.7 ± 4.5 minutes versus 137.3 ± 4.9 minutes, P < 0.05) than that in the neuronavigation group. There was no significant difference between in the symptomatic improvement rate, complication, postoperative hospital stay, and period of follow-up (P > 0.05). No death and recurrence appeared in both groups. CONCLUSION Ultrasound showed certain advantages than neuronavigation in guiding resection of deep-seated cavernomas by transsulcal microsurgical approach.
Collapse
|
18
|
Udhay P, Bhattacharjee K, Ananthnarayanan P, Sundar G. Computer-assisted navigation in orbitofacial surgery. Indian J Ophthalmol 2019; 67:995-1003. [PMID: 31238394 PMCID: PMC6611296 DOI: 10.4103/ijo.ijo_807_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.
Collapse
Affiliation(s)
- Priti Udhay
- DRR Eye Care and Oculoplasty Hospital, Chennai, Tamil Nadu, India
| | | | - P Ananthnarayanan
- Department of Maxillofacial Surgery, Ananthan Facial Surgery, Chennai, Tamil Nadu, India
| | - Gangadhar Sundar
- Department of Ophthalmic Plastic and Reconstructive Surgery, National University Hospital, Singapore
| |
Collapse
|
19
|
Schwake M, Schipmann S, Müther M, Köchling M, Brentrup A, Stummer W. 5-ALA fluorescence-guided surgery in pediatric brain tumors-a systematic review. Acta Neurochir (Wien) 2019; 161:1099-1108. [PMID: 30989383 DOI: 10.1007/s00701-019-03898-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND 5-Aminolevulinic acid (5-ALA)-guided resection of gliomas in adults enables better differentiation between tumor and normal brain tissue, allowing a higher degree of resection, and improves patient outcomes. In recent years, several reports have emerged regarding the use of 5-ALA in other brain tumor entities, including pediatric brains tumors. Since gross total resection (GTR) of many brain tumors in children is crucial and the role of 5-ALA-guided resection of these tumors is not clear, we sought to perform a comprehensive literature review on this topic. METHODS A systematic literature review of EMBASE and MEDLINE/PubMed databases revealed 19 eligible publications encompassing 175 5-ALA-guided operations on pediatric brain tumors. To prevent bias, publications were revised independently by two authors. RESULTS We found that 5-ALA-guided resection enabled the surgeons to identify the tumor more easily and was considered helpful mainly in cases of glioblastoma (GBM, 21/27, 78%), anaplastic ependymoma WHO grade III (10/14, 71%), and anaplastic astrocytoma (4/6, 67%). In contrast, cases of pilocytic astrocytomas (PAs) and medulloblastomas 5-ALA-guided surgery did not show consistent fluorescent signals and 5-ALA was considered helpful only in 12% and 22% of cases, respectively. Accumulation of fluorescent porphyrins seems to depend on WHO tumor grading. One important finding is that when 5-ALA-guided resections were considered helpful, the degree of resection was higher than is cases where it was not helpful. The rate of adverse events related to 5-ALA was negligible, especially new postoperative sequelae. CONCLUSION 5-ALA could play a role in resection of pediatric brain tumors. However, further prospective clinical trials are needed.
Collapse
|
20
|
Picart T, Berhouma M, Dumot C, Pallud J, Metellus P, Armoiry X, Guyotat J. Optimization of high-grade glioma resection using 5-ALA fluorescence-guided surgery: A literature review and practical recommendations from the neuro-oncology club of the French society of neurosurgery. Neurochirurgie 2019; 65:164-177. [PMID: 31125558 DOI: 10.1016/j.neuchi.2019.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/17/2019] [Accepted: 04/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND When feasible, the surgical resection is the standard first step of the management of high-grade gliomas. 5-ALA fluorescence-guided-surgery (5-ALA-FGS) was developed to ease the intra-operative delineation of tumor borders in order to maximize the extent of resection. METHODS A Medline electronic database search was conducted. English language studies from January 1998 until July 2018 were included, following the PRISMA guidelines. RESULTS 5-ALA can be considered as a specific tool for the detection of tumor remnant but has a weaker sensibility (level 2). 5-ALA-FGS is associated with a significant increase in the rate of gross total resection reaching more than 90% in some series (level 1). Consistently, 5-ALAFGS improves progression-free survival (level 1). However, the gain in overall survival is more debated. The use of 5-ALA-FGS in eloquent areas is feasible but requires simultaneous intraoperative electrophysiologic functional brain monitoring to precisely locate and preserve eloquent areas (level 2). 5-ALA is usable during the first resection of a glioma but also at recurrence (level 2). From a practical standpoint, 5-ALA is orally administered 3 hours before the induction of anesthesia, the recommended dose being 20 mg/kg. Intra-operatively, the procedure is performed as usually with a central debulking and a peripheral dissection during which the surgeon switches from white to blue light. Provided that some precautions are observed, the technique does not expose the patient to particular complications. CONCLUSION Although 5-ALA-FGS contributes to improve gliomas management, there are still some limitations. Future methods will be developed to improve the sensibility of 5-ALA-FGS.
Collapse
Affiliation(s)
- T Picart
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; Inserm 1052, UMR 5286,Team ATIP/AVENIR Transcriptomic diversity of stem cells, centre de cancérologie de Lyon, centre Léon-Bérard, 69008 Lyon, France.
| | - M Berhouma
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; CREATIS Laboratory, Inserm U1206, UMR 5220, université de Lyon, 69100 Villeurbanne, France
| | - C Dumot
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France; CREATIS Laboratory, Inserm U1206, UMR 5220, université de Lyon, 69100 Villeurbanne, France
| | - J Pallud
- Département de neurochirurgie, hôpital Sainte-Anne, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75005 Paris, France; IMA-Brain, Inserm U894, institut de psychiatrie et neurosciences de Paris, 7013 Paris, France
| | - P Metellus
- Hôpital Privé Clairval, Ramsay général de santé, 13009 Marseille, France; UMR 7051, institut de neurophysiopathologie, université d'Aix-Marseille, 13344 Marseille, France
| | - X Armoiry
- MATEIS (Team I2B), University of Lyon, Lyon school of pharmacy, 69008 Lyon, France; Édouard-Herriot Hospital, Pharmacy Department, 69008 Lyon, France; University of Warwick, Warwick Medical School, Coventry, UK
| | - J Guyotat
- Service de neurochirurgie D, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France
| |
Collapse
|
21
|
Atallah S, Parra-Davila E, Melani AGF, Romagnolo LG, Larach SW, Marescaux J. Robotic-assisted stereotactic real-time navigation: initial clinical experience and feasibility for rectal cancer surgery. Tech Coloproctol 2019; 23:53-63. [PMID: 30656579 DOI: 10.1007/s10151-018-1914-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics has not been previously explored in a clinical setting. METHODS After pre-clinical assessment, and configuration of a robotic-assisted navigational system, two patients with locally advanced rectal cancer were selected for enrollment into a pilot study designed to assess the feasibility of navigation coupled with the robotic da Vinci Xi platform via TilePro interface. In one case, fluorescence-guided surgery was also used as an adjunct for structure localization, with local administration of indocyanine green into the ureters and at the tumor site. RESULTS Each operation was successfully completed with a robotic-assisted approach; image-guided navigation provided computed accuracy of ± 4.5 to 4.6 mm. The principle limitation encountered was navigation signal dropout due to temporary loss of direct line-of-sight with the navigational system's infrared camera. Subjectively, the aid of navigation assisted the operating surgeon in identifying critical anatomical planes. The combination of fluorescence with image-guided surgery further augmented the surgeon's perception of the operative field. CONCLUSIONS The combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery.
Collapse
Affiliation(s)
- S Atallah
- Department of Colorectal Surgery, EndoSurgical Center of Florida, Florida Hospital, 100 N. Dean Road, Orlando, FL, 32825, USA.
| | - E Parra-Davila
- Department of Surgery, Good Samaritan Hospital, West Palm Beach, FL, 33401, USA
| | - A G F Melani
- Department of Surgery, IRCAD, Latin America, Rio de Jeneiro, Brazil
| | - L G Romagnolo
- Department of Surgery, IRCAD, Latin America, Barretos, Brazil
| | - S W Larach
- Department of Colorectal Surgery, EndoSurgical Center of Florida, Florida Hospital, 100 N. Dean Road, Orlando, FL, 32825, USA
| | - J Marescaux
- Department of Surgery, IRCAD, France, Strasbourg, France
| |
Collapse
|
22
|
Kaushik A, Dwarakanath TA, Bhutani G. Autonomous neuro-registration for robot-based neurosurgery. Int J Comput Assist Radiol Surg 2018; 13:1807-1817. [DOI: 10.1007/s11548-018-1826-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
|
23
|
Surgical Simulation and Custom-Made Implant for Cranial Fibrous Dysplasia. J Craniofac Surg 2018; 29:1352-1353. [PMID: 29561485 DOI: 10.1097/scs.0000000000004493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The management of fronto-orbital fibrous dysplasia involves total excision of the dysplastic bone and bone reconstruction using implants. Custom-made implants are used to achieve good contouring. However, the remnant defect after excising the lesion often does not match the implant. METHODS To design the craniotomy line, a template was prepared by preoperative computed surgical simulation. The template was overlaid on the preoperative cranium, such that its inner surface fits exactly with the cranial surface. After excising the lesion by performing osteotomy, the implant was placed in the defect and fixed. Both template and implant were made of hydroxyapatite. RESULTS The authors treated 4 patients, with fibrous dysplasia involving the fronto-facial region by using the template. Intraoperative trimming of the implant or bone defect was not required in 2 patients, while the third patient required mild trimming. They did not have any complications and obtained good contouring. CONCLUSION The hydroxyapatite templates reduced the surgical time by determining the precise craniotomy line preoperatively, thus avoiding needless trimming of the implant and bone defect. Therefore, they can enhance the efficacy of treatment for fronto-orbital fibrous dysplasia lesion.
Collapse
|
24
|
Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
Collapse
Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| |
Collapse
|
25
|
Diagnostic ability of intraoperative ultrasound for identifying tumor residual in glioma surgery operation. Oncotarget 2017; 8:73105-73114. [PMID: 29069853 PMCID: PMC5641196 DOI: 10.18632/oncotarget.20394] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022] Open
Abstract
Achieving total glioma resection represents a major challenge to neurosurgeons with no distinct margin between tumor and surrounding brain tissue. Many imaging methods are employed in surgery visualization and resection control. We performed this meta-analysis to assess the diagnosis value of intraoperative ultrasound and judged whether ultrasound is a suitable tool in detecting glioma residual. The databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu were systematically searched to find out relevant studies and published up to May 5, 2017. A total of 14 studies involving 542 participants met the selection criteria and bivariate mixed effects models were used for analysis. The parameters and their corresponding 95% confidence interval (CI) were computed on Stata 12.0 software. The pooled sensitivity was 0.75 (95%CI: 0.62-0.84), specificity was 0.88 (95%CI: 0.79-0.94), positive likelihood ratios was 6.27 (95%CI: 3.76-10.47), negative likelihood ratios was 0.29 (95%CI: 0.20-0.42), diagnostic odds ratios was 21.83 (95%CI: 14.20-33.55) and area under the curve of summary receiver operator characteristic was 0.89. Stratified meta-analysis showed sensitivity and area under the curve in low-grade glioma were both higher than high-grade glioma. The Deek's plot showed no significant publication bias (t = -1.03, P = 0.33). Intraoperative ultrasound has high overall diagnostic value to identify glioma remnants, especially in low-grade glioma, which shows a benefit for prognosis and life quality of patients. In general, Intraoperative ultrasound is an effective tool for maximizing the extent of glioma resection.
Collapse
|
26
|
Usefulness of an Osteotomy Template for Skull Tumorectomy and Simultaneous Skull Reconstruction. J Craniofac Surg 2017; 27:1565-7. [PMID: 27391660 DOI: 10.1097/scs.0000000000002841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Simultaneous tumor resection and cranioplasty with hydroxyapatite osteosynthesis are sometimes necessary in patients of skull neoplasms or skull-invasive tumors. However, the disadvantage of simultaneous surgery is that mismatches often occur between the skull defect and the hydroxyapatite implant. To solve this problem, the authors developed a customized template for designing the craniotomy line. METHODS Before each operation, the craniotomy design was discussed with a neurosurgeon. Based on the discussion, 2 hydroxyapatite implants were customized for each patient on the basis of models prepared using computed tomography data. The first implant was an onlay template for the preoperative cranium, which was customized for designing the osteotomy line. The other implant was used for the skull defect. Using the template, the osteotomy line was drawn along the template edge, osteotomy was performed along this line, and the implant was placed in the skull defect. RESULTS This technique was performed in 3 patients. No implant or defect trimming was required in any patient, good cosmetic outcomes were noted in all patients, and no complications occurred. CONCLUSION Use of predesigned hydroxyapatite templates for craniotomy during simultaneous skull tumor resection and cranioplasty has some clinical advantages: the precise craniotomy line can be designed, the implant and skull defect fit better and show effective osteoconduction, trimming of the implant or defect is minimized, and the operation time is shortened.
Collapse
|
27
|
|
28
|
Ji YB, Oh SJ, Kang SG, Heo J, Kim SH, Choi Y, Song S, Son HY, Kim SH, Lee JH, Haam SJ, Huh YM, Chang JH, Joo C, Suh JS. Terahertz reflectometry imaging for low and high grade gliomas. Sci Rep 2016; 6:36040. [PMID: 27782153 PMCID: PMC5080552 DOI: 10.1038/srep36040] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/10/2016] [Indexed: 01/02/2023] Open
Abstract
Gross total resection (GTR) of glioma is critical for improving the survival rate of glioma patients. One of the greatest challenges for achieving GTR is the difficulty in discriminating low grade tumor or peritumor regions that have an intact blood brain barrier (BBB) from normal brain tissues and delineating glioma margins during surgery. Here we present a highly sensitive, label-free terahertz reflectometry imaging (TRI) that overcomes current key limitations for intraoperative detection of World Health Organization (WHO) grade II (low grade), and grade III and IV (high grade) gliomas. We demonstrate that TRI provides tumor discrimination and delineation of tumor margins in brain tissues with high sensitivity on the basis of Hematoxylin and eosin (H&E) stained image. TRI may help neurosurgeons to remove gliomas completely by providing visualization of tumor margins in WHO grade II, III, and IV gliomas without contrast agents, and hence, improve patient outcomes.
Collapse
Affiliation(s)
- Young Bin Ji
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Jae Oh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Heo
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hoon Kim
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Applied Electromagnetic Wave Research Center, Korea Electrotechnology Research Institute, Ansan, Republic of Korea
| | - Yuna Choi
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungri Song
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hye Young Son
- Severance Biomedical Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Joo Haam
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong Min Huh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chulmin Joo
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jin-Suck Suh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
29
|
Gerard IJ, Kersten-Oertel M, Petrecca K, Sirhan D, Hall JA, Collins DL. Brain shift in neuronavigation of brain tumors: A review. Med Image Anal 2016; 35:403-420. [PMID: 27585837 DOI: 10.1016/j.media.2016.08.007] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Neuronavigation based on preoperative imaging data is a ubiquitous tool for image guidance in neurosurgery. However, it is rendered unreliable when brain shift invalidates the patient-to-image registration. Many investigators have tried to explain, quantify, and compensate for this phenomenon to allow extended use of neuronavigation systems for the duration of surgery. The purpose of this paper is to present an overview of the work that has been done investigating brain shift. METHODS A review of the literature dealing with the explanation, quantification and compensation of brain shift is presented. The review is based on a systematic search using relevant keywords and phrases in PubMed. The review is organized based on a developed taxonomy that classifies brain shift as occurring due to physical, surgical or biological factors. RESULTS This paper gives an overview of the work investigating, quantifying, and compensating for brain shift in neuronavigation while describing the successes, setbacks, and additional needs in the field. An analysis of the literature demonstrates a high variability in the methods used to quantify brain shift as well as a wide range in the measured magnitude of the brain shift, depending on the specifics of the intervention. The analysis indicates the need for additional research to be done in quantifying independent effects of brain shift in order for some of the state of the art compensation methods to become useful. CONCLUSION This review allows for a thorough understanding of the work investigating brain shift and introduces the needs for future avenues of investigation of the phenomenon.
Collapse
Affiliation(s)
- Ian J Gerard
- McConnell Brain Imaging Center, MNI, McGill University, Montreal, Canada.
| | | | - Kevin Petrecca
- Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Denis Sirhan
- Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jeffery A Hall
- Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - D Louis Collins
- McConnell Brain Imaging Center, MNI, McGill University, Montreal, Canada; Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
30
|
Panciani PP, Fontanella M, Garbossa D, Agnoletti A, Ducati A, Lanotte M. 5-aminolevulinic acid and neuronavigation in high-grade glioma surgery: results of a combined approach. Neurocirugia (Astur) 2016; 23:23-8. [PMID: 22520100 DOI: 10.1016/j.neucir.2012.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 11/09/2011] [Indexed: 10/24/2022]
Abstract
In high-grade glioma surgery, several techniques are used to achieve the maximum cytoreductive treatment preserving neurological functions. However, the effectiveness of all the methods used alone is reduced by specific limitations of each. We assessed the reliability of a multimodal strategy based on 5-aminolevulinic acid (5-ALA) and neuronavigation. We prospectively studied 18 patients with suspected, non eloquent-area malignant gliomas amenable for complete resection. Conventional illumination was used until the excision appeared complete. The cavity was then systematically inspected in violet-blue light to identify any residual tumour. Multiple biopsies of both fluorescent and non-fluorescent tissue were performed in all cases. Each specimen was labelled according to the sampling location (inside or outside the boundary set by the neuronavigator). The samples were analysed by a neuropathologist blinded to the intraoperative classification. We reviewed the results of both methods, either singly or in combination. Individual analysis showed higher 5-ALA reliability compared to neuronavigation. However, several false-negative fluorescent specimens were detected. With the combined use of fluorescence and neuroimaging, only 1 sample (negative for both 5-ALA and navigation) was tumoral tissue. In our experience, the combined approach showed the best sensitivity and it is recommended in cases of lesions involving non-eloquent areas.
Collapse
Affiliation(s)
- Pier Paolo Panciani
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Italy
| | | | | | | | | | | |
Collapse
|
31
|
Guyotat J, Pallud J, Armoiry X, Pavlov V, Metellus P. 5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review. Adv Tech Stand Neurosurg 2016:61-90. [PMID: 26508406 DOI: 10.1007/978-3-319-21359-0_3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).
Collapse
Affiliation(s)
- Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Johan Pallud
- Department of Neurosurgery, Sainte Anne Hospital, Paris, France.
- Paris Descartes University, Paris, France.
| | - Xavier Armoiry
- Délégation à la recherche clinique et à l'innovation, cellule innovation Hospices Civils de, Lyon, France.
| | - Vladislav Pavlov
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Philippe Metellus
- Department of Neurosurgery, Timone Hospital, Marseille, France.
- University Aix Marseille, Marseille, France.
| |
Collapse
|
32
|
Satoh M, Hara T, Tamai K, Shiba J, Hotta K, Takeuchi M, Watanabe E. Optical surgical navigation system causes pulse oximeter malfunction. JA Clin Rep 2015; 1:5. [PMID: 29497637 PMCID: PMC5818690 DOI: 10.1186/s40981-015-0007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/14/2015] [Indexed: 11/10/2022] Open
Abstract
An optical surgical navigation system is used as a navigator to facilitate surgical approaches, and pulse oximeters provide valuable information for anesthetic management. However, saw-tooth waves on the monitor of a pulse oximeter and the inability of the pulse oximeter to accurately record the saturation of a percutaneous artery were observed when a surgeon started an optical navigation system. The current case is thought to be the first report of this navigation system interfering with pulse oximetry. The causes of pulse jamming and how to manage an optical navigation system are discussed.
Collapse
Affiliation(s)
- Masaaki Satoh
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Tetsuhito Hara
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Kenji Tamai
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Juntaro Shiba
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Kunihisa Hotta
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Mamoru Takeuchi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| | - Eiju Watanabe
- Department of Neurosurgery, Jichi Medical University, Yakushiji, Shimotsuke-City, Tochigi 329-0498 Japan
| |
Collapse
|
33
|
Kantelhardt SR, Gutenberg A, Neulen A, Keric N, Renovanz M, Giese A. Video-Assisted Navigation for Adjustment of Image-Guidance Accuracy to Slight Brain Shift. Oper Neurosurg (Hagerstown) 2015; 11:504-511. [PMID: 29506163 DOI: 10.1227/neu.0000000000000921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Information supplied by an image-guidance system can be superimposed on the operating microscope oculars or on a screen, generating augmented reality. Recently, the outline of a patient's head and skull, injected in the oculars of a standard operating microscope, has been used to check the registration accuracy of image guidance. OBJECTIVE To propose the use of the brain surface relief and superficial vessels for real-time intraoperative visualization and image-guidance accuracy and for intraoperative adjustment for brain shift. METHODS A commercially available image-guidance system and a standard operating microscope were used. Segmentation of the brain surface and cortical blood vessel relief was performed manually on preoperative computed tomography and magnetic resonance images. The overlay of segmented digital and real operating-microscope images was used to monitor image-guidance accuracy. Adjustment for brain shift was performed by manually matching digital images on real structures. RESULTS Experimental manipulation on a phantom proved that the brain surface relief could be used to restore accuracy if the primary registration shifted. Afterward, the technique was used to assist during surgery of 5 consecutive patients with 7 deep-seated brain tumors. The brain surface relief could be successfully used to monitor registration accuracy after craniotomy and during the whole procedure. If a certain degree of brain shift occurred after craniotomy, the accuracy could be restored in all cases, and corticotomies were correctly centered in all cases. CONCLUSION The proposed method was easy to perform and augmented image-guidance accuracy when operating on small deep-seated lesions.
Collapse
Affiliation(s)
- Sven R Kantelhardt
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Angelika Gutenberg
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Axel Neulen
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Mirjam Renovanz
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| |
Collapse
|
34
|
Grimm F, Naros G, Gutenberg A, Keric N, Giese A, Gharabaghi A. Blurring the boundaries between frame-based and frameless stereotaxy: feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 2015; 123:737-42. [PMID: 26067616 DOI: 10.3171/2014.12.jns141781] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Frame-based stereotactic interventions are considered the gold standard for brain biopsies, but they have limitations with regard to flexibility and patient comfort because of the bulky head ring attached to the patient. Frameless image guidance systems that use scalp fiducial markers offer more flexibility and patient comfort but provide less stability and accuracy during drilling and biopsy needle positioning. Head-mounted robot-guided biopsies could provide the advantages of these 2 techniques without the downsides. The goal of this study was to evaluate the feasibility and safety of a robotic guidance device, affixed to the patient's skull through a small mounting platform, for use in brain biopsy procedures. METHODS This was a retrospective study of 37 consecutive patients who presented with supratentorial lesions and underwent brain biopsy procedures in which a surgical guidance robot was used to determine clinical outcomes and technical procedural operability. RESULTS The portable head-mounted device was well tolerated by the patients and enabled stable drilling and needle positioning during surgery. Flexible adjustments of predefined paths and selection of new trajectories were successfully performed intraoperatively without the need for manual settings and fixations. The patients experienced no permanent deficits or infections after surgery. CONCLUSIONS The head-mounted robot-guided approach presented here combines the stability of a bone-mounted set-up with the flexibility and tolerability of frameless systems. By reducing human interference (i.e., manual parameter settings, calibrations, and adjustments), this technology might be particularly useful in neurosurgical interventions that necessitate multiple trajectories.
Collapse
Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Angelika Gutenberg
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| |
Collapse
|
35
|
Schatlo B, Fandino J, Smoll NR, Wetzel O, Remonda L, Marbacher S, Perrig W, Landolt H, Fathi AR. Outcomes after combined use of intraoperative MRI and 5-aminolevulinic acid in high-grade glioma surgery. Neuro Oncol 2015; 17:1560-7. [PMID: 25858636 PMCID: PMC4633924 DOI: 10.1093/neuonc/nov049] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have shown the individual benefits of 5-aminolevulinic acid (5-ALA) and intraoperative (i)MRI in enhancing survival for patients with high-grade glioma. In this retrospective study, we compare rates of progression-free and overall survival between patients who underwent surgical resection with the combination of 5-ALA and iMRI and a control group without iMRI. Methods In 200 consecutive patients with high-grade gliomas, we recorded age, sex, World Health Organization tumor grade, and pre- and postoperative Karnofsky performance status (good ≥80 and poor <80). A 0.15-Tesla magnet was used for iMRI; all patients operated on with iMRI received 5-ALA. Overall and progression-free survival rates were compared using multivariable regression analysis. Results Median overall survival was 13.8 months in the non-iMRI group and 17.9 months in the iMRI group (P = .043). However, on identifying confounding variables (ie, KPS and resection status) in this univariate analysis, we then adjusted for these confounders in multivariate analysis and eliminated this distinction in overall survival (hazard ratio: 1.23, P = .34, 95% CI: 0.81, 1.86). Although 5-ALA enhanced the achievement of gross total resection (odds ratio: 3.19, P = .01, 95% CI: 1.28, 7.93), it offered no effect on overall or progression-free survival when adjusted for resection status. Conclusions Gross total resection is the key surgical variable that influences progression and survival in patients with high-grade glioma and more likely when surgical adjuncts, such as iMRI in combination with 5-ALA, are used to enhance resection.
Collapse
Affiliation(s)
- Bawarjan Schatlo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Nicolas R Smoll
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Oliver Wetzel
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Luca Remonda
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Wolfgang Perrig
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Hans Landolt
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Ali-Reza Fathi
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| |
Collapse
|
36
|
Bergeron M, Leclerc JE. Is image guidance accurate in children sinus surgery? Int J Pediatr Otorhinolaryngol 2015; 79:469-73. [PMID: 25661034 DOI: 10.1016/j.ijporl.2014.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the precision of the calibration of a 3D navigation system for endoscopic sinus surgery in children and adults. To compare the complication and calibration failure rates of the system in both populations. METHODS The precision of the calibration of the Stryker navigation system (Stryker Neuronavigation ENT 2.0 Software) was found in the charts of children and adults operated on for various nasosinusal procedures between May 2008 and February 2013 in a tertiary care center. Demographic characteristics and complication rates were also noted. RESULTS Thirty-eight adults and 21 children were included in the study. No statistically significant difference was found between the two groups with an identical mean precision of 0.7mm (p=0.90). The rate of precision unreliability and calibration failures was not statistically different between the two groups (14% children vs 5% adults). No major complications occurred in both groups (p=1.00). No demographic characteristic predicted a failed calibration (height, weight, BMI, age). CONCLUSION The Stryker image-guided system can provide a precision level that is equivalent in both children and adults. This study also demonstrated an absent/low complication rate respectively for children and adults post endoscopic surgery.
Collapse
Affiliation(s)
- Mathieu Bergeron
- Department of Otolaryngology - Head & Neck Surgery, Laval University, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, bureau 4889, Quebec, Quebec G1V 0A6, Canada.
| | - Jacques E Leclerc
- Department of Otolaryngology - Head & Neck Surgery, Centre Hospitalier Universitaire de Québec, 2705 Boulevard Laurier, Québec, Qc, G1V 4G2, Canada.
| |
Collapse
|
37
|
Peacock ZS, Magill JC, Tricomi BJ, Murphy BA, Nikonovskiy V, Hata N, Chauvin L, Troulis MJ. Assessment of the OsteoMark-Navigation System for Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2015; 73:2005-16. [PMID: 25865717 DOI: 10.1016/j.joms.2015.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the accuracy of a novel navigation system for maxillofacial surgery using human cadavers and a live minipig model. MATERIALS AND METHODS We tested an electromagnetic tracking system (OsteoMark-Navigation) that uses simple sensors to determine the position and orientation of a hand-held pencil-like marking device. The device can translate 3-dimensional computed tomographic data intraoperatively to allow the surgeon to localize and draw a proposed osteotomy or the resection margins of a tumor on bone. The accuracy of the OsteoMark-Navigation system in locating and marking osteotomies and screw positions in human cadaver heads was assessed. In group 1 (n = 3, 6 sides), OsteoMark-Navigation marked osteotomies and screw positions were compared to virtual treatment plans. In group 2 (n = 3, 6 sides), marked osteotomies and screw positions for distraction osteogenesis devices were compared with those performed using fabricated guide stents. Three metrics were used to document the precision and accuracy. In group 3 (n = 1), the system was tested in a standard operating room environment. RESULTS For group 1, the mean error between the points was 0.7 mm (horizontal) and 1.7 mm (vertical). Compared with the posterior and inferior mandibular border, the mean error was 1.2 and 1.7 mm, respectively. For group 2, the mean discrepancy between the points marked using the OsteoMark-Navigation system and the surgical guides was 1.9 mm (range 0 to 4.1). The system maintained accuracy on a live minipig in a standard operating room environment. CONCLUSION Based on this research OsteoMark-Navigation is a potentially powerful tool for clinical use in maxillofacial surgery. It has accuracy and precision comparable to that of existing clinical applications.
Collapse
Affiliation(s)
- Zachary S Peacock
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
| | - John C Magill
- Principle Research Scientist, Physical Sciences, Inc, Andover, MA
| | - Brad J Tricomi
- Masters Student, University of Massachusetts Boston; Research Fellow, Massachusetts General Hospital, Boston, MA
| | - Brian A Murphy
- Principle Scientist, Physical Sciences, Inc, Andover, MA
| | | | - Nobuhiko Hata
- Software Engineer, Assistant Professor, Department of Radiology, Harvard Medical School; Director, Surgical Navigation and Robotics Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Laurent Chauvin
- Research Associate, Surgical Navigation and Robotics Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Maria J Troulis
- Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
38
|
Motekallemi A, Jeltema HR, Metzemaekers JDM, van Dam GM, Crane LMA, Groen RJM. The current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review. Neurosurg Rev 2015; 38:619-28. [PMID: 25736455 PMCID: PMC4561998 DOI: 10.1007/s10143-015-0615-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/25/2014] [Accepted: 11/16/2014] [Indexed: 12/04/2022]
Abstract
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. In the present paper, we review the existing literature about the application of 5-ALA as an intraoperative tool for the resection of intracranial meningiomas. PubMed was used as the database for search tasks. We included articles published in English without limitations regarding publication date. Tumor fluorescence can occur in benign meningiomas (WHO grade I) as well as in WHO grade II and WHO grade III meningiomas. Most of the reviewed studies report fluorescence of the main tumor mass with high sensitivity and specificity. However, different parts of the same tumor can present with a different fluorescent pattern (heterogenic fluorescence). Quantitative probe fluorescence can be superior, especially in meningiomas with difficult anatomical accessibility. However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.
Collapse
|
39
|
Intraoperative portable CT-scanner based spinal navigation--a feasibility and safety study. Acta Neurochir (Wien) 2014; 156:1807-12. [PMID: 25056633 DOI: 10.1007/s00701-014-2184-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Navigation based on an intraoperative CT scan is not a new approach to spinal instrumentation. Innovative intraoperative imaging technology, however, opens new horizons to more precise image acquisition as well as to further workflow. Planning of screw entry-points and trajectories in this study had been based on intraoperative imaging obtained by a portable 32-slice CT scanner. This prospective study evaluates feasibility, accuracy, and safety of this novel approach in an initial series of 85 surgeries. METHOD Medical records and radiological materials of 82 patients who underwent the first 85 consecutive stabilisations were analysed. Incorrect screw position, medical and technical complications as well as availability of this procedure in particular spinal levels were the subject of evaluation. RESULTS Out of 571 implants inserted in all spinal levels, only five screws (0.87 %) did not meet the criteria for correct implant position. These screw misplacements had not been complicated by neural, vascular or visceral injury and the surgeon was not forced to change the position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging sufficient for navigation was obtained at all spinal segments regardless of a patient's habitus or positioning or comorbidity. CONCLUSION Intraoperative portable CT scanner-based navigation seems to be an effective way of doing spinal instrumentation guidance. High precision of implant insertion confirms the preconditions of navigation usage during more complex surgeries at any level of the spine.
Collapse
|
40
|
|
41
|
Schwake M, Günes D, Köchling M, Brentrup A, Schroeteler J, Hotfilder M, Fruehwald MC, Stummer W, Ewelt C. Kinetics of porphyrin fluorescence accumulation in pediatric brain tumor cells incubated in 5-aminolevulinic acid. Acta Neurochir (Wien) 2014; 156:1077-84. [PMID: 24777761 DOI: 10.1007/s00701-014-2096-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/10/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) enables more complete resections of tumors in adults. 5-ALA elicits accumulation of fluorescent porphyrins in various cancerous tissues, which can be visualized using a modified neurosurgical microscope with blue light. Although this technique is well established in adults, it has not been investigated systematically in pediatric brain tumors. Specifically, it is unknown how quickly, how long, and to what extent various pediatric tumors accumulate fluorescence. The purpose of this study was to determine utility and time course of 5-ALA-induced fluorescence in typical pediatric brain tumors in vitro. METHODS Cell cultures of medulloblastoma [DAOY and UW228], cPNET [PFSK] atypical teratoid rhabdoid tumor [BT16] and ependymoma [RES196] were incubated with 5-ALA for either 60 minutes or continuously. Porphyrin fluorescence intensities were determined using a fluorescence-activated cell sorter (FACS) after 1, 3, 6, 9, 12 and 24 hours. C6 and U87 cells served as controls. RESULTS All pediatric brain tumor cell lines displayed fluorescence compared to their respective controls without 5-ALA (p < 0.05). Sixty minutes of incubation resulted in peaks between 3 and 6 hours, whereas continuous incubation resulted in peaks at 12 hours or beyond. 60 minute incubation peak levels were between 52 and 91 % of maxima achieved with continuous incubation. Accumulation and clearance varied between cell types. CONCLUSIONS We demonstrate that 5-ALA exposure of cell lines derived from typical pediatric central nervous system (CNS) tumors induces accumulation of fluorescent porphyrins. Differences in uptake and clearance indicate that different application modes may be necessary for fluorescence-guided resection, depending on tumor type.
Collapse
Affiliation(s)
- Michael Schwake
- Department of Neurosurgery, University Hospital, Albert-Schweitzer-Campus 1, Gebäude A1, D-48149, Münster, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Schödel P, Schebesch KM, Brawanski A, Proescholdt MA. Surgical resection of brain metastases-impact on neurological outcome. Int J Mol Sci 2013; 14:8708-18. [PMID: 23615466 PMCID: PMC3676752 DOI: 10.3390/ijms14058708] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/13/2013] [Accepted: 04/16/2013] [Indexed: 11/16/2022] Open
Abstract
Brain metastases (BM) develop in about 30% of all cancer patients. Surgery plays an important role in confirming neuropathological diagnosis, relieving mass effects and improving the neurological status. To select patients with the highest benefit from surgical resection, prognostic indices (RPA, GPA) have been formulated which are solely focused on survival without considering neurological improvement. In this study we analyzed the impact of surgical resection on the neurological status in addition to overall survival in 206 BM patients. Surgical mortality and morbidity was 0.0% and 10.3% respectively. New neurologic deficits occurred in 6.3% of all patients. The median overall survival was 6.3 months. Poor RPA class and short time interval between diagnosis of cancer and the occurrence of BM were independent factors predictive for poor survival. Improvement of neurological performance was achieved in 56.8% of all patients, with the highest improvement rate seen in patients presenting with increased intracranial pressure and hemiparesis. Notably, the neurological benefits were independent from RPA class. In conclusion, surgical resection leads to significant neurological improvement despite poor RPA class and short overall survival. Considering the low mortality and morbidity rates, resection should be considered as a valid option to increase neurological function and quality of life for patients with BM.
Collapse
Affiliation(s)
- Petra Schödel
- Department of Neurosurgery, University of Regensburg Medical Center, Franz Josef Strauß Allee 11, Regensburg 93053, Germany.
| | | | | | | |
Collapse
|
43
|
Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthetic Plast Surg 2013; 37:380-7. [PMID: 23354764 DOI: 10.1007/s00266-012-0046-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Autologous fat transplantation has gained great recognition in aesthetic and reconstructive surgery. Two main aspects are of predominant importance for progress control after autologous fat transplantation to the breast: quantitative information about the rate of fat survival in terms of effective volume persistence and qualitative information about the breast tissue to exclude potential complications of autologous fat transplantation. There are several tools available for use in evaluating the rate of volume survival. They are extensively compared in this review. The anthropometric method, thermoplastic casts, and Archimedes' principle of water displacement are not up to date anymore because of major drawbacks, first and foremost being reduced reproducibility and exactness. They have been replaced by more exact and reproducible tools such as MRI volumetry or 3D body surface scans. For qualitative and quantitative progress control, MRI volumetry offers all the necessary information: evaluation of fat survival and diagnostically valuable imaging to exclude possible complications of autologous fat transplantation. For frequent follow-up, e.g., monthly volume analysis, repeated MRI exams would not be good for the patient and are not cost effective. In these cases, 3D surface imaging is a good tool and especially helpful in a private practice setting where fast data acquisition is needed. This tool also offers the possibility of simulating the results of autologous fat transplantation. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
44
|
Exérèse neurochirurgicale optimale des gliomes de haut grade guidée par fluorescence : mise au point à partir d’une série rétrospective de 22 patients. Neurochirurgie 2013; 59:9-16. [DOI: 10.1016/j.neuchi.2012.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 07/09/2012] [Accepted: 07/27/2012] [Indexed: 11/21/2022]
|
45
|
Jeon JS, Lee SH, Son YJ, Yang HJ, Chung YS, Jung HW. Mobile computed tomography : three year clinical experience in Korea. J Korean Neurosurg Soc 2013; 53:39-42. [PMID: 23440939 PMCID: PMC3579080 DOI: 10.3340/jkns.2013.53.1.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/15/2012] [Accepted: 01/15/2013] [Indexed: 11/27/2022] Open
Abstract
Objective Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. Methods A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. Results Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. Conclusion mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.
Collapse
Affiliation(s)
- Jin Sue Jeon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
46
|
Saito T, Uga M, Tsuzuki D, Yokota H, Oguro K, Yamamoto T, Dan I, Watanabe E. Evoked potential mapping of the rostral region by frameless navigation system in Mexican hairless pig. J Neurosci Methods 2013; 212:100-5. [DOI: 10.1016/j.jneumeth.2012.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/21/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022]
|
47
|
|
48
|
Valdés PA, Leblond F, Jacobs VL, Wilson BC, Paulsen KD, Roberts DW. Quantitative, spectrally-resolved intraoperative fluorescence imaging. Sci Rep 2012; 2:798. [PMID: 23152935 PMCID: PMC3497712 DOI: 10.1038/srep00798] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/01/2012] [Indexed: 01/19/2023] Open
Abstract
Intraoperative visual fluorescence imaging (vFI) has emerged as a promising aid to surgical guidance, but does not fully exploit the potential of the fluorescent agents that are currently available. Here, we introduce a quantitative fluorescence imaging (qFI) approach that converts spectrally-resolved data into images of absolute fluorophore concentration pixel-by-pixel across the surgical field of view (FOV). The resulting estimates are linear, accurate, and precise relative to true values, and spectral decomposition of multiple fluorophores is also achieved. Experiments with protoporphyrin IX in a glioma rodent model demonstrate in vivo quantitative and spectrally-resolved fluorescence imaging of infiltrating tumor margins for the first time. Moreover, we present images from human surgery which detect residual tumor not evident with state-of-the-art vFI. The wide-field qFI technique has broad implications for intraoperative surgical guidance because it provides near real-time quantitative assessment of multiple fluorescent biomarkers across the operative field.
Collapse
Affiliation(s)
- Pablo A Valdés
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Wang YY, Thiryayi WA, Ramaswamy R, Gnanalingham KK. Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation. Skull Base 2012; 21:193-200. [PMID: 22451825 DOI: 10.1055/s-0031-1275635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed the accuracy of a surgeon's localization of sella margins during endoscopic transsphenoidal surgery for pituitary adenomas, as verified using a neuronavigational system, and we identify types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas. We assessed the margin of error in the surgeon's localization of the superior and inferior margins of the sella and the lateral margins as determined by the medial border of left and right carotid arteries, using a magnetic resonance-based neuronavigational system. The overall mean error of localization of sella margins by the surgeon was 4.5 ± 3 mm. Localization of the inferior sella margin was more accurate (3.1 ± 2 mm mean error) compared with localization of the left (4.8 ± 3 mm) or right carotid arteries (4.6 ± 3 mm). Giant adenomas (> 2.5 cm), more invasive adenomas (Hardy grade IV), and those with parasellar extension (Hardy grades D and E) were associated with larger errors in localization of the carotid arteries. There was no significant difference when stratifying for recurrent surgery, nostril of approach, and sella morphology. During endoscopic transsphenoidal surgery, the margin of error in the surgeon's estimation of the sella margins for adenomas less than 2.5 cm located predominantly within the sella is relatively small. The margin of error increases for giant adenomas, with greater invasiveness and parasellar spread, and the use of neuronavigation can be especially useful in such cases.
Collapse
Affiliation(s)
- Yi Yuen Wang
- Department of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust Hospital, Greater Manchester, United Kingdom
| | | | | | | |
Collapse
|
50
|
Wei KC, Tsai HC, Lu YJ, Yang HW, Hua MY, Wu MF, Chen PY, Huang CY, Yen TC, Liu HL. Neuronavigation-guided focused ultrasound-induced blood-brain barrier opening: a preliminary study in swine. AJNR Am J Neuroradiol 2012; 34:115-20. [PMID: 22723060 DOI: 10.3174/ajnr.a3150] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE FUS-induced BBB opening is a promising technique for noninvasive and local delivery of drugs into the brain. Here we propose the novel use of a neuronavigation system to guide the FUS-induced BBB opening procedure and investigate its feasibility in vivo in large animals. MATERIALS AND METHODS We developed an interface between the neuronavigator and FUS to allow guidance of the focal energy produced by the FUS transducer. The system was tested in 29 swine by more than 40 sonication procedures and evaluated by MR imaging. Gd-DTPA concentration was quantitated in vivo by MR imaging R1 relaxometry and compared with ICP-OES assay. Brain histology after FUS exposure was investigated using H&E and TUNEL staining. RESULTS Neuronavigation could successfully guide the focal beam, with precision comparable to neurosurgical stereotactic procedures (2.3 ± 0.9 mm). A FUS pressure of 0.43 MPa resulted in consistent BBB opening. Neuronavigation-guided BBB opening increased Gd-DTPA deposition by up to 1.83 mmol/L (a 140% increase). MR relaxometry demonstrated high correlation with ICP-OES measurements (r(2) = 0.822), suggesting that Gd-DTPA deposition can be directly measured by imaging. CONCLUSIONS Neuronavigation provides sufficient precision for guiding FUS to temporally and locally open the BBB. Gd-DTPA deposition in the brain can be quantified by MR relaxometry, providing a potential tool for the in vivo quantification of therapeutic agents in CNS disease treatment.
Collapse
Affiliation(s)
- K-C Wei
- Department of Neurosurgery, Chang-Gung University and Memorial Hospital, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|