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Dauleac C, Jacquesson T, Frindel C, André-Obadia N, Ducray F, Mertens P, Cotton F. Value of Spinal Cord Diffusion Imaging and Tractography in Providing Predictive Factors for Tumor Resection in Patients with Intramedullary Tumors: A Pilot Study. Cancers (Basel) 2024; 16:2834. [PMID: 39199605 PMCID: PMC11352615 DOI: 10.3390/cancers16162834] [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: 07/16/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 09/01/2024] Open
Abstract
This pilot study aimed to investigate the interest of high angular resolution diffusion imaging (HARDI) and tractography of the spinal cord (SC) in the management of patients with intramedullary tumors by providing predictive elements for tumor resection. Eight patients were included in a prospective study. HARDI images of the SC were acquired using a 3T MRI scanner with a reduced field of view. Opposed phase-encoding directions allowed distortion corrections. SC fiber tracking was performed using a deterministic approach, with extraction of tensor metrics. Then, regions of interest were drawn to track the spinal pathways of interest. HARDI and tractography added value by providing characteristics about the microstructural organization of the spinal white fibers. In patients with SC tumors, tensor metrics demonstrated significant changes in microstructural architecture, axonal density, and myelinated fibers (all, p < 0.0001) of the spinal white matter. Tractography aided in the differentiation of tumor histological types (SC-invaded vs. pushed back by the tumor), and differentiation of the spinal tracts enabled the determination of precise anatomical relationships between the tumor and the SC, defining the tumor resectability. This study underlines the value of using HARDI and tractography in patients with intramedullary tumors, to show alterations in SC microarchitecture and to differentiate spinal tracts to establish predictive factors for tumor resectability.
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Affiliation(s)
- Corentin Dauleac
- Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurochirurgie de la Moelle Spinale et des Nerfs Périphériques, 69002 Lyon, France;
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon I, 69100 Villeurbanne, France; (T.J.); (F.D.); (F.C.)
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1296, INSA Lyon, 69100 Villeurbanne, France;
| | - Timothée Jacquesson
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon I, 69100 Villeurbanne, France; (T.J.); (F.D.); (F.C.)
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1296, INSA Lyon, 69100 Villeurbanne, France;
- Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurochirurgie Crânienne, 69002 Lyon, France
| | - Carole Frindel
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1296, INSA Lyon, 69100 Villeurbanne, France;
| | - Nathalie André-Obadia
- Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurologie Fonctionnelle et Electrophysiologie, 69002 Lyon, France;
| | - François Ducray
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon I, 69100 Villeurbanne, France; (T.J.); (F.D.); (F.C.)
- Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neuro-Oncologie, 69002 Lyon, France
| | - Patrick Mertens
- Hospices Civils de Lyon, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Service de Neurochirurgie de la Moelle Spinale et des Nerfs Périphériques, 69002 Lyon, France;
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon I, 69100 Villeurbanne, France; (T.J.); (F.D.); (F.C.)
| | - François Cotton
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon I, 69100 Villeurbanne, France; (T.J.); (F.D.); (F.C.)
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1296, INSA Lyon, 69100 Villeurbanne, France;
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Radiologie, 69002 Lyon, France
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Scullen T, Milburn J, Aria K, Mathkour M, Tubbs RS, Kalyvas J. The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08231-8. [PMID: 39014075 DOI: 10.1007/s00586-024-08231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/14/2023] [Accepted: 09/23/2023] [Indexed: 07/18/2024]
Abstract
STUDY DESIGN We reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OBJECTIVE To evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology. BACKGROUND sDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management. METHODS Studies were included if they presented or discussed data from investigative or therapeutic procedures involving sDTI on human subjects in the setting of surgically amenable spinal pathology. Studies were excluded if they were (1) restricted to computational models investigating parameters using data not obtained clinically, (2) about cranial DTI methods, (3) about spinal pathology data not related to surgical management, (4) discussions or overviews of methods/techniques with minimal inclusion of objective experimental or clinical data. RESULTS Degenerative pathologies of interest were restricted to either cervical myelopathy (22/29,75.9%) or lumbar spondylosis 7/29,24.1%). Mass-occupying lesions included intradural pathology and discussed preoperative (7/9,77.8%) and intraoperative imaging(2/9,22.2%) as an adjunct to surgery 22.2%. Traumatic pathology focused on spinal cord injury prognosis and severity grading. CONCLUSIONS sDTI seems useful in surgical decision making and outcome measurements and in establishing clinical prognoses over a wide range of surgical pathologies. Further research is warranted with longer follow-up and larger population sizes in a prospective and controlled protocol.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA.
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA.
| | - James Milburn
- Department of Radiology, Ochsner Clinic Foundation, Jefferson, LA, 70121, USA
| | - Kevin Aria
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - R Shane Tubbs
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - James Kalyvas
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
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Yildiz S, Schecht M, Aggarwal A, Nael K, Doshi A, Pawha PS. Diffusion Weighted Imaging in Spine Tumors. Neuroimaging Clin N Am 2023; 33:459-475. [PMID: 37356862 DOI: 10.1016/j.nic.2023.04.001] [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: 06/27/2023]
Abstract
Diffusion weighted imaging (DWI) has developed into a powerful tool for the evaluation of spine tumors, particularly for the assessment of vertebral marrow lesions and intramedullary tumors. Advances in magnetic resonance techniques have improved the quality of spine DWI and diffusion tensor imaging (DTI) in recent years, with increased reproducibility and utilization. DTI, with quantitative parameters such as fractional anisotropy and qualitative visual assessment of nerve fiber tracts, can play a valuable role in the evaluation and surgical planning of spinal cord tumors. These widely available techniques can be used to enhance the diagnostic evaluation of spinal tumors.
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Affiliation(s)
- Sema Yildiz
- Division of Neuroradiology, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue MC Level, New York, NY 10029, USA.
| | - Michael Schecht
- Division of Neuroradiology, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue MC Level, New York, NY 10029, USA
| | - Amit Aggarwal
- Division of Neuroradiology, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue MC Level, New York, NY 10029, USA
| | - Kambiz Nael
- Division of Neuroradiology, Department of Radiology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Amish Doshi
- Division of Neuroradiology, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue MC Level, New York, NY 10029, USA
| | - Puneet S Pawha
- Division of Neuroradiology, Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, 1468 Madison Avenue MC Level, New York, NY 10029, USA
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Sadeghmousavi S, Soltani Khaboushan A, Jafarnezhad-Ansariha F, Nejad-Gashti R, Farsi M, Esmaeil-Pour R, Alijani M, Majidi Zolbin M, Niknejad H, Kajbafzadeh AM. The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit. Neurourol Urodyn 2022; 41:1539-1552. [PMID: 35842827 DOI: 10.1002/nau.25009] [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: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neurogenic lower urinary tract dysfunction (NLUTD), a challenging disorder, is defined by lack of bladder control due to the abnormalities in neural pathways and can be classified based on the location of lesions within the nervous system, thus investigating the neural pathways can help us to know the site of the lesion and specify the class of the NLUTD. Diffusion Tensor Imaging (DTI) tractography, a noninvasive advanced imaging method, is capable of detecting central nervous system pathologies, even if routine magnetic resonance imaging shows no abnormality. Accordingly, tractography is an ideal technique to evaluate patients with NLUTD and visualize the pathology site within the spine. This study aimed to introduce a novel method of spinal cord injury (SCI) to establish NLUTD in the rabbit and to investigate the potential of tractography in tracing neural tracts of the spinal cord in an induced NLUTD animal model. MATERIALS AND METHODS An animal model of NLUTD was induced through cauterization of the spinal cord at the level T12-L1 in 12 rabbits. Then rabbits were assessed via DTI, urodynamic studies (UDS), voiding cystourethrogram (VCUG), and pathology assessments using antineurofilament 200 (NF200) antibody, anti-S100, anti-Smooth Muscle Actin, anti-Myogenin, and anti-MyoD1. RESULTS The tractography visualized lesions within spinal cord fibers. DTI parameters including fractional anisotropy (FA) value and tract density were significantly decreased (FA: p-value = 0.01, Tract density: p-value = 0.05) after injury. The mean diffusivity (MD) was insignificantly increased compared to before the injury. Also, the results of UDS and pathology assessments corroborated that applying SCI and the establishment of the NLUTD model was completely successful. CONCLUSION In the present study, we investigated the auxiliary role of tractography in detecting the spinal cord lesions in the novel established rabbit model of NLUTD. The introduced method of NLUTD induction was without the leg's neurological deficit, easily applicable, low-cost, and was accompanied by minimal surgical preparation and a satisfactory survival rate in comparison with other SCI animal models.
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Affiliation(s)
- Shaghayegh Sadeghmousavi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Soltani Khaboushan
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fahimeh Jafarnezhad-Ansariha
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Nejad-Gashti
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farsi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Esmaeil-Pour
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alijani
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Majidi Zolbin
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Childern's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Diffusion tensor imaging in unclear intramedullary tumor-suspected lesions allows separating tumors from inflammation. Spinal Cord 2021; 60:655-663. [PMID: 34966172 PMCID: PMC9287173 DOI: 10.1038/s41393-021-00741-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
DESIGN Prospective diagnostic study. OBJECTIVES Primary imaging-based diagnosis of spinal cord tumor-suspected lesions is often challenging. The identification of the definite entity is crucial for dedicated treatment and therefore reduction of morbidity. The aim of this trial was to investigate specific quantitative signal patterns to differentiate unclear intramedullary tumor-suspected lesions based on diffusion tensor imaging (DTI). SETTING Medical Center - University of Freiburg, Germany. METHODS Forty patients with an unclear tumor-suspected lesion of the spinal cord prospectively underwent DTI. Primary diagnosis was determined by histological or clinical work-up or remained indeterminate with follow-up. DTI metrics (FA/ADC) were evaluated at the central lesion area, lesion margin, edema, and normal spinal cord and compared between different diagnostic groups (ependymomas, other spinal cord tumors, inflammations). RESULTS Mean DTI metrics for all spinal cord tumors (n = 18) showed significantly reduced FA and increased ADC values compared to inflammatory lesions (n = 8) at the lesion margin (p < 0.001, p = 0.001) and reduced FA at the central lesion area (p < 0.001). There were no significant differences comparing the neoplastic subgroups of ependymomas (n = 10) and other spinal cord tumors (n = 8), but remaining differences for both compared to the inflammation subgroup. We found significant higher ADC (p = 0.040) and a trend to decreased FA (p = 0.081) for ependymomas compared to inflammations at the edema. CONCLUSION Even if distinct differentiation of ependymomas from other spinal cord neoplasms was not possible based on quantitative DTI metrics, FA and ADC were feasible to separate inflammatory lesions. This may avoid unnecessary surgery in patients with unclear intramedullary tumor-suspected lesions.
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Omar MKM, Abd Allah AEKH, Maghrabi MG, Mohamed MZ. The value of quantitative diffusion tensor imaging indices of spinal cord disorders. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Different lesions affecting the spinal cord can lead to myelopathy. Diffusion tensor imaging (DTI) is widely used to predict the degree of spinal cord microstructure affection and to assess axonal integrity and diffusion directionality. We hypothesized that not all DTI parameters have the same affection with different spinal cord pathologies. The purpose of this study is to assess the value of the quantitative diffusion tensor imaging indices in different spinal cord lesions.
Results
There is highly statistically significant difference of the fractional anisotropy (FA), relative anisotropy (RA), volume ratio (VR) and secondary eigenvector values (E2 and E3) between various studied cord lesions and control levels. There is no statistically significant difference of the apparent diffusion coefficient (ADC) and the primary eigenvector value (E1) (ANOVA test). The ROC curve analysis showed the higher sensitivity and accuracy were ‘88% and 62.5%, respectively,’ with FA cutoff value about 0.380.
Conclusion
The resulted quantitative DTI indices ‘fractional anisotropy, relative anisotropy, volume ratio and secondary eigenvalues’ work as a numerical in vivo marker of overall tissue injury in different pathologies affecting the spinal cord.
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Pojskić M, Rotim K, Splavski B, Arnautović KI. MICROSURGICAL MANAGEMENT OF LOW-GRADE SPINAL CORD ASTROCYTOMA IN ADULTS: A PERSONAL CASE SERIES REPORT AND BRIEF LITERATURE REVIEW. Acta Clin Croat 2021; 59:505-512. [PMID: 34177061 PMCID: PMC8212640 DOI: 10.20471/acc.2020.59.03.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Astrocytoma is the second most common intramedullary tumor of predominantly low-grade malignancy in adult patients. Adult astrocytomas have better-quality prognosis compared with astrocytomas in children. Although a standardized surgical management protocol for spinal cord glioma is currently unavailable, surgery of low-grade astrocytoma should be aimed at gross total resection to preserve neurological function and to improve the outcome. Herein, we present a personal case series of four consecutive adult spinal cord astrocytoma patients who were operated on during the last few years. Tumor resection was performed in all patients utilizing microsurgical technique and intraoperative neurophysiologic monitoring. We also provide a literature review of the treatment of intramedullary astrocytoma in adults and discuss contemporary surgical management and prognosis.
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Affiliation(s)
| | - Krešimir Rotim
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5School of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, United States; 7Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bruno Splavski
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5School of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, United States; 7Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Kenan I Arnautović
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5School of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 6Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, United States; 7Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
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Pojskić M, Bopp M, Saß B, Kirschbaum A, Nimsky C, Carl B. Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci 2021; 11:brainsci11050646. [PMID: 34063546 PMCID: PMC8156391 DOI: 10.3390/brainsci11050646] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Correspondence: ; Tel.: +49-64215869848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
| | - Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University of Marburg, 35043 Marburg, Germany;
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
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Olguner SK, Arslan A, Açık V, İstemen İ, Can M, Gezercan Y, Ökten Aİ. Sodium Fluorescein for Spinal Intradural Tumors. Front Oncol 2021; 10:618579. [PMID: 33585245 PMCID: PMC7877540 DOI: 10.3389/fonc.2020.618579] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/11/2020] [Indexed: 01/11/2023] Open
Abstract
Technological innovations in spinal intradural tumor surgery simplify treatment. Surgical treatment of cranial benign and malignant pathologies under microscope with sodium (Na)-fluorescein guidance has often been reported, but few studies have focused on spinal intradural tumors. We aimed to investigate the usefulness of Na-fluorescein under yellow filter in intradural spinal tumor surgery by retrospectively reviewing cases involving intramedullary and extramedullary tumors operated under the guidance of Na-fluorescein. Forty-nine adult patients with a diagnosis of spinal intradural tumor operated under a yellow filter (560 nm) microscope using Na-fluorescein dye were included in the study. Demographic data, such as age and sex, neurological status, extent of tumor resection, histopathological diagnosis, Na-fluorescein staining pattern, and its usefulness during surgery were noted and statistically analyzed. Of all recruited patients, 26 women (53.1%) and 23 men (46.9%), were included for analysis. The age range of the patients was 18–64 years, with a mean age of 41.6 ± 13.9. An intradural intramedullary mass was found in 30.6% (n = 15) of the patients, and an intradural extramedullary mass in 69.4% (n: 34). While Na-fluorescein staining was homogeneous in all intradural extramedullary tumors, 73.3% (n: 11) of intradural intramedullary tumors were homogeneous, and 13.3% (n: 2) moderately heterogeneous. In the whole study group, the Na-fluorescein staining pattern was helpful in surgical resection in 47 cases (95.9%). While 34/34 (100%) found it helpful for extramedullary tumors, 13/15 (86.7%) did in intramedullary tumors, and for 2/15 (13.3%) it was not. In conclusion, Na-fluorescein helps in distinguishing tumor from healthy tissue in intradural extramedullary and intramedullary tumor surgery under a yellow filter microscope in most cases, thus providing convenient assistance to surgeons.
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Affiliation(s)
- Semih Kivanc Olguner
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali Arslan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Vedat Açık
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - İsmail İstemen
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Mehmet Can
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali İhsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
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Dauleac C, Frindel C, Mertens P, Jacquesson T, Cotton F. Overcoming challenges of the human spinal cord tractography for routine clinical use: a review. Neuroradiology 2020; 62:1079-1094. [DOI: 10.1007/s00234-020-02442-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
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Role of Diffusion Tensor Imaging Parameters in the Characterization and Differentiation of Infiltrating and Non-Infiltrating Spinal Cord Tumors : Preliminary Study. Clin Neuroradiol 2019; 30:739-747. [PMID: 31754759 PMCID: PMC7728647 DOI: 10.1007/s00062-019-00851-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/25/2019] [Indexed: 01/23/2023]
Abstract
Background and Purpose Recent attempts to utilize diffusion tensor imaging (DTI) to identify the extent of microinfiltration of a tumor in the brain have been successful. It was therefore speculated that this technique could also be useful in the spinal cord. The aim of this study was to differentiate between infiltrating and noninfiltrating intramedullary spinal tumors using DTI-derived metrics. Material and Methods The study group consisted of 6 patients with infiltrating and 12 with noninfiltrating spinal cord tumors. Conventional magnetic resonance imaging (MRI) with gadolinium administration was performed followed by DTI. Fractional anisotropy (FA), diffusivity (TRACE) and apparent diffusion coefficient (ADC) were measured in the enhancing tumor mass, peritumoral margins, peritumoral edema and normal appearing spinal cord. The results were compared using non-parametric Mann–Whitney U test with statistical significance p < 0.05. Results In peritumoral margins the FA values were significantly higher in the noninfiltrating compared to the infiltrating tumors (p < 0.007), whereas TRACE values were significantly lower (p < 0.017). The results were similar in peritumoral edema. The FA values in the tumor mass showed no significant differences between the two groups while TRACE showed a statistically significant difference (p < 0.003). There was no statistical difference in any parameters in normal appearing spinal cord. Conclusion Quantitative analysis of DTI parameters of spinal cord tissue surroundings spinal masses can be useful for differentiation between infiltrating and non-infiltrating intramedullary spinal tumors.
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Atik AF, Calabrese E, Gramer R, Adil SM, Rahimpour S, Pagadala P, Johnson GA, Lad SP. Structural mapping with fiber tractography of the human cuneate fasciculus at microscopic resolution in cervical region. Neuroimage 2019; 196:200-206. [PMID: 30981859 DOI: 10.1016/j.neuroimage.2019.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/04/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022] Open
Abstract
Human spinal white matter tract anatomy has been mapped using post mortem histological information with the help of molecular tracing studies in animal models. This study used 7 Tesla diffusion MR tractography on a human cadaver that was harvested 24 hours post mortem to evaluate cuneate fasciculus anatomy in cervical spinal cord. Based on this method, for the first time much more nuanced tractographic anatomy was used to investigate possible new routes for cuneate fasciculus in the posterior and lateral funiculus. Additionally, current molecular tracing studies were reviewed, and confirmatory data was presented along with our radiological results. Both studies confirm that upon entry to the spinal cord, upper cervical level tracts (C1-2-3) travel inside lateral funiculus and lower level tracts travel medially inside the posterior funiculus after entry at posterolateral sulcus which is different than traditional knowledge of having cuneate fasciculus tracts concentrated in the lateral part of posterior funiculus.
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Affiliation(s)
- Ahmet Fatih Atik
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Evan Calabrese
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Robert Gramer
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Promila Pagadala
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - G Allan Johnson
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Abstract
Primary spinal astrocytoma is a subtype of glioma, the most common spinal cord tumor found in the intradural intramedullary compartment. Spinal astrocytomas account for 6-8% of all spinal cord tumors and are primarily low grade (World Health Organization grade I (WHO I) or WHO II). They are seen in both the adult and pediatric population with the most common presenting symptoms being back pain, sensory dysfunction, or motor dysfunction. Magnetic Resonance Imaging (MRI) with and without gadolinium is the imaging of choice, which usually reveals a hypointense T1 weighted and hyperintense T2 weighted lesion with a heterogeneous pattern of contrast enhancement. Further imaging which may aid in surgical planning includes computerized tomography, diffusion tensor imaging, and tractography. Median survival in spinal cord astrocytomas ranges widely. The factors most significantly associated with poor prognosis and shorter median survival are older age at initial diagnosis, higher grade lesion based on histology, and extent of resection. The mainstay of treatment for primary spinal cord astrocytomas is surgical resection, with the goal of preservation of neurologic function, guided by intraoperative neuromonitoring. Adjunctive radiation has been shown beneficial and may increase overall survival. The role of adjunctive chemotherapy is employed, however, its benefit has not been clearly defined. Primary spinal cord astrocytomas are rare and challenging to treat. The gold standard treatment is surgical resection. Second-line treatments include radiation and chemotherapy, although, the optimal regimen for adjunctive therapy has not yet been clearly defined.
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Affiliation(s)
- John Ogunlade
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James G Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Christopher Elia
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tiffany Odell
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Sanjay C Rao
- Neurosurgery, Kaiser Permanente - Fontana Medical Center, Fontana, USA
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Tumors of the Spine and Spinal Cord. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_41-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tumors of the Spine and Spinal Cord. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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