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Ogiwara T, Sato A, Wakabayashi M, Nakamura K, Hanaoka Y, Hongo K, Hayashi Y. Real-time fluorescence-guided glioblastoma resection with 5-aminolevulinic acid using ORBEYE™. J Clin Neurosci 2025; 136:111276. [PMID: 40262451 DOI: 10.1016/j.jocn.2025.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 04/14/2025] [Accepted: 04/18/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Although fluorescence-guided surgery (FGS) using 5-aminolevulinic acid (5-ALA) for glioblastomas (GBMs) can maximize the extent of resection (EOR), its superiority when used with ORBEYE™, a three-dimensional exoscope, compared with that of conventional microscopy remains unclear. This study aimed to evaluate the effectiveness of ORBEYE™ in 5-ALA FGS for GBM resection and compare the results with those of conventional microscopic FGS. METHODS This retrospective, single-center study included 41 patients with histologically confirmed GBM who underwent 5-ALA FGS between January 2016 and April 2024. Twenty patients underwent surgery using a conventional operating microscope, while 21 underwent surgery using ORBEYE™. Tumor size, location, EOR, operative time, and surgical complications were compared between the two groups. RESULTS No significant differences in EOR were observed between the groups; gross total resection was achieved in 45 % and 52.4 % of patients in the microscope and ORBEYE groups, respectively. Although not significant, the ORBEYE group had shorter operative times (195.3 ± 53.8 min) than the microscope group (219.4 ± 79.3 min). Postoperative complications were comparable between the two groups. ORBEYE™ allowed continuous resection under blue light without switching modes, enabling "real-time FGS with 5-ALA," which enhanced surgical workflow, reduced surgeon's fatigue, and eliminated the need for repositioning the surgeon's eyes to the operating microscope eyepieces-although this was a subjective opinion of the surgeons. CONCLUSIONS ORBEYE™ provides effective real-time visualization during 5-ALA FGS for GBM resection, comparable to conventional microscopy. Its continuous fluorescence guidance and improved ergonomics may contribute to shorter operative times and reduced surgeon fatigue. ORBEYE™ is a promising tool in GBM surgery, warranting further in-depth investigation.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan; Pituitary and Neuroendoscopy Center, Ina Central Hospital, Ina, Japan; Department of Neurosurgery, Kanazawa Medical University, Kahoku, Japan.
| | - Atsushi Sato
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan; Pituitary and Neuroendoscopy Center, Ina Central Hospital, Ina, Japan
| | | | - Kotaro Nakamura
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Kanazawa Medical University, Kahoku, Japan
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Sulangi AJ, Husain A, Lei H, Okun J. Neuronavigation in glioma resection: current applications, challenges, and clinical outcomes. Front Surg 2024; 11:1430567. [PMID: 39165667 PMCID: PMC11334078 DOI: 10.3389/fsurg.2024.1430567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
Background Glioma resection aims for maximal tumor removal while preserving neurological function. Neuronavigation systems (NS), with intraoperative imaging, have revolutionized this process through precise tumor localization and detailed anatomical navigation. Objective To assess the efficacy and breadth of neuronavigation and intraoperative imaging in glioma resections, identify operational challenges, and provide educational insights to medical students and non-neurosurgeons regarding their practical applications. Methods This systematic review analyzed studies from 2012 to 2023 on glioma patients undergoing surgical resection with neuronavigation, sourced from MEDLINE (PubMed), Embase, and Web of Science. A database-specific search strategy was employed, with independent reviewers screening for eligibility using Rayyan and extracting data using the Joanna Briggs Institute (JBI) tool. Results The integration of neuronavigation systems with intraoperative imaging modalities such as iMRI, iUS, and 5-ALA significantly enhances gross total resection (GTR) rates and extent of resection (EOR). While advanced technology improves surgical outcomes, it does not universally reduce operative times, and its impact on long-term survival varies. Combinations like NS + iMRI and NS + 5-ALA + iMRI achieve higher GTR rates compared to NS alone, indicating that advanced imaging adjuncts enhance tumor resection accuracy and success. The results underscore the multifaceted nature of successful surgical outcomes. Conclusions Integrating intraoperative imaging with neuronavigation improves glioma resection. Ongoing research is vital to refine technology, enhance accuracy, reduce costs, and improve training, considering various factors impacting patient survival.
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Affiliation(s)
- Albert Joseph Sulangi
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine—Tampa Bay Regional Campus, Clearwater, FL, United States
| | - Adam Husain
- University of Texas Medical Branch, Galveston, TX, United States
| | - Haoyi Lei
- Elson S. Floyd College of Medicine, Spokane, WA, United States
| | - Jessica Okun
- Steward Medical Group, Fort Lauderdale, FL, United States
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García-Milán V, Franco A, Zvezdanova ME, Marcos S, Martin-Laez R, Moreno F, Velasquez C, Fernandez-Luna JL. Discriminating Glioblastoma from Peritumoral Tissue by a Nanohole Array-Based Optical and Label-Free Biosensor. BIOSENSORS 2023; 13:591. [PMID: 37366956 DOI: 10.3390/bios13060591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
In glioblastoma (GBM) patients, maximal safe resection remains a challenge today due to its invasiveness and diffuse parenchymal infiltration. In this context, plasmonic biosensors could potentially help to discriminate tumor tissue from peritumoral parenchyma based on differences in their optical properties. A nanostructured gold biosensor was used ex vivo to identify tumor tissue in a prospective series of 35 GBM patients who underwent surgical treatment. For each patient, two paired samples, tumor and peritumoral tissue, were extracted. Then, the imprint left by each sample on the surface of the biosensor was individually analyzed, obtaining the difference between their refractive indices. The tumor and non-tumor origins of each tissue were assessed by histopathological analysis. The refractive index (RI) values obtained by analyzing the imprint of the tissue were significantly lower (p = 0.0047) in the peritumoral samples (1.341, Interquartile Range (IQR) 1.339-1.349) compared with the tumor samples (1.350, IQR 1.344-1.363). The ROC (receiver operating characteristic) curve showed the capacity of the biosensor to discriminate between both tissues (area under the curve, 0.8779, p < 0.0001). The Youden index provided an optimal RI cut-off point of 0.003. The sensitivity and specificity of the biosensor were 81% and 80%, respectively. Overall, the plasmonic-based nanostructured biosensor is a label-free system with the potential to be used for real-time intraoperative discrimination between tumor and peritumoral tissue in patients with GBM.
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Affiliation(s)
- Víctor García-Milán
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Alfredo Franco
- Department of Applied Physics, Faculty of Sciences, Universidad de Cantabria, 39005 Santander, Spain
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), 39012 Santander, Spain
| | | | - Sara Marcos
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Rubén Martin-Laez
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Fernando Moreno
- Department of Applied Physics, Faculty of Sciences, Universidad de Cantabria, 39005 Santander, Spain
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), 39012 Santander, Spain
| | - Carlos Velasquez
- Department of Neurological Surgery and Spine Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), 39012 Santander, Spain
- Department of Anatomy and Cell Biology, Universidad de Cantabria, 39005 Santander, Spain
| | - José L Fernandez-Luna
- Instituto de Investigación Marqués de Valdecilla (IDIVAL), 39012 Santander, Spain
- Genetics Unit, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
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Ogiwara T, Goto T, Fujii Y, Hanaoka Y, Miyaoka Y, Koyama JI, Hongo K, Horiuchi T. The Current Status in Intraoperative Image-Guided Neurosurgery Associated with Progressive Operating Rooms: A Retrospective Analysis. World Neurosurg 2022; 167:e710-e716. [PMID: 35998811 DOI: 10.1016/j.wneu.2022.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Shinshu University Hospital has advanced operating rooms including a mobile computed tomography (mCT) room, Smart Cyber Operating Theater (SCOT) with intraoperative magnetic resonance imaging, hybrid operating room (hOR) with intraoperative image-guided surgery, and conventional operating rooms. We investigated the characteristics of cases assigned to each operating room. METHODS Five hundred forty neurosurgery cases from January 2018 to April 2021 were analyzed. We analyzed the selection of operating room according to pathology, surgical device requirement, and urgency, and we examined associations between operating room characteristics and these factors. RESULTS Neurological surgeries were performed in an mCT room, an hOR, a SCOT, and a conventional operating room in 333 (61.7%), 64 (11.9%), 49 (9.1%), and 94 (17.4%) cases, respectively. mCT rooms were more frequently selected than other rooms for vascular/extra-axial tumors, which have a lower need for intraoperative image guidance. Spinal surgeries with segment diagnosis or intraoperative bone removal tended to be performed in the hOR. The rate of SCOT use tended to be higher for intra-axial tumors with poorly circumscribed borders than for vascular/extra-axial tumors. Endoscopic procedures were more frequently performed in the SCOT and mCT rooms than in hORs and conventional operating rooms. Emergency surgeries were often performed in the conventional operating rooms, even in cases where SCOT and hOR seemed suitable. CONCLUSIONS Intraoperative image-guided surgeries were performed according to the characteristics of each operating room best suited for various diseases and operative methods. Further research is needed to prove whether operating room selection improves neurosurgical outcomes.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinari Miyaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun-Ichi Koyama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Mosteiro A, Di Somma A, Ramos PR, Ferrés A, De Rosa A, González-Ortiz S, Enseñat J, González JJ. Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis. Front Oncol 2022; 12:1016264. [PMID: 36387079 PMCID: PMC9650059 DOI: 10.3389/fonc.2022.1016264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Intraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenient and yet effective asset, no formal comparison between the efficiency of iUS and iMR in neurosurgical oncology has been performed. Methods A cost-effectiveness analysis comparing two single-center prospectively collected surgical cohorts, classified according to the intraoperative imaging used. iMR (2013-2016) and iUS (2021-2022) groups comprised low- and high-grade gliomas, with a maximal safe resection intention. Units of health gain were gross total resection and equal or increased Karnofsky performance status. Surgical and health costs were considered for analysis. The incremental cost-effectiveness ratio (ICER) was calculated for the two intervention alternatives. The cost-utility graphic and the evolution of surgical duration with the gained experience were also analyzed. Results 50 patients followed an iMR-assisted operation, while 17 underwent an iUS-guided surgery. Gross total resection was achieved in 70% with iMR and in 60% with iUS. Median postoperative Karnofsky was similar in both group (KPS 90). Health costs were € 3,220 higher with iMR, and so were surgical-related costs (€ 1,976 higher). The ICER was € 322 per complete resection obtained with iMR, and € 644 per KPS gained or maintained with iMR. When only surgical-related costs were analyzed, ICER was € 198 per complete resection with iMR and € 395 per KPS gained or maintained. Conclusion This is an unprecedented but preliminary cost-effectiveness analysis of the two most common intraoperative imaging devices in neurosurgical oncology. iMR, although being costlier and time-consuming, seems cost-effective in terms of complete resection rates and postoperative performance status. However, the differences between both techniques are small. Possibly, iMR and iUS are complementary aids during the resection: iUS real-time images assist while advancing towards the tumor limits, informing about the distance to relevant landmarks and correcting neuronavigation inaccuracy due to brain shift. Yet, at the end of resection, it is the iMR that reliably corroborates whether residual tumor remains.
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Affiliation(s)
- Alejandra Mosteiro
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
- *Correspondence: Alejandra Mosteiro,
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Roldán Ramos
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Abel Ferrés
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Andrea De Rosa
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Sofía González-Ortiz
- Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Jose Juan González
- Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
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