First in vivo visualization of the human subarachnoid space and brain cortex via optical coherence tomography

Anatomical correlates for the newly discovered meningeal layer in the existing literature: A systematic review

The existence of a previously unrecognized subarachnoid lymphatic-like membrane (SLYM) was reported in a recent study. SLYM is described as an intermediate leptomeningeal layer between the arachnoid and pia mater in mouse and human brains, which divides the subarachnoid space (SAS) into two functional compartments. Being a macroscopic structure, having missed detection in previous studies is surprising. We systematically reviewed the published reports in animals and humans to explore whether prior descriptions of this meningeal layer were reported in some way. A comprehensive search was conducted in PubMed/Medline, EMBASE, Google Scholar, Science Direct, and Web of Science databases using combinations of MeSH terms and keywords with Boolean operators from inception until 31 December 2023. We found at least eight studies that provided structural evidence of an intermediate leptomeningeal layer in the brain or spinal cord. However, unequivocal descriptions for this layer all along the central nervous system were scarce. Obscure names like the epipial, intermediate meningeal, outer pial layers, or intermediate lamella were used to describe it. Its microscopic/ultrastructural details closely resemble the recently reported SLYM. We further examined the counterarguments in current literature that are skeptical of the existence of this layer. The potential physiological and clinical implications of this new meningeal layer are significant, underscoring the urgent need for further exploration of its structural and functional details.

Revisiting equivalent optical properties for cerebrospinal fluid to improve diffusion-based modeling accuracy in the brain

Significance

The diffusion approximation (DA) is used in functional near-infrared spectroscopy (fNIRS) studies despite its known limitations due to the presence of cerebrospinal fluid (CSF). Many of these studies rely on a set of empirical CSF optical properties, recommended by a previous simulation study, that were not selected for the purpose of minimizing DA modeling errors.

Aim

We aim to directly quantify the accuracy of DA solutions in brain models by comparing those with the gold-standard solutions produced by the mesh-based Monte Carlo (MMC), based on which we derive updated recommendations.

Approach

For both a five-layer head and Colin27 atlas models, we obtain DA solutions by independently sweeping the CSF absorption (μ a ) and reduced scattering (μ s ' ) coefficients. Using an MMC solution with literature CSF optical properties as a reference, we compute the errors for surface fluence, total brain sensitivity, and brain energy deposition, and identify the optimized settings where such error is minimized.

Results

Our results suggest that previously recommended CSF properties can cause significant errors (8.7% to 52%) in multiple tested metrics. By simultaneously sweepingμ a andμ s ' , we can identify infinite numbers of solutions that can exactly match DA with MMC solutions for any single tested metric. Furthermore, it is also possible to simultaneously minimize multiple metrics at multiple source/detector separations, leading to our updated recommendation of settingμ s ' = 0.15    mm - 1 while maintaining physiologicalμ a for CSF in DA simulations.

Conclusions

Our updated recommendation of CSF equivalent optical properties can greatly reduce the model mismatches between DA and MMC solutions at multiple metrics without sacrificing computational speed. We also show that it is possible to eliminate such a mismatch for a single or a pair of metrics of interest.

Advances and controversies in meningeal biology

The dura, arachnoid and pia mater, as the constituent layers of the meninges, along with cerebrospinal fluid in the subarachnoid space and ventricles, are essential protectors of the brain and spinal cord. Complemented by immune cells, blood vessels, lymphatic vessels and nerves, these connective tissue layers have held many secrets that have only recently begun to be revealed. Each meningeal layer is now known to have molecularly distinct types of fibroblasts. Cerebrospinal fluid clearance through peripheral lymphatics and lymph nodes is well documented, but its routes and flow dynamics are debated. Advances made in meningeal immune functions are also debated. This Review considers the cellular and molecular structure and function of the dura, arachnoid and pia mater in the context of conventional views, recent progress, and what is uncertain or unknown. The hallmarks of meningeal pathophysiology are identified toward developing a more complete understanding of the meninges in health and disease.

Microscope integrated MHz optical coherence tomography system for neurosurgery: development and clinical in-vivo imaging

Neurosurgical interventions on the brain are impeded by the requirement to keep damages to healthy tissue at a minimum. A new contrast channel enhancing the visual separation of malign tissue should be created. A commercially available surgical microscope was modified with adaptation optics adapting the MHz speed optical coherence tomography (OCT) imaging system developed in our group. This required the design of a scanner optics and beam delivery system overcoming constraints posed by the mechanical and optical parameters of the microscope. High quality volumetric OCT C-scans with dense sample spacing can be acquired in-vivo as part of surgical procedures within seconds and are immediately available for post-processing.

Exploration of the Noncoding Genome for Human-Specific Therapeutic Targets-Recent Insights at Molecular and Cellular Level

While it is well known that 98-99% of the human genome does not encode proteins, but are nevertheless transcriptionally active and give rise to a broad spectrum of noncoding RNAs [ncRNAs] with complex regulatory and structural functions, specific functions have so far been assigned to only a tiny fraction of all known transcripts. On the other hand, the striking observation of an overwhelmingly growing fraction of ncRNAs, in contrast to an only modest increase in the number of protein-coding genes, during evolution from simple organisms to humans, strongly suggests critical but so far essentially unexplored roles of the noncoding genome for human health and disease pathogenesis. Research into the vast realm of the noncoding genome during the past decades thus lead to a profoundly enhanced appreciation of the multi-level complexity of the human genome. Here, we address a few of the many huge remaining knowledge gaps and consider some newly emerging questions and concepts of research. We attempt to provide an up-to-date assessment of recent insights obtained by molecular and cell biological methods, and by the application of systems biology approaches. Specifically, we discuss current data regarding two topics of high current interest: (1) By which mechanisms could evolutionary recent ncRNAs with critical regulatory functions in a broad spectrum of cell types (neural, immune, cardiovascular) constitute novel therapeutic targets in human diseases? (2) Since noncoding genome evolution is causally linked to brain evolution, and given the profound interactions between brain and immune system, could human-specific brain-expressed ncRNAs play a direct or indirect (immune-mediated) role in human diseases? Synergistic with remarkable recent progress regarding delivery, efficacy, and safety of nucleic acid-based therapies, the ongoing large-scale exploration of the noncoding genome for human-specific therapeutic targets is encouraging to proceed with the development and clinical evaluation of novel therapeutic pathways suggested by these research fields.

Effects of atlas-based anatomy on modelled light transport in the neonatal head

Objective.Diffuse optical tomography (DOT) provides a relatively convenient method for imaging haemodynamic changes related to neuronal activity on the cerebral cortex. Due to practical challenges in obtaining anatomical images of neonates, an anatomical framework is often created from an age-appropriate atlas model, which is individualized to the subject based on measurements of the head geometry. This work studies the approximation error arising from using an atlas instead of the neonate's own anatomical model.Approach.We consider numerical simulations of frequency-domain (FD) DOT using two approaches, Monte Carlo simulations and diffusion approximation via finite element method, and observe the variation in (1) the logarithm of amplitude and phase shift measurements, and (2) the corresponding inner head sensitivities (Jacobians), due to varying segmented anatomy. Varying segmentations are sampled by registering 165 atlas models from a neonatal database to the head geometry of one individual selected as the reference model. Prior to the registration, we refine the segmentation of the cerebrospinal fluid (CSF) by separating the CSF into two physiologically plausible layers.Main results.In absolute measurements, a considerable change in the grey matter or extracerebral tissue absorption coefficient was found detectable over the anatomical variation. In difference measurements, a small local 10%-increase in brain absorption was clearly detectable in the simulated measurements over the approximation error in the Jacobians, despite the wide range of brain maturation among the registered models.Significance.Individual-level atlas models could potentially be selected within several weeks in gestational age in DOT difference imaging, if an exactly age-appropriate atlas is not available. The approximation error method could potentially be implemented to improve the accuracy of atlas-based imaging. The presented CSF segmentation algorithm could be useful also in other model-based imaging modalities. The computation of FD Jacobians is now available in the widely-used Monte Carlo eXtreme software.

The neurosurgical benefit of contactless in vivo optical coherence tomography regarding residual tumor detection: A clinical study

Purpose

In brain tumor surgery, it is crucial to achieve complete tumor resection while conserving adjacent noncancerous brain tissue. Several groups have demonstrated that optical coherence tomography (OCT) has the potential of identifying tumorous brain tissue. However, there is little evidence on human in vivo application of this technology, especially regarding applicability and accuracy of residual tumor detection (RTD). In this study, we execute a systematic analysis of a microscope integrated OCT-system for this purpose.

Experimental design

Multiple 3-dimensional in vivo OCT-scans were taken at protocol-defined sites at the resection edge in 21 brain tumor patients. The system was evaluated for its intraoperative applicability. Tissue biopsies were obtained at these locations, labeled by a neuropathologist and used as ground truth for further analysis. OCT-scans were visually assessed with a qualitative classifier, optical OCT-properties were obtained and two artificial intelligence (AI)-assisted methods were used for automated scan classification. All approaches were investigated for accuracy of RTD and compared to common techniques.

Results

Visual OCT-scan classification correlated well with histopathological findings. Classification with measured OCT image-properties achieved a balanced accuracy of 85%. A neuronal network approach for scan feature recognition achieved 82% and an auto-encoder approach 85% balanced accuracy. Overall applicability showed need for improvement.

Conclusion

Contactless in vivo OCT scanning has shown to achieve high values of accuracy for RTD, supporting what has well been described for ex vivo OCT brain tumor scanning, complementing current intraoperative techniques and even exceeding them in accuracy, while not yet in applicability.

Automated counting of cerebral penetrating vessels using optical coherence tomography images of a mouse brain in vivo

RATIONALE AND OBJECTIVES

Penetrating blood vessels emanating from cortical surface vasculature and lying deep in the cortex are essential vascular conduits for the shuttling of blood from superficial pial vessels to the capillary beds in parenchyma for the nourishment of neuronal brain tissues. Locating and counting the penetrating vessels is beneficial for the quantification of a course of ischemia in blood occlusive events such as stroke. This paper seeks to demonstrate and validate a method for automated penetrating vessel counting that uses optical coherence tomography (OCT).

MATERIALS AND METHODS

This paper proposes an OCT method that effectively identifies and grades the cortical penetrating vessels in perfusion. The key to the proposed method is the harnessing of vascular features found in the penetrating vessels, which are distinctive from those of other vessels. In particular, with an increase in the light attenuation and flow turbulence, the contrast in the mean projection of the OCT datacube decreases, whereas that in the maximum projection of the Doppler frequency variance datacube increases. By multiplying the inversion of the former with the latter, its binary thresholding is sufficient to highlight the penetrating vessels and allows for their counting over the projection image.

RESULTS

A computational method that leverages the decrease in mean OCT projection intensity and the increase in Doppler frequency variance at the penetrating vessel is developed. It successfully identifies and counts penetrating vessels with a high accuracy of over 87%. The penetrating vessel density is observed to be significantly reduced in the mouse model of focal ischemic stroke.

CONCLUSION

The OCT analysis is effective for counting penetrating blood vessels in mice brains and may be applied to the rapid diagnosis and treatment of stroke in stroke models of small animals. This article is protected by copyright. All rights reserved.

Transvascular in vivo microscopy of the subarachnoid space

BACKGROUND

The micro-architectonics of the subarachnoid space (SAS) remain partially understood and largely ignored, likely the result of the inability to image these structures in vivo. We explored transvascular imaging with high-frequency optical coherence tomography (HF-OCT) to interrogate the SAS.

METHODS

In vivo HF-OCT was performed in 10 dogs in both the posterior and anterior cerebral circulations. The conduit vessels used were the basilar, anterior spinal, and middle and anterior cerebral arteries through which the perivascular SAS was imaged. The HF-OCT imaging probe was introduced via a microcatheter and images were acquired using a contrast injection (3.5 mL/s) for blood clearance. Segmentation and three-dimensional rendering of HF-OCT images were performed to study the different configurations and porosity of the subarachnoid trabeculae (SAT) as a function of location.

RESULTS

Of 13 acquisitions, three were excluded due to suboptimal image quality. Analysis of 15 locations from seven animals was performed showing six distinct configurations of arachnoid structures in the posterior circulation and middle cerebral artery, ranging from minimal presence of SAT to dense networks and membranes. Different locations showed predilection for specific arachnoid morphologies. At the basilar bifurcation, a thick, fenestrated membrane had a unique morphology. SAT average thickness was 100 µm and did not vary significantly based on location. Similarly, the porosity of the SAT averaged 91% and showed low variability.

CONCLUSION

We have demonstrated the feasibility to image the structures of the SAS with transvascular HF-OCT. Future studies are planned to further map the SAT to increase our understanding of their function and possible impact on neurovascular pathologies.

OCT-Guided Surgery for Gliomas: Current Concept and Future Perspectives

Optical coherence tomography (OCT) has been recently suggested as a promising method to obtain in vivo and real-time high-resolution images of tissue structure in brain tumor surgery. This review focuses on the basics of OCT imaging, types of OCT images and currently suggested OCT scanner devices and the results of their application in neurosurgery. OCT can assist in achieving intraoperative precision identification of tumor infiltration within surrounding brain parenchyma by using qualitative or quantitative OCT image analysis of scanned tissue. OCT is able to identify tumorous tissue and blood vessels detection during stereotactic biopsy procedures. The combination of OCT with traditional imaging such as MRI, ultrasound and 5-ALA fluorescence has the potential to increase the safety and accuracy of the resection. OCT can improve the extent of resection by offering the direct visualization of tumor with cellular resolution when using microscopic OCT contact probes. The theranostic implementation of OCT as a part of intelligent optical diagnosis and automated lesion localization and ablation could achieve high precision, automation and intelligence in brain tumor surgery. We present this review for the increase of knowledge and formation of critical opinion in the field of OCT implementation in brain tumor surgery.

Theranostic applications of optical coherence tomography in neurosurgery?

In light of our own experiences, we value the existing literature to critically point out possible “near” future applications of optical coherence tomography (OCT) as an intraoperative neurosurgical guidance tool. “Pub Med”, “Cochrane Library”, “Crossref Metadata Search”, and “IEEE Xplore” databases as well as the search engine “Google Scholar” were screened for “optical coherence tomography + neurosurgery”, “optical coherence tomography + intraoperative imaging + neurosurgery”, and “microscope integrated optical coherence tomography + neurosurgery”. n = 51 articles related to the use of OCT as an imaging technique in the field of neurosurgery or neurosurgical research. n = 7 articles documented the intraoperative use of OCT in patients. n = 4 articles documented the use of microscope-integrated optical coherence tomography as a neurosurgical guidance tool. The Results demonstrate that OCT is the first imaging technique to study microanatomy in vivo. Postoperative analysis of intraoperative scans holds promise to enrich our physiological and pathophysiological understanding of the human brain. No data exists to prove that OCT-guided surgery minimizes perioperative morbidity or extends tumor resection. But results suggest that regular use of microscope-integrated OCT could increase security during certain critical microsurgical steps like, e.g., dural dissection at cavernous sinus, transtentorial approaches, or aneurysm clip placement. Endoscopy integration could aid surgery in regions which are not yet accessible to real-time imaging modalities like the ventricles or hypophysis. Theranostic instruments which combine OCT with laser ablation might gain importance in the emerging field of minimal invasive tumor surgery. OCT depicts vessel wall layers and its pathologies uniquely. Doppler OCT could further visualize blood flow in parallel. These abilities shed light on promising future applications in the field of vascular neurosurgery.

Mechanical Properties of the Cranial Meninges: A Systematic Review

The meninges are membranous tissues that are pivotal in maintaining homeostasis of the central nervous system. Despite the importance of the cranial meninges in nervous system physiology and in head injury mechanics, our knowledge of the tissues' mechanical behavior and structural composition is limited. This systematic review analyzes the existing literature on the mechanical properties of the meningeal tissues. Publications were identified from a search of Scopus, Academic Search Complete, and Web of Science and screened for eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review details the wide range of testing techniques employed to date and the significant variability in the observed experimental findings. Our findings identify many gaps in the current literature that can serve as a guide for future work for meningeal mechanics investigators. The review identifies no peer-reviewed mechanical data on the falx and tentorium tissues, both of which have been identified as key structures in influencing brain injury mechanics. A dearth of mechanical data for the pia-arachnoid complex also was identified (no experimental mechanics studies on the human pia-arachnoid complex were identified), which is desirable for biofidelic modeling of human head injuries. Finally, this review provides recommendations on how experiments can be conducted to allow for standardization of test methodologies, enabling simplified comparisons and conclusions on meningeal mechanics.

Optical coherence tomography of cranial dura mater: Microstructural visualization in vivo

PURPOSE

The study explores microscope integrated optical coherence tomography (OCT) as a intraoperative imaging technique to delineate the microstructural composition of human dura mater cranialis and underlying leptomeninges for surgical guidance.

METHODS

OCT volume scans, light microscopic pictures and light microscopic videos of the dura mater were acquired in patients (n = 20) with indication for craniotomy. OCT volume scans and corresponding light microscopic data were analyzed post procedural. Thickness of anatomical structures was measured during this phase.

RESULTS

OCT scanning of the human cranial dura mater was feasible during microsurgical dissection. A discrimination of the endosteal and inner meningeal layer of the cranial dura mater was possible in 70 % (n = 14) of the patients. Transdural OCT scans could further demonstrate subdural anatomical structures: subdural space 10 % (n = 2), subarachnoid space in 35 % (n = 7), arachnoid vessels in 80 % (n = 16) and brain cortex in 90 % (n = 16) of the patients. Orthogonal distance measurement was possible. The cranial dura mater showed a mean depth of 216 μm, the endosteal layer of 120 μm and the inner meningeal layer of 132 μm. Imaging quality of the dural segment was high - approaching spatial resolution of histopathology. Imaging quality of subdural segments was lower and demonstrated A-line artifacts in 45 % (n = 7).

CONCLUSION

These results illustrate - for the first time - strengths and weaknesses of three dimensional microscope integrated OCT as an in vivo imaging method of the human cranial dura mater, underlying leptomeninges and human brain cortex as a surgical guidance tool. OCT imaging of the cranial dura mater showed extensive details. Transdural imaging of subdural micro anatomical structures was possible, but showed lower image quality with intermittent A-line artifacts. OCT stated the first intraoperative imaging tool to measure the depth of micro anatomical structures with a high spatial resolution of 7,5 μm.

Ex-vivo quantification of ovine pia arachnoid complex biomechanical properties under uniaxial tension

Background

The pia arachnoid complex (PAC) is a cerebrospinal fluid-filled tissue conglomerate that surrounds the brain and spinal cord. Pia mater adheres directly to the surface of the brain while the arachnoid mater adheres to the deep surface of the dura mater. Collagen fibers, known as subarachnoid trabeculae (SAT) fibers, and microvascular structure lie intermediately to the pia and arachnoid meninges. Due to its structural role, alterations to the biomechanical properties of the PAC may change surface stress loading in traumatic brain injury (TBI) caused by sub-concussive hits. The aim of this study was to quantify the mechanical and morphological properties of ovine PAC.

Methods

Ovine brain samples (n = 10) were removed from the skull and tissue was harvested within 30 min post-mortem. To access the PAC, ovine skulls were split medially from the occipital region down the nasal bone on the superior and inferior aspects of the skull. A template was used to remove arachnoid samples from the left and right sides of the frontal and occipital regions of the brain. 10 ex-vivo samples were tested with uniaxial tension at 2 mm s⁻¹, average strain rate of 0.59 s⁻¹, until failure at < 5 h post extraction. The force and displacement data were acquired at 100 Hz. PAC tissue collagen fiber microstructure was characterized using second-harmonic generation (SHG) imaging on a subset of n = 4 stained tissue samples. To differentiate transverse blood vessels from SAT by visualization of cell nuclei and endothelial cells, samples were stained with DAPI and anti-von Willebrand Factor, respectively. The Mooney-Rivlin model for average stress–strain curve fit was used to model PAC material properties.

Results

The elastic modulus, ultimate stress, and ultimate strain were found to be 7.7 ± 3.0, 2.7 ± 0.76 MPa, and 0.60 ± 0.13, respectively. No statistical significance was found across brain dissection locations in terms of biomechanical properties. SHG images were post-processed to obtain average SAT fiber intersection density, concentration, porosity, tortuosity, segment length, orientation, radial counts, and diameter as 0.23, 26.14, 73.86%, 1.07 ± 0.28, 17.33 ± 15.25 µm, 84.66 ± 49.18°, 8.15%, 3.46 ± 1.62 µm, respectively.

Conclusion

For the sizes, strain, and strain rates tested, our results suggest that ovine PAC mechanical behavior is isotropic, and that the Mooney-Rivlin model is an appropriate curve-fitting constitutive equation for obtaining material parameters of PAC tissues.

Microscope integrated optical coherence tomography of a cerebral arachnoid cyst: A new technique to increase intraoperative security

PURPOSE

This technical note illustrates microscope integrated optical coherence tomography (iOCT) as an imaging technique to delineate concealed micro anatomical structures not displayable by conventional intraoperative imaging methods in the context of a cerebral arachnoid cyst.

METHODS

iOCT was used for the first time to scan a cerebral arachnoid cyst in vivo. Scanning sites were defined at the outer membrane of the arachnoid cyst, the inner membrane at the temporal cortex as well as at the fenestration site to the basal cisterns - a point out of reach and resolution for conventional intraoperative imaging methods like e. g. ultrasound or neuroendoscopy.

RESULTS

iOCT was feasible during microsurgical fenestration of an arachnoid cyst. A clear delineation of the arachnoid cyst membrane was possible. The differentiation of the arachnoid cyst membrane and underlying arachnoid barrier cell membrane was possible. Trans cystic scanning at the temporal cortex could delineate the content of the subarachnoid space like subarachnoid blood vessels, trabecular sytem and vessel wall morphology of a M4 middle cerebral artery branch. Scanning of the inner membrane of the arachnoid cyst at site of fenestration to the basal cisterns excluded underlying micro anatomical structures.

CONCLUSION

This case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.

Optics Based Label-Free Techniques and Applications in Brain Monitoring

Functional near-infrared spectroscopy (fNIRS) has been utilized already around three decades for monitoring the brain, in particular, oxygenation changes in the cerebral cortex. In addition, other optical techniques are currently developed for in vivo imaging and in the near future can be potentially used more in human brain research. This paper reviews the most common label-free optical technologies exploited in brain monitoring and their current and potential clinical applications. Label-free tissue monitoring techniques do not require the addition of dyes or molecular contrast agents. The following optical techniques are considered: fNIRS, diffuse correlations spectroscopy (DCS), photoacoustic imaging (PAI) and optical coherence tomography (OCT). Furthermore, wearable optical brain monitoring with the most common applications is discussed.

Spatial distribution of human arachnoid trabeculae

Traumatic brain injury (TBI) is a common injury modality affecting a diverse patient population. Axonal injury occurs when the brain experiences excessive deformation as a result of head impact. Previous studies have shown that the arachnoid trabeculae (AT) in the subarachnoid space significantly influence the magnitude and distribution of brain deformation during impact. However, the quantity and spatial distribution of cranial AT in humans is unknown. Quantification of these microstructural features will improve understanding of force transfer during TBI, and may be a valuable dataset for microneurosurgical procedures. In this study, we quantify the spatial distribution of cranial AT in seven post-mortem human subjects. Optical coherence tomography (OCT) was used to conduct in situ imaging of AT microstructure across the surface of the human brain. OCT images were segmented to quantify the relative amounts of trabecular structures through a volume fraction (VF) measurement. The average VF for each brain ranged from 22.0% to 29.2%. Across all brains, there was a positive spatial correlation, with VF significantly greater by 12% near the superior aspect of the brain (p < .005), and significantly greater by 5%-10% in the frontal lobes (p < .005). These findings suggest that the distribution of AT between the brain and skull is heterogeneous, region-dependent, and likely contributes to brain deformation patterns. This study is the first to image and quantify human AT across the cerebrum and identify region-dependencies. Incorporation of this spatial heterogeneity may improve the accuracy of computational models of human TBI and enhance understanding of brain dynamics.