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Uda T. Neuroimaging of Brain Tumor Surgery and Epilepsy. Brain Sci 2023; 13:1701. [PMID: 38137149 PMCID: PMC10742002 DOI: 10.3390/brainsci13121701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
To make the best clinical judgements, surgeons need to integrate information acquired via multimodal imaging [...].
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Affiliation(s)
- Takehiro Uda
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka City 545-8585, Osaka, Japan
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Nakae S, Kumon M, Teranishi T, Ohba S, Hirose Y. Applied Fence-Post Techniques Using Deep Electrodes Instead of Catheters for Resection of Glioma Complicated with Frequent Epileptic Seizures: A Case Report. Brain Sci 2023; 13:brainsci13030482. [PMID: 36979292 PMCID: PMC10046720 DOI: 10.3390/brainsci13030482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Fence-post catheter techniques are used to use tumor margins when resecting gliomas. In the present study, deep electrodes instead of catheters were used as fence-posts. The case of a 25-year-old female patient whose magnetic resonance images (MRI) revealed a tumor in the left cingulate gyrus is presented in this study. She underwent daily seizures without loss of consciousness under the administration of anti-seizure medications. Despite video electroencephalography (EEG) monitoring, the scalp inter-ictal EEG did not show obvious epileptiform discharges. We were consequently uncertain whether such frequent seizures were epileptic seizures or not. As a result, deep electrodes were used as fence-posts: three deep electrodes were inserted into the tumor’s anterior, lateral, and posterior margins using a navigation-guided method. The highest epileptic discharge was detected from the anterior deep electrode. As a result, ahead of the tumor was extendedly resected, and epileptic discharges were eliminated using EEG. The postoperative MRI revealed that the tumor was resected. The patient has never experienced seizures after the surgery. In conclusion, when supratentorial gliomas complicated by frequent seizures are resected, intraoperative EEG monitoring using deep electrodes as fence-posts is useful for estimating epileptogenic areas.
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Mizobuchi Y, Nakajima K, Fujihara T, Azumi M, Takagi Y. Development of a Navigation-guided Fence-post Catheter for Brain Tumor Resection. J Med Invest 2022; 69:117-119. [PMID: 35466132 DOI: 10.2152/jmi.69.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Navigation system devices have been developed to allow precise resection of brain tumor. The fence-post catheter techniques that use a navigation system have been used in many neurosurgery centers. However, an exclusive catheter for the fence-post catheter techniques have not been made, and substituted silicon tube of the cerebral ventricle drainage or a Nelaton catheter is widely used. OBJECTIVE In this brief technical note, we describe a new fence-post catheter with steel tip device that was designed for more precise tissue resection and is useful in tumor resection. METHODS The newly designed fence-post catheter helps to visually gauge the accurate depth from the tumor bottom during tumor resection. Furthermore, the catheter tip has moderate weight and is made of a non-magnetic material. RESULTS Using our fence-post catheter, which has a metal part at the tip of the tube (length, 13 mm), operators can clearly notice that they are getting closer to base of the tumor by checking the metal part during the resection of deep tumors. CONCLUSION Our newly developed fence-post tube enables easy confirmation of the distance to deep-tissue regions and improves the degree of safety during tumor removal. J. Med. Invest. 69 : 117-119, February, 2022.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Toshitaka Fujihara
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Mai Azumi
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
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Tamura M, Kurihara H, Saito T, Nitta M, Maruyama T, Tsuzuki S, Fukui A, Koriyama S, Kawamata T, Muragaki Y. Combining Pre-operative Diffusion Tensor Images and Intraoperative Magnetic Resonance Images in the Navigation Is Useful for Detecting White Matter Tracts During Glioma Surgery. Front Neurol 2022; 12:805952. [PMID: 35126299 PMCID: PMC8812689 DOI: 10.3389/fneur.2021.805952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose We developed a navigation system that superimposes the fractional anisotropy (FA) color map of pre-operative diffusion tensor imaging (DTI) and intraoperative magnetic resonance imaging (MRI). The current study aimed to investigate the usefulness of this system for neurophysiological monitoring and examination under awake craniotomy during tumor removal. Method A total of 10 glioma patients (4 patients with right-side tumors; 5 men and 5 women; average age, 34 years) were evaluated. Among them, the tumor was localized to the frontal lobe, insular cortex, and parietal lobe in 8, 1, and 1 patient, respectively. There were 3 patients who underwent surgery on general anesthesia, while 7 patients underwent awake craniotomy. The index of DTI anisotropy taken pre-operatively (magnetic field: 3 tesla, 6 motion probing gradient directions) was analyzed as a color map (FA color map) and concurrently co-registered in the intraoperative MRI within the navigation. In addition to localization of the bipolar coagulator and the cortical stimulator for brain mapping on intraoperative MRI, the pre-operative FA color map was also concurrently integrated and displayed on the navigation monitor. This white matter nerve functional information was confirmed directly by using neurological examination and referring to the electrophysiological monitoring. Results Intraoperative MRI, integrated pre-operative FA color map, and microscopic surgical view were displayed on one screen in all 10 patients, and white matter fibers including the pyramidal tract were displayed as a reference in blue. Regarding motor function, motor-evoked potential was monitored as appropriate in all cases, and removal was possible while directly confirming motor symptoms under awake craniotomy. Furthermore, the white matter fibers including the superior longitudinal fasciculus were displayed in green. Importantly, it was useful not only to localize the resection site, but to identify language-related, eye movement-related, and motor fibers at the electrical stimulation site. All motor and/or language white matter tracts were identified and visualized with the co-registration and then with an acceptable post-operative neurological outcome. Conclusion Co-registering an intraoperative MR images and a pre-operative FA color map is a practical and useful method to predict the localization of critical white matter nerve functions intraoperatively in glioma surgery.
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Affiliation(s)
- Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Kurihara
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Taiichi Saito
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunichi Koriyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
- *Correspondence: Yoshihiro Muragaki
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Koizumi S, Shiraishi Y, Makita I, Kadowaki M, Sameshima T, Kurozumi K. A novel technique for fence-post tube placement in glioma using the robot-guided frameless neuronavigation technique under exoscope surgery: patient series. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21466. [PMID: 35855488 PMCID: PMC9281438 DOI: 10.3171/case21466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Robotic technology is increasingly used in neurosurgery. The authors reported a new technique for fence-post tube placement using robot-guided frameless stereotaxic technology with neuronavigation in patients with glioma. OBSERVATIONS Surgery was performed using the StealthStation S8 linked to the Stealth Autoguide cranial robotic guidance platform and a high-resolution three-dimensional (3D) surgical microscope. A surgical plan was created to determine the removal area using fence-post tube placement at the tumor and normal brain tissue boundary. Using this surgical plan, the robotic system allowed quick and accurate fence-post tube positioning, automatic alignment of the needle insertion and measurement positions in the brain, and quick and accurate puncture needle insertion into the brain tumor. Use of a ventricular drainage tube for the outer needle cylinder allowed placement of the puncture needle in a single operation. Furthermore, use of a high-resolution 3D exoscope allowed the surgeon to simultaneously view the surgical field image and the navigation screen with minimal line-of-sight movement, which improved operative safety. The position memory function of the 3D exoscope allowed easy switching between the exoscope and the microscope and optimal field of view adjustment. LESSONS Fence-post tube placement using robot-guided frameless stereotaxic technology, neuronavigation, and an exoscope allows precise glioma resection.
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Affiliation(s)
- Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuki Shiraishi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ippei Makita
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Makoto Kadowaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazuhiko Kurozumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Fujii Y, Ogiwara T, Goto T, Kanaya K, Hara Y, Hanaoka Y, Hardian RF, Hongo K, Horiuchi T. Microscopic Navigation-Guided Fence Post Technique for Maximal Tumor Resection During Glioma Surgery. World Neurosurg 2021; 151:e355-e362. [PMID: 33887499 DOI: 10.1016/j.wneu.2021.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The fence post technique, which involves insertion of catheters as fence posts around a tumor, has been widely used to demarcate the tumor border for maximal resection of intraparenchymal tumors, such as gliomas. However, a standard procedure for fence post insertion has not been established, and there are some limitations. To overcome this problem, a simple microscopic navigation-guided fence post technique was developed. The feasibility and efficacy of this novel technique during glioma surgery were assessed. METHODS The microscopic navigation-guided fence post technique was used in 46 glioma surgeries performed in 42 patients. Intraoperatively, the preplanned trajectory was overlaid on the microscopic surgical field, and the microscope angle was changed until the entry and target points of the trajectory overlapped. A fence post catheter was inserted as planned under microscopic view, and the tumor was resected with fence post guidance. Preoperative tumor characteristics and surgical outcomes were evaluated. RESULTS Mean age of patients was 50 years (range, 16-78 years), and 19 (45%) of 42 patients were women. Maximal safe resection was successfully achieved in 45 surgeries (97.8%), which was planned preoperatively with identification of the tumor border with fence posts without adverse effects of brain shift. No surgical complications attributable to fence post insertion occurred. CONCLUSIONS Clinical experience indicated that the microscopic navigation-guided fence post technique, in which fence posts can be placed without requiring the surgeon to take their eyes off the microscope, is safe and useful in glioma surgery.
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Affiliation(s)
- Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Saint Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Han SJ, Teton Z, Gupta K, Kawamoto A, Raslan AM. Novel Use of Stimulating Fence-Post Technique for Functional Mapping of Subcortical White Matter During Tumor Resection: A Technical Case Series. Oper Neurosurg (Hagerstown) 2020; 19:264-270. [DOI: 10.1093/ons/opaa027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Maximal safe resection remains a key principle in infiltrating glioma management. Stimulation mapping is a key adjunct for minimizing functional morbidity while “fence-post” procedures use catheters or dye to mark the tumor border at the start of the procedure prior to brain shift.
Objective
To report a novel technique using stereotactically placed electrodes to guide tumor resection near critical descending subcortical fibers.
Methods
Navigated electrodes were placed prior to tumor resection along the deep margin bordering presumed eloquent tracts. Stimulation was administered through these depth electrodes for subcortical motor and language mapping.
Results
Twelve patients were included in this preliminary technical report. Seven patients (7/12, 58%) were in asleep cases, while the other 5 cases (5/12, 42%) were performed awake. Mapping of motor fibers was performed in 8 cases, and language mapping was done in 1 case. In 3 cases, both motor and language mapping were performed using the same depth electrode spanning corticospinal tract and the arcuate fasciculus.
Conclusion
Stereotactic depth electrode placement coupled with stimulation mapping of white matter tracts can be used concomitantly to demarcate the border between deep tumor margins and eloquent brain, thus helping to maximize extent of resection while minimizing functional morbidity.
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Affiliation(s)
- Seunggu Jude Han
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Zoe Teton
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Kunal Gupta
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Aaron Kawamoto
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Ahmed M Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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Masuda Y, Fujimoto A, Nishimura M, Sato K, Enoki H, Okanishi T. The fence post depth electrode technique to control both brain tumors and epileptic seizures in patients with brain tumor-related epilepsy. Surg Neurol Int 2019; 10:187. [PMID: 31637088 PMCID: PMC6778326 DOI: 10.25259/sni_241_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
Background: To control brain tumor-related epilepsy (BTRE), both epileptological and neuro-oncological approaches are required. We hypothesized that using depth electrodes (DEs) as fence post catheters, we could detect the area of epileptic seizure onset and achieve both brain tumor removal and epileptic seizure control. Methods: Between August 2009 and April 2018, we performed brain tumor removal for 27 patients with BTRE. Patients who underwent lesionectomy without DEs were classified into Group 1 (13 patients) and patients who underwent the fence post DE technique were classified into Group 2 (14 patients). Results: The patients were 15 women and 12 men (mean age, 28.1 years; median age 21 years; range, 5–68 years). The brain tumor was resected to a greater extent in Group 2 than Group 1 (P < 0.001). Shallower contacts showed more epileptogenicity than deeper contacts (P < 0.001). Group 2 showed better epilepsy surgical outcomes than Group 1 (P = 0.041). Conclusion: Using DEs as fence post catheters, we detected the area of epileptic seizure onset and controlled epileptic seizures. Simultaneously, we removed the brain tumor to a greater extent with fence post DEs than without.
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Affiliation(s)
- Yosuke Masuda
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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Hasegawa H, Shin M, Kin T, Saito N. Fully Endoscopic Minimally Invasive Tumor Resection for Cystic Cerebellar Hemangioblastoma. World Neurosurg 2019; 126:484-490. [PMID: 30922906 DOI: 10.1016/j.wneu.2019.03.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND von Hippel-Lindau disease-related hemangioblastoma is likely to occur in the cerebellum and accompany a cyst. As multiple hemangioblastomas commonly occur in von Hippel-Lindau disease, and multiple surgeries may thus be necessary, a minimally invasive surgical strategy is of great importance. METHODS We present 2 patients with von Hippel-Lindau disease-related hemangioblastomas successfully treated by a fully endoscopic transcranial approach via a short skin incision and a 2 cm × 2 cm small bony window. Before surgery, a three-dimensional virtual reality model was created to determine the ideal trajectory. RESULTS Patient 1 had 2 serial large cystic tumors that equally contributed to obstructive hydrocephalus and were resected sequentially via a single endoscopic trajectory. Patient 2 had a progressive large cystic tumor that was resected endoscopically. Complete resection of the tumors was achieved without any complications in either patient. CONCLUSIONS Small nodular tumors accompanying a large cyst are plausible candidates for endoscopic transcranial surgery. The spatial relationship of nodules, cyst, and cerebellar parenchyma is important to determine the applicability of the present technique. Preoperative three-dimensional virtual reality simulation helps assess the feasibility of this approach.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
| | - Masahiro Shin
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
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Abstract
Purpose: A challenging aspect of glioma surgery is to distinguish tumour tissue from surrounding eloquent structures and perform resection with accuracy. Various technologies have been used to address this issue including neuronavigator, intraoperative magnetic resonant imaging, intraoperative ultrasound, and fluorescence, each of which has certain drawbacks and limitations. In this study, authors demonstrate the technique of using stereotactically placed catheters as guidance during cerebral glioma resection and report the surgical outcomes. Materials and methods: This study included patients with intrinsic cerebral tumour adjacent to the eloquent structures. Catheter trajectories were planned using three-dimensional cerebral reconstruction on navigation software and catheters were stereotactically placed to mark the intended extent of resection. All craniotomies were performed in awake fashion under neurophysiologic mapping and continuous physical examination for safe maximal resection. Clinical outcome and intended versus actual extent of resection were analysed. Results: Between January 2015 and December 2016, 15 consecutive patients (8 males and 7 females) with intrinsic cerebral tumour underwent craniotomy with this technique. Median age was 43 years. Seven patients (46.7%) had worsening neurological status within 24 h postoperatively. Of these 7 patients, 6 patients (85.7%) regained preoperative neurological status by 6 months. The intended extent of resections were total, subtotal and partial in 3 (20%), 9 (60%), and 3 (20%) patients, respectively. The actual extent of resections were total, subtotal and partial in 3 (20%), 8(53.3%), and 4 (26.7%) patients, respectively. There were no catheter related complications. There was no 30-day postoperative mortality. Conclusions: Catheter guided resection along with awake surgery and neurophysiologic monitoring is a valid technique for infiltrative tumour, especially for ones locating near eloquent structures where the margin of error is low. This is a simple and economical technique which requires only standard equipment widely available to neurosurgical operating theatres.
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Affiliation(s)
- Krishnapundha Bunyaratavej
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
| | - Piyanat Wangsawatwong
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
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Ideguchi M, Nishizaki T, Ikeda N, Okamura T, Tanaka Y, Fujii N, Ohno M, Shimabukuro T, Kimura T, Ikeda E, Suga K. A surgical strategy using a fusion image constructed from 11C-methionine PET, 18F-FDG-PET and MRI for glioma with no or minimum contrast enhancement. J Neurooncol 2018. [PMID: 29516344 DOI: 10.1007/s11060-018-2821-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective of this study was to investigate the distribution of 11C-methionine (MET) and F-18 fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) imaging and the hyperintense area in T2 weighted imaging (T2WI) in glioma with no or poor gadolinium enhancement in magnetic resonance imaging (GdMRI). Cases were also analyzed pathologically. We prospectively investigated 16 patients with non- or minimally enhancing (< 10% volume) glioma. All patients underwent MET-PET and FDG-PET scans preoperatively. After delineating the tumor based on MET uptake, integrated 3D images from FDG-PET and MRI (GdMRI, T2WI or FLAIR) were generated and the final resection plane was planned. This resection plane was determined intraoperatively using the navigation-guided fencepost method. The delineation obtained by MET-PET imaging was larger than that with GdMRI in all cases with an enhanced effect. In contrast, the T2WI-abnormal signal area (T2WI+) tended to be larger than the MET uptake area (MET+). Tumor resection was > 95% in the non-eloquent area in 4/5 cases (80%), whereas 10 of 11 cases (90.9%) had partial resection in the eloquent area. In a case including the language area, 92% resection was achieved based on the MET-uptake area, in contrast to T2WI-based partial resection (65%), because the T2WI+/MET- area defined the language area. Pathological findings showed that the T2WI+/MET+ area is glioma, whereas 6 of 9 T2WI+/MET- lesions included normal tissues. Tissue from T2W1+/MET+/FDG+/GdMRI+ lesions gave an accurate diagnosis of grade in six cases. Non- or minimally enhancing gliomas were classified as having a MET uptake area that totally or partially overlapped with the T2WI hyperintense area. Resection planning with or without a metabolically active area in non- or minimally enhancing gliomas may be useful for accurate diagnosis, malignancy grading, and particularly for eloquent area although further study is needed to analyze the T2WI+/MET- area.
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Affiliation(s)
- Makoto Ideguchi
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan.
| | - Takafumi Nishizaki
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Norio Ikeda
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Tomomi Okamura
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Yasue Tanaka
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Natsumi Fujii
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Machiko Ohno
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Taichi Shimabukuro
- Department of Neurosurgery, Ube-kohsan Central Hospital Corporation, 750 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan
| | - Tokuhiro Kimura
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazuyoshi Suga
- The Department of Radiology, St. Hill Hospital, Ube, Japan
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Akiyama Y, Ohtaki S, Komatsu K, Toyama K, Enatsu R, Mikami T, Wanibuchi M, Mikuni N. Intraoperative Mapping and Monitoring of the Pyramidal Tract Using Endoscopic Depth Electrodes. World Neurosurg 2017; 105:14-19. [PMID: 28529055 DOI: 10.1016/j.wneu.2017.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate motor function during neuroendoscopic resectioning of deep-seated brain tumors using endoscopically guided depth electrodes. METHODS For 12 cases of thalamic tumors, including high-grade gliomas, germinomas, and malignant lymphomas, depth electrodes were inserted using endoscopic guides between the tumor and the pyramidal tract in the thalamus. Motor-evoked potentials (MEPs) were continuously recorded during neuroendoscopic resectioning of the tumors. RESULTS Monitoring of MEP responses using depth electrodes in all 12 cases was successful. The minimum stimulus intensity threshold required to induce MEP responses was 3 mA. Gross total or subtotal resections were successful with this technique for all patients with glioma. No additional neurologic impairments were found after surgery in any of the cases. CONCLUSIONS Continuous MEP measurement using depth electrodes can serve as a new monitoring technique for endoscopic resectioning of deep-seated brain tumors.
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Affiliation(s)
- Yukinori Akiyama
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Shunya Ohtaki
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Kentaro Toyama
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Rei Enatsu
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan.
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KUROZUMI K, HISHIKAWA T, KAMEDA M, AGARI T, ICHIKAWA T, DATE I. Surgical Treatment of Intracranial Cavernous Malformations Using Neuronavigation and Monitoring. ACTA ACUST UNITED AC 2016. [DOI: 10.2335/scs.44.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kazuhiko KUROZUMI
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tomohito HISHIKAWA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Masahiro KAMEDA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi AGARI
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tomotsugu ICHIKAWA
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao DATE
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Margetis K, Rajappa P, Tsiouris AJ, Greenfield JP, Schwartz TH. Intraoperative stereotactic injection of Indigo Carmine dye to mark ill-defined tumor margins: a prospective phase I-II study. J Neurosurg 2015; 122:40-8. [PMID: 25361489 DOI: 10.3171/2014.9.jns14113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A critical goal in neurosurgical oncology is maximizing the extent of tumor resection while minimizing the risk to normal white matter tracts. Frameless stereotaxy and white matter mapping are indispensable tools in this effort, but deep tumor margins may not be accurately defined because of the "brain shift" at the end of the operation. The authors investigated the safety and efficacy of a technique for marking the deep margins of intraaxial tumors with stereotactic injection of Indigo Carmine dye. METHODS Investigational New Drug study approval for a prospective study in adult patients with gliomas was obtained from the FDA (Investigational New Drug no. 112680). At surgery, 1-3 stereotactic injections of 0.01 ml of Indigo Carmine dye were performed through the initial bur holes into the deep tumor margins before elevation of the bone flap. White light microscopic resection was conducted in standard fashion by using frameless stereotactic navigation until the injected margins were identified. The resection of the injected tumor margins and the extent of resection of the whole tumor volume were determined by using postoperative volumetric MRI. RESULTS In total 17 injections were performed in 10 enrolled patients (6 male, 4 female), whose mean age was 49 years. For all patients, the injection points were identified intraoperatively and tumor was resected at these points. The staining pattern was reproducible; it was a sphere of stained tissue approximately 5 mm in diameter. A halo of stained tissue and a backflow of dye through the needle tract were also noted, but these were clearly distinct from the staining pattern of the injection point, which was vividly colored and demarcated. Postoperative MR images verified the resection of all injection points. The mean extent of resection of the tumor as a whole was 97.1%. For 1 patient, a brain abscess developed on postoperative Day 16 and needed additional surgical treatment. CONCLUSIONS Stereotactic injection of Indigo Carmine dye can be used to demarcate multiple deep tumor margins, which can be readily identified intraoperatively by using standard white light microscopy. This technique may enhance the accuracy of frameless stereotactic navigation and increase the extent of resection of intraaxial tumors.
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Ohue S, Kohno S, Inoue A, Yamashita D, Matsumoto S, Suehiro S, Kumon Y, Kikuchi K, Ohnishi T. Surgical results of tumor resection using tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials for preservation of motor function in patients with glioblastomas near the pyramidal tracts. Neurosurg Rev 2014; 38:293-306; discussion 306-7. [DOI: 10.1007/s10143-014-0593-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 09/09/2014] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
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Abstract
Neuronavigation has become an ubiquitous tool in the surgical management of brain tumors. This review describes the use and limitations of current neuronavigational systems for brain tumor biopsy and resection. Methods for integrating intraoperative imaging into neuronavigational datasets developed to address the diminishing accuracy of positional information that occurs over the course of brain tumor resection are discussed. In addition, the process of integration of functional MRI and tractography into navigational models is reviewed. Finally, emerging concepts and future challenges relating to the development and implementation of experimental imaging technologies in the navigational environment are explored.
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Affiliation(s)
- Daniel A Orringer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Shinoda J, Yokoyama K, Miwa K, Ito T, Asano Y, Yonezawa S, Yano H. Epilepsy surgery of dysembryoplastic neuroepithelial tumors using advanced multitechnologies with combined neuroimaging and electrophysiological examinations. Epilepsy Behav Case Rep 2013; 1:97-105. [PMID: 25667839 PMCID: PMC4150595 DOI: 10.1016/j.ebcr.2013.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/26/2022]
Abstract
Purpose We report three cases of dysembryoplastic neuroepithelial tumor (DNT) with intractable epilepsy which were successfully treated with surgery. Methods In all cases, technology beyond the routine workup was critical to success. Preoperative magnetic resonance imaging, 18F-fluorodeoxyglucose positron emission tomography (PET), 11C-methionine-PET, interictal electroencephalography, and intraoperative electrocorticography were utilized in all patients. In individual cases, however, additional procedures such as preoperative magnetoencephalography (Case 1), diffusion tensor fiber tractography, a neuronavigation system, and intraoperative somatosensory-evoked potential (Case 2), and fiber tractography and the neuronavigation-guided fence-post tube technique (Case 3) were instrumental. Results In all the cases, the objectives of total tumor resection, resection of the epileptogenic zone, and complete postoperative seizure control and the avoidance of surgical complications were achieved. Conclusions Dysembryoplastic neuroepithelial tumor is commonly associated with medically intractable epilepsy, and surgery is frequently utilized. As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits. We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Kazutoshi Yokoyama
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Kazuhiro Miwa
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Takeshi Ito
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Shingo Yonezawa
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan
| | - Hirohito Yano
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Japan
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