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Xiao Y, Yan CXB, Drouin S, De Nigris D, Kochanowska A, Collins DL. User-friendly freehand ultrasound calibration using Lego bricks and automatic registration. Int J Comput Assist Radiol Surg 2016; 11:1703-11. [PMID: 26984553 DOI: 10.1007/s11548-016-1368-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE As an inexpensive, noninvasive, and portable clinical imaging modality, ultrasound (US) has been widely employed in many interventional procedures for monitoring potential tissue deformation, surgical tool placement, and locating surgical targets. The application requires the spatial mapping between 2D US images and 3D coordinates of the patient. Although positions of the devices (i.e., ultrasound transducer) and the patient can be easily recorded by a motion tracking system, the spatial relationship between the US image and the tracker attached to the US transducer needs to be estimated through an US calibration procedure. Previously, various calibration techniques have been proposed, where a spatial transformation is computed to match the coordinates of corresponding features in a physical phantom and those seen in the US scans. However, most of these methods are difficult to use for novel users. METHODS We proposed an ultrasound calibration method by constructing a phantom from simple Lego bricks and applying an automated multi-slice 2D-3D registration scheme without volumetric reconstruction. The method was validated for its calibration accuracy and reproducibility. RESULTS Our method yields a calibration accuracy of [Formula: see text] mm and a calibration reproducibility of 1.29 mm. CONCLUSION We have proposed a robust, inexpensive, and easy-to-use ultrasound calibration method.
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Affiliation(s)
- Yiming Xiao
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4.
| | - Charles Xiao Bo Yan
- Department of Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon Drouin
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4
| | | | - Anna Kochanowska
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4
| | - D Louis Collins
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4
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Adams H, Adams HHH, Jackson C, Rincon-Torroella J, Jallo GI, Quiñones-Hinojosa A. Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis. Childs Nerv Syst 2016; 32:493-503. [PMID: 26767842 DOI: 10.1007/s00381-015-3006-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/23/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE The benefit of radical resections for glioblastoma patients remains a source of contention in the literature. Few studies have been conducted in pediatric patients, and it is becoming increasingly evident that data regarding adult glioblastoma (GB) patients cannot be generalized to pediatric patients affected by this neoplasm. A comparative effectiveness study is performed for different extent of resection (EOR) groups in the largest cohort of pediatric GB (pGB) patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used to identify pGB patients from 1988 through 2009. Multivariate- and multiple propensity score (mPS)-adjusted analyses were used to determine the effect of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival. Survival prospects were summarized using direct adjusted survival curves. RESULTS A total of 342 pGB patients were identified, and 35.4 % of patients received a GTR, 28.8 % PR, 17.3 % Bx, and 17.0 % did not undergo surgery. In our cohort, a median overall survival of 12 months was observed with 1-, 2-, and 5-year survival rates of 51.7, 28.3, and 15.7 %, respectively. EOR was a predictor of survival in both the multivariate- (P < 0.001) and mPS-adjusted model (P < 0.001). Compared to the GTR group, a higher mortality rate was observed in patients who underwent a PR (HR 1.50; 95 % CI, 1.02-2.21) or Bx (HR 1.87; 95 % CI, 1.18-2.98). There were no significant differences in (adjusted) mortality risk between the PR and Bx groups. CONCLUSION Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.
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Affiliation(s)
- Hadie Adams
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Hieab H H Adams
- Division of Neuro-Epidemiology, Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christina Jackson
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - George I Jallo
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - Alfredo Quiñones-Hinojosa
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
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Abstract
Neurosurgical intervention remains the first step in effective glioma management. Mounting evidence suggests that cytoreduction for low- and high-grade gliomas is associated with a survival benefit. Beyond conventional neurosurgical principles, an array of techniques have been refined in recent years to maximize the effect of the neurosurgical oncologist and facilitate the impact of subsequent adjuvant therapy. With intraoperative mapping techniques, aggressive microsurgical resection can be safely pursued even when tumors occupy essential functional pathways. Other adjunct techniques, such as intraoperative magnetic resonance imaging, intraoperative ultrasonography, and fluorescence-guided surgery, can be valuable tools to safely reduce the tumor burden of low- and high-grade gliomas. Taken together, this collection of surgical strategies has pushed glioma extent of resection towards the level of cellular resolution.
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Affiliation(s)
- Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
| | - Nader Sanai
- Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, USA
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54
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Jackson C, Westphal M, Quiñones-Hinojosa A. Complications of glioma surgery. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:201-18. [PMID: 26948356 DOI: 10.1016/b978-0-12-802997-8.00012-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Even with current advances in adjunctive therapies, including radiation, chemotherapy, and various clinical trials of gene therapy and immunotherapy, surgical resection remains one of the most effective treatment for intra-axial gliomas. Survival in these patients has been shown to be related to the extent of resection. In some cases, it can provide cures of long-term remission; in others, it can provide disease control when combined with the above adjunctive treatments. However, surgical resection carries its own risks and complications. These complications can be broadly divided into neurologic, regional, and systemic, including direct cortical and vascular injury, surgical wound complications, and postsurgical medical complications. Certain patient characteristics, including Karnofsky performance status score (KPS) and pathology of the tumor, have been shown to have an impact on the risk of postsurgical complications. Advancement in preoperative and intraoperative adjunct technology such as cortical mapping and navigation has improved the surgeon's ability to safely and maximally resect the tumors. It is therefore important to understand the perioperative complications after craniotomy and tumor resection and factors affecting morbidity and mortality in order for surgeons to optimally select and counsel patients who will benefit the most from surgical resection. This chapter will focus on the complications associated with craniotomy for intrinsic glioma and ways of avoiding these events.
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Affiliation(s)
- Christina Jackson
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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55
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Miller D, Sure U. Current Standards and Future Perspectives in Intraoperative Ultrasound. Neurooncol Pract 2015. [DOI: 10.1093/nop/npv047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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56
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Farnia P, Ahmadian A, Shabanian T, Serej ND, Alirezaie J. A hybrid method for non-rigid registration of intra-operative ultrasound images with pre-operative MR images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5562-5. [PMID: 25571255 DOI: 10.1109/embc.2014.6944887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years intra-operative ultrasound images have been used for many procedures in neurosurgery. The registration of intra-operative ultrasound images with preoperative magnetic resonance images is still a challenging problem. In this study a new hybrid method based on residual complexity is proposed for this problem. A new two stages method based on the matching echogenic structures such as sulci is achieved by optimizing the residual complexity (RC) value with quantized coefficients between the ultrasound image and the probabilistic map of MR image. The proposed method is a compromise between feature-based and intensity-based approaches. The evaluation is performed on both a brain phantom and patient data set. The results of the phantom data set confirmed that the proposed method outperforms the accuracy of conventional RC by 39%. Also the mean of fiducial registration errors reached to 1.45, 1.94 mm when the method was applied on phantom and clinical data set, respectively. This hybrid method based on RC enables non-rigid multimodal image registration in a computational time compatible with clinical use as well as being accurate.
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Prada F, Del Bene M, Casali C, Saladino A, Legnani FG, Perin A, Moiraghi A, Richetta C, Rampini A, Mattei L, Vetrano IG, Fornaro R, Saini M, Martegani A, DiMeco F. Intraoperative Navigated Angiosonography for Skull Base Tumor Surgery. World Neurosurg 2015; 84:1699-707. [PMID: 26193670 DOI: 10.1016/j.wneu.2015.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/04/2015] [Accepted: 07/07/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND One of the main challenges during skull base tumor surgery is identifying the relationships between the lesion and the principal intracranial vessels. To this end, neuronavigation systems based on preoperative imaging lack accuracy because of brain shift and brain deformation. Intraoperative navigated B-mode ultrasonography is useful in defining the extent of brain tumor. Doppler imaging adds information regarding flow entity in neighboring vessels. Second-generation ultrasound contrast agents improve the signal-to-noise ratio of B-mode imaging and permit the study of the vessel's course, blood flow, and perfusion characteristics of focal lesions. We report our experience using intraoperative navigated contrast-enhanced ultrasound to perform a navigated angiosonography (N-ASG) for the visualization of vessels in a series of 18 skull base tumors. METHODS We performed N-ASG in a series of 18 skull base tumors (10 meningiomas, 3 craniopharyngiomas, 2 giant pituitary adenomas, 1 posterior fossa epidermoid, 2 dermoid cysts). N-ASG was obtained after craniotomy before resecting each lesion and during tumor removal, after intravenous injection of ultrasound contrast agent. RESULTS In all 18 cases, major vessels and their branches were simultaneously identified (both high and low flow) using N-ASG, which allowed to visualize the whole length of each vessels. N-ASG was also useful in highlighting the lesion, compared with standard B-mode imaging, and showing its perfusion patterns. CONCLUSIONS N-ASG can be applied to skull base tumor surgery, providing helpful information about the relationship between principal intracranial vessels and tumors. This technique could be of assistance in approaching the tumor and avoiding vascular damages.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Alessandro Moiraghi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Carla Richetta
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Angela Rampini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Riccardo Fornaro
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA
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Pallud J, Le Van Quyen M, Bielle F, Pellegrino C, Varlet P, Cresto N, Baulac M, Duyckaerts C, Kourdougli N, Chazal G, Devaux B, Rivera C, Miles R, Capelle L, Huberfeld G. Cortical GABAergic excitation contributes to epileptic activities around human glioma. Sci Transl Med 2015; 6:244ra89. [PMID: 25009229 DOI: 10.1126/scitranslmed.3008065] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Brain gliomas are highly epileptogenic. Excitatory glutamatergic mechanisms are involved in the generation of epileptic activities in the neocortex surrounding gliomas. However, chloride homeostasis is known to be perturbed in glioma cells. Thus, the contribution of γ-aminobutyric acidergic (GABAergic) mechanisms that depend on intracellular chloride merits closer study. We studied the occurrence, networks, cells, and signaling basis of epileptic activities in neocortical slices from the peritumoral surgical margin resected around human brain gliomas. Postoperative glioma tissue from 69% of patients spontaneously generated interictal-like discharges, synchronized, with a high-frequency oscillation signature, in superficial layers of neocortex around areas of glioma infiltration. Interictal-like events depended both on glutamatergic AMPA receptor-mediated transmission and on depolarizing GABAergic signaling. GABA released by interneurons depolarized 65% of pyramidal cells, in which chloride homeostasis was perturbed because of changes in expression of neuronal chloride cotransporters: KCC2 (K-Cl cotransporter 2) was reduced by 42% and expression of NKCC1 (Na-K-2Cl cotransporter 1) increased by 144%. Ictal-like activities were initiated by convulsant stimuli exclusively in these epileptogenic areas. This study shows that epileptic activities are sustained by excitatory effects of GABA in human peritumoral neocortex, as reported in temporal lobe epilepsies, suggesting that both glutamate and GABA signaling and cellular chloride regulation processes, all also involved in oncogenesis as already shown, induce an imbalance between synaptic excitation and inhibition underlying epileptic discharges in glioma patients. Thus, the control of chloride in neurons and glioma cells may provide a therapeutic target for patients with epileptogenic gliomas.
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Affiliation(s)
- Johan Pallud
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France.,Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France.,Université Paris Descartes, France
| | - Michel Le Van Quyen
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Franck Bielle
- Service de Neuropathologie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Christophe Pellegrino
- INMED, Parc Scientifique de Luminy, Marseille, France.,Université de la Méditerranée, UMR S901 Aix-Marseille Université, Marseille, France
| | - Pascale Varlet
- Service de Neuropathologie, Centre Hospitalier Sainte-Anne, Paris, France
| | - Noemie Cresto
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Michel Baulac
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France.,Unité d'Epileptologie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Charles Duyckaerts
- Service de Neuropathologie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Nazim Kourdougli
- INMED, Parc Scientifique de Luminy, Marseille, France.,Université de la Méditerranée, UMR S901 Aix-Marseille Université, Marseille, France
| | - Geneviève Chazal
- INMED, Parc Scientifique de Luminy, Marseille, France.,Université de la Méditerranée, UMR S901 Aix-Marseille Université, Marseille, France
| | - Bertrand Devaux
- Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, Paris, France.,Université Paris Descartes, France
| | - Claudio Rivera
- INMED, Parc Scientifique de Luminy, Marseille, France.,Université de la Méditerranée, UMR S901 Aix-Marseille Université, Marseille, France.,Neuroscience Center, University of Helsinki, Finland
| | - Richard Miles
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France
| | - Laurent Capelle
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France.,Service de Neurochirurgie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Gilles Huberfeld
- Institut du Cerveau et de la Moelle Epinière, INSERM UMRS975, CNRS UMR7225, Université Pierre et Marie Curie (UPMC), Paris, France.,Service de Neuropathologie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Unité d'Epileptologie, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Département de Neurophysiologie, UPMC, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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Mohammadi AM, Sullivan TB, Barnett GH, Recinos V, Angelov L, Kamian K, Vogelbaum MA. Use of high-field intraoperative magnetic resonance imaging to enhance the extent of resection of enhancing and nonenhancing gliomas. Neurosurgery 2014; 74:339-48; discussion 349; quiz 349-50. [PMID: 24368543 DOI: 10.1227/neu.0000000000000278] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (IoMRI) is used to improve the extent of resection of brain tumors. Most previous studies evaluating the utility of IoMRI have focused on enhancing tumors. OBJECTIVE To report our experience with the use of high-field IoMRI (1.5 T) for both enhancing and nonenhancing gliomas. METHODS An institutional review board-approved retrospective review was performed of 102 consecutive glioma patients (104 surgeries, 2010-2012). Pre-, intra-, and postoperative tumor volumes were assessed. Analysis was performed with the use of volumetric T2 images in 43 nonenhancing and 13 minimally enhancing tumors and with postcontrast volumetric magnetization-prepared rapid gradient-echo images in 48 enhancing tumors. RESULTS In 58 cases, preoperative imaging showed tumors likely to be amenable to complete resection. Intraoperative electrocorticography was performed in 32 surgeries, and 14 cases resulted in intended subtotal resection of tumors due to involvement of deep functional structures. No further resection (complete resection before IoMRI) was required in 25 surgeries, and IoMRI showed residual tumor in 79 patients. Of these, 25 surgeries did not proceed to further resection (9 due to electrocorticography findings, 14 due to tumor in deep functional areas, and 2 due to surgeon choice). Additional resection that was performed in 54 patients resulted in a final median residual tumor volume of 0.21 mL (0.6%). In 79 patients amenable to complete resection, the intraoperative median residual tumor volume for the T2 group was higher than for the magnetization-prepared rapid gradient-echo group (1.088 mL vs 0.437 mL; P = .049), whereas the postoperative median residual tumor volume was not statistically significantly different between groups. CONCLUSION IoMRI enhances the extent of resection, particularly for nonenhancing gliomas.
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Affiliation(s)
- Alireza Mohammad Mohammadi
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Oliveira MDL, Picarelli H, Menezes MR, Teixeira MJ, Bor-Seng-Shu E. Using contrast-enhanced ultrasound for brain tumor surgery. Neurosurgery 2014; 76:E104-5. [PMID: 25255267 DOI: 10.1227/neu.0000000000000571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Marcelo de Lima Oliveira
- Divison of Neurological Surgery Hospital das Clínicas, School of Medicine University of São Paulo São Paulo, Brazil
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Fomekong E, Duprez T, Docquier MA, Ntsambi G, Maiter D, Raftopoulos C. Intraoperative 3T MRI for pituitary macroadenoma resection: Initial experience in 73 consecutive patients. Clin Neurol Neurosurg 2014; 126:143-9. [PMID: 25255158 DOI: 10.1016/j.clineuro.2014.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a single-center experience with a 3T intraoperative magnetic resonance imaging (iMRI) to assess transsphenoidal microsurgery on pituitary macroadenomas. METHODS In a dual, independent operating room (OR) magnetic resonance imaging (MRI) suite, the operating table with the anesthetized patient was moved on rail tracks once a supposed maximized resection was reached to the MRI room for intraoperative image acquisition and interpretation. After the assessment of the iMRI images, the neurosurgeon evaluated whether additional resection was still possible. The resection rates were assessed on iMRI and postoperative MRI at 3 months. RESULTS A total of 73 macroadenomas benefited from an iMRI from March 2006 to October 2011. The gross total resection (GTR) rate at the time of the first iMRI was 58.9% (n=43). Based on the iMRI, eight patients (10.9%) underwent a second surgical resection. In 3 cases, the intraoperative imaging results were suspicious for a minor residue but not convincing enough for further surgery. Fortunately, the 3 months postoperative MRI control did not disclose any residual tumor in these cases. Finally, the GTR rate at the 3-month postoperative MRI increased to 72.6% (n=53). CONCLUSIONS 3T intraoperative MRI offered excellent quality images. Its use during transsphenoidal microsurgery on pituitary macroadenomas led to an increase not only in the extent of tumor resection (in 8 patients) but also in the rate of radical resections (69% instead of 60%). No complications due to the iMRI procedure were observed.
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Affiliation(s)
- Edward Fomekong
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Agnès Docquier
- Department of Anesthesiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Glennie Ntsambi
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Department of Internal Medicine, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Choudhri AF, Klimo P, Auschwitz TS, Whitehead MT, Boop FA. 3T intraoperative MRI for management of pediatric CNS neoplasms. AJNR Am J Neuroradiol 2014; 35:2382-7. [PMID: 25059696 DOI: 10.3174/ajnr.a4040] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors. MATERIALS AND METHODS We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging-related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed. RESULTS One hundred ninety-four patients underwent intraoperative MRI-guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma (n = 31, 19%), low-grade glioma (n = 31, 19%), and medulloblastoma (n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging-related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was <1% (n = 1), and no patient required additional postoperative MR imaging during the same hospital stay. CONCLUSIONS Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.
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Affiliation(s)
- A F Choudhri
- From the Departments of Radiology (A.F.C., M.T.W.) Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee
| | - P Klimo
- Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee
| | | | - M T Whitehead
- From the Departments of Radiology (A.F.C., M.T.W.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Department of Radiology (M.T.W.), Children's National Medical Center, Washington, DC
| | - F A Boop
- Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee
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Brain-shift compensation by non-rigid registration of intra-operative ultrasound images with preoperative MR images based on residual complexity. Int J Comput Assist Radiol Surg 2014; 10:555-62. [DOI: 10.1007/s11548-014-1098-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
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Abstract
Malignant astrocytomas constitute the most aggressive and common primary tumors of the central nervous system. The standard treatment protocol for these tumors involves maximum safe surgical resection with adjuvant chemoradiotherapy. Despite numerous advances in surgical techniques and adjuncts, as well as the ongoing renaissance in the genetic and molecular characterization of these tumors, malignant astrocytomas continue to be associated with poor prognosis, with median overall survival averaging 15 months for grade IV astrocytomas after standard-of-care treatment. In this article, the goals, principles, techniques, prognostic factors, and modern outcomes of malignant astrocytoma surgery are reviewed. Particular attention is paid to contemporary methods of neuronavigation and functional mapping, the prognostic significance of the extent of resection, surgically delivered adjunctive therapies, and future avenues of research.
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Affiliation(s)
- Eli T Sayegh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shayan Fakurnejad
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel E Oyon
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Prada F, Del Bene M, Mattei L, Casali C, Filippini A, Legnani F, Mangraviti A, Saladino A, Perin A, Richetta C, Vetrano I, Moiraghi A, Saini M, DiMeco F. Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery. J Ultrasound 2014; 17:243-51. [PMID: 25177400 DOI: 10.1007/s40477-014-0111-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/19/2022] Open
Abstract
The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Luca Mattei
- Università degli Studi di Milano, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Assunta Filippini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Federico Legnani
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | | | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Carla Richetta
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Ignazio Vetrano
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Alessandro Moiraghi
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Department of Neurosurgery, Johns Hopkins University, Baltimore, USA
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66
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Fluorescein-guided surgery for malignant gliomas: a review. Neurosurg Rev 2014; 37:547-57. [DOI: 10.1007/s10143-014-0546-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/08/2014] [Accepted: 01/26/2014] [Indexed: 01/11/2023]
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El Beltagy MA, Atteya MME. The benefits of navigated intraoperative ultrasonography during resection of fourth ventricular tumors in children. Childs Nerv Syst 2013; 29:1079-88. [PMID: 23609897 DOI: 10.1007/s00381-013-2103-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Safe and radical excision of pediatric fourth ventricular tumors is by far the best line of management. Pediatric fourth ventricular tumor surgery is a challenge for neurosurgeons. The aim of the study is to present the authors' experience and to evaluate the possible benefits of neuro-navigated intraoperative ultrasonography (NIOUS) during the surgery of fourth ventricular tumors in children. METHODS Nonrandomized clinical trial study was conducted on 60 children with fourth ventricular tumors who were treated at Children's Cancer Hospital-Egypt. Mean age was 5.2 (±2.6) years. Thirty cases were operated upon utilizing the conventional microneurosurgical techniques. Another 30 cases were operated upon utilizing the NIOUS technique. RESULTS Total tumor excision was achieved in 29 cases (96.7%) of NIOUS group versus 24 cases (80%) in the conventional group. Mean operative time NIOUS group was 150 min [standard deviation (SD) = 18.28) versus 140.6 min (SD = 18.6) in the conventional group (p value = 0.055). The mean operative blood loss was 67.5 ml (SD = 17) in NIOUS group versus 71 ml (SD = 15.4) in the conventional group. Postoperative cerebellar mutism occurred in one case (3.3%) of NIOUS group versus in six cases (20%) of the conventional group. CONCLUSIONS Integration of navigated intraoperative ultrasonography in surgery of pediatric fourth ventricular tumors is a useful technology. It safely monitors maximum stepwise tumor excision. It is associated with less operative morbidity without significantly added operative time. It is a real-time, cost-effective, easily applicable, and easily interpretable tool that could substitute the use of intraoperative MRI especially in pediatric neurosurgery.
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Affiliation(s)
- Mohamed A El Beltagy
- Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. .,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Mostafa M E Atteya
- Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Picarelli H, Oliveira MDL, Bor-Seng-Shu E, Ribas ESC, Santos AM, Teixeira MJ. Intraoperative ultrasonography for presumed brain metastases: a case series study. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:793-8. [PMID: 23060106 DOI: 10.1590/s0004-282x2012001000008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/15/2012] [Indexed: 11/22/2022]
Abstract
UNLABELLED Brain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. METHODS To evaluate the use of IOUS for BM resection, 20 consecutive patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.
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Affiliation(s)
- Helder Picarelli
- Division of Neurological Surgery, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, São Paulo SP, Brazil.
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3D Rigid Registration of Intraoperative Ultrasound and Preoperative MR Brain Images Based on Hyperechogenic Structures. Int J Biomed Imaging 2012; 2012:531319. [PMID: 22315583 PMCID: PMC3270552 DOI: 10.1155/2012/531319] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 10/10/2011] [Accepted: 10/13/2011] [Indexed: 11/18/2022] Open
Abstract
The registration of intraoperative ultrasound (US) images with preoperative magnetic resonance (MR) images is a challenging problem due to the difference of
information contained in each image modality. To overcome this difficulty, we
introduce a new probabilistic function based on the matching of cerebral hyperechogenic structures. In brain imaging, these structures are the liquid interfaces such as the cerebral falx and the sulci, and the lesions when the corresponding tissue is hyperechogenic. The registration procedure is achieved by maximizing the joint probability for a voxel to be included in hyperechogenic structures in both modalities. Experiments were carried out on real datasets acquired during neurosurgical procedures. The proposed validation framework is based on (i) visual assessment, (ii) manual expert estimations , and (iii) a robustness study. Results show that the proposed method (i) is visually efficient, (ii) produces no statistically different registration accuracy compared to manual-based expert registration, and (iii) converges robustly. Finally, the computation time required by our method is compatible with intraoperative use.
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70
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Affiliation(s)
- Marta Penas-Prado
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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71
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Chen B, Wang H, Ge P, Zhao J, Li W, Gu H, Wang G, Luo Y, Chen D. Gross total resection of glioma with the intraoperative fluorescence-guidance of fluorescein sodium. Int J Med Sci 2012; 9:708-14. [PMID: 23091408 PMCID: PMC3477680 DOI: 10.7150/ijms.4843] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/17/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE High dose fluorescein sodium has been utilized for fluorescence-guided tumor resection with conflicting reports on the efficacy of this procedure. The aim of this study was to reevaluate the utility and clinical limitations of using fluorescein sodium for the treatment and resection of glioma brain tumors. METHODS Patients diagnosed with glioma were divided into two groups with a total of 22 patients enrolled in the study: 1) the study group (n=10), patients that received intravenous injection of fluorescein sodium and 2) the control group (n=12), patients that did not receive injections during surgical resection. Quality of life was evaluated according to Karnofsky Performance Scale (KPS) score and neurological status. Fluorescein sodium was intravenously injected at a dose of 15-20mg/kg of body weight. Glioma resection was evaluated preoperative and postoperatively with enhanced Magnetic Resonance Imaging (MRI). RESULTS Significant differences in the gross total resection (GTR) rates were observed between the two patient groups (Fisher's Exact Test p=0.047). Progressive free survival was significantly longer in the study group (Student's T-Test p=0.033) as well as in the GTR group (Student's T-Test p=0.0001) compared to the control and non-GTR groups, respectively. Three patients in the study group and four patients in the control group had transient neurological deterioration. One patient in the control group had permanent hemiplegia. CONCLUSION The intraoperative utility of using fluorescein sodium can significantly increase the GTR rate without obvious deterioration. In addition, we find that it is better to apply the fluorescein sodium in the cases with BBB (blood-brain barrier) disruption, which had been enhanced in preoperative MRI.
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Affiliation(s)
- Bo Chen
- Department of neurosurgery The First Hospital of Jilin University, Changchun, Jilin 130021, China
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72
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Post-craniotomy neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning. Neurosurg Rev 2011; 35:263-8; discussion 268. [DOI: 10.1007/s10143-011-0357-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 06/19/2011] [Accepted: 07/31/2011] [Indexed: 10/16/2022]
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Moiyadi A, Shetty P. Objective assessment of utility of intraoperative ultrasound in resection of central nervous system tumors: A cost-effective tool for intraoperative navigation in neurosurgery. J Neurosci Rural Pract 2011; 2:4-11. [PMID: 21716843 PMCID: PMC3123010 DOI: 10.4103/0976-3147.80077] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Localization and delineation of extent of lesions is critical for safe maximal resection of brain and spinal cord tumors. Frame-based and frameless stereotaxy and intraoperative MRI are costly and not freely available especially in economically constrained nations. Intraoperative ultrasound has been around for a while but has been relegated to the background. Lack of objective evidence for its usefulness and the perceived “user unfriendliness” of US are probably responsible for this. We recount our experience with this “forgotten” tool and propose an objective assessment score of its utility in an attempt to revive this practice. Materials and Methods: Seventy seven intraoperative ultrasound (IOUS) studies were carried out in patients with brain and spinal cord tumors. Seven parameters were identified to measure the “utility” of the IOUS and a “utility score” was devised (minimum 0 and maximum 7). Individual parameter and overall scores were calculated for each case. Results: IOUS was found to be useful in many ways. The median overall score was 6 (mean score 5.65). There were no scores less than 4 with the majority demonstrating usefulness in 5 or more parameters (91%). The use of the IOUS significantly influenced the performance of the surgery in these cases without significantly prolonging surgery. Conclusions: The IOUS is a very useful tool in intraoperative localization and delineation of lesions and planning various stages of tumor resection. It is easy, convenient, reliable, widely available, and above all a cost-effective tool. It should be increasingly used by neurosurgeons in the developing world where costlier intraoperative localization and imaging is not available freely.
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Affiliation(s)
- Aliasgar Moiyadi
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre, Parel, Mumbai, India
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74
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Two-dimensional high-end ultrasound imaging compared to intraoperative MRI during resection of low-grade gliomas. J Clin Neurosci 2011; 18:669-73. [DOI: 10.1016/j.jocn.2010.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 11/21/2022]
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75
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Wong JM, Governale LS, Friedlander RM. Use of a simple internal fiducial as an adjunct to enhance intraoperative ultrasound-assisted guidance: technical note. Neurosurgery 2011; 69:ons34-9; discussion ons39. [PMID: 21346649 DOI: 10.1227/neu.0b013e3182124851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Image-based navigational techniques have been used increasingly in neurosurgery to improve intraoperative precision. These techniques, however, have the disadvantage of inherent inaccuracies, which are significant especially when targeting small, subcortical lesions in eloquent areas. Intraoperative ultrasound serves as a useful, real-time adjunct to these techniques, but at times, precise correlation of the true anatomical location to the ultrasound image can be challenging. OBJECTIVE : To improve the accuracy and precision of intraoperative ultrasound by using a simple internal fiducial marker made from materials already present on the sterile field. METHODS We present 3 cases (2 cranial, 1 spinal) of small lesions with deep and eloquent locations. Magnetic resonance imaging (MRI)-based frameless stereotaxy or spinal fluoroscopy was used to modify the incision and to approximate the surgical trajectory, which was marked intradurally with a small piece of Gelfoam soaked in autologous blood. Ultrasound was used to visualize the echogenic lesion, and the precise trajectory was then refined using the echogenic blood-soaked Gelfoam on the cortical or spinal cord surface. RESULTS In all 2 patients, the combined use of MRI-based frameless stereotaxy (cranial cases only) and ultrasound guidance minimized dissection through normal tissue. All cases resulted in a gross total resection and no added long-term surgical morbidity. CONCLUSION We describe a neuronavigational tool to aid in the precise localization of a subcortical or spinal lesion, particularly one that is small and in close proximity to eloquent areas.
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Affiliation(s)
- Judith M Wong
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Solheim O, Selbekk T, Jakola AS, Unsgård G. Ultrasound-guided operations in unselected high-grade gliomas--overall results, impact of image quality and patient selection. Acta Neurochir (Wien) 2010; 152:1873-86. [PMID: 20652608 DOI: 10.1007/s00701-010-0731-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/23/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND A number of tools, including intraoperative ultrasound, are reported to facilitate surgical resection of high-grade gliomas. However, results from selected surgical series do not necessarily reflect the effectiveness in common neurosurgical practice. Delineation of seemingly similar brain tumours vary in different ultrasound-guided operations, perhaps limiting usefulness in certain patients. METHODS We explore and describe the results associated with use of the SonoWand system with intraoperative ultrasound in a population-based, unselected, high-grade glioma series. Surgeons filled out questionnaires about presumed extent of resection, use of ultrasound and ultrasound image quality just after surgery. We evaluate the impact of ultrasound image quality. We also explore the importance of patient selection for surgical results. RESULTS Of 156 consecutive malignant glioma operations, 142 (91%) were resections whilst 14 (9%) were only biopsies. We achieved gross total resection (GTR) in 37% of all high-grade glioma resections, whilst worsening of functional status was seen in 13%. The risk of getting worse was significantly higher in reoperations, resections in eloquent locations, resections in cases with poor ultrasound image quality, resection when surgeons' resection grade estimates were inaccurate and in cases with surgery-related complications. Aiming for GTR, unifocality of lesion, non-eloquent location and medium or good ultrasound image quality were identified as independent factors associated with achieving GTR. CONCLUSION We report good overall results, both in terms of resection grades and functional outcome in consecutive malignant glioma resections, in which intraoperative ultrasound was used in 95%. We observed a seeming dose-response relationship between ultrasound image quality and clinical and radiological results. This may suggest that better ultrasound facilitates better surgery. The study also clearly demonstrates that, in terms of surgical results, the selection of patients seems to be much more important than the selection of surgical tools.
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Affiliation(s)
- Ole Solheim
- Department of Neuroscience, Norwegian University of Science and Technology, 7005, Trondheim, Norway.
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Ng WH, Mukhida K, Rutka JT. Image guidance and neuromonitoring in neurosurgery. Childs Nerv Syst 2010; 26:491-502. [PMID: 20174925 DOI: 10.1007/s00381-010-1083-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 01/18/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The localization of tumors and epileptogenic foci within the somatosensory or language cortex of the brain of a child poses unique neurosurgical challenges. In the past, lesions in these regions were not treated aggressively for fear of inducing neurological deficits. As a result, while function may have been preserved, the underlying disease may not have been optimally treated, and repeat neurosurgical procedures were frequently required. Today, with the advent of preoperative brain mapping, image guidance or neuronavigation, and intraoperative monitoring, peri-Rolandic and language cortex lesions can be approached directly and definitively with a high degree of confidence that neurosurgical function will be maintained. METHODS AND RESULTS The preoperative brain maps can now be achieved with magnetic resonance imaging (MRI), functional MRI, magnetoencephalography, and diffusion tensor imaging. Image guidance systems have improved significantly and include the use of the intraoperative MRI. Somatosensory, motor, and brainstem auditory-evoked potentials are used as standard neuromonitoring techniques in many centers around the world. Added to this now is the use of continuous train-of-five monitoring of the integrity of the corticospinal tract while operating in the peri-Rolandic region. CONCLUSION We are in an era where continued advancements can be expected in mapping additional pathways such as visual, memory, and hearing pathways. With these new advances, neurosurgeons can expect to significantly improve their surgical outcomes further.
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Affiliation(s)
- Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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78
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Arbel T, Morandi X, Comeau RM, Collins DL. Automatic non-linear MRI-ultrasound registration for the correction of intra-operative brain deformations. ACTA ACUST UNITED AC 2010; 9:123-36. [PMID: 16192052 DOI: 10.3109/10929080500079248] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Movements of brain tissue during neurosurgical procedures reduce the effectiveness of using pre-operative images for intra-operative surgical guidance. In this paper, we explore the use of acquiring intra-operative ultrasound (US) images for the quantification of and correction for non-linear brain deformations. MATERIALS AND METHODS We will present a multi-modal registration strategy that automatically matches pre-operative images (e.g., MRI) to intra-operative US to correct for these deformations. The strategy involves using the predicted appearance of neuroanatomical structures in US images to build "pseudo ultrasound" images based on pre-operative segmented MRI. These images can then be non-linearly registered to intra-operative US using cross-correlation measurements within the ANIMAL package. The feasibility of the theory is demonstrated through its application to clinical patient data acquired during 12 neurosurgical procedures. RESULTS Results of applying the method to 12 surgical cases, including those with brain tumors and selective amygdalo-hippocampectomies, indicate that our strategy significantly recovers from non-linear brain deformations occurring during surgery. Quantitative results at tumor boundaries indicate up to 87% correction for brain shift. CONCLUSIONS Qualitative and quantitative examination of the results indicate that the system is able to correct for non-linear brain deformations in clinical patient data.
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Affiliation(s)
- Tal Arbel
- Department of Electrical and Computer Engineering, Centre for Intelligent Machines, McGill University, Montréal, Québec, Canada.
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79
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Grunert P, Müller-forell W, Darabi K, Reisch R, Busert C, Hopf N, Perneczky A. Basic Principles and Clinical Applications of Neuronavigation and Intraoperative Computed Tomography. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929089809148141] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Selbekk T, Brekken R, Solheim O, Lydersen S, Hernes TAN, Unsgaard G. Tissue motion and strain in the human brain assessed by intraoperative ultrasound in glioma patients. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:2-10. [PMID: 19854562 DOI: 10.1016/j.ultrasmedbio.2009.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 03/24/2009] [Accepted: 05/11/2009] [Indexed: 05/05/2023]
Abstract
The objective of the study was to investigate tissue motion and strain imposed by cardiovascular pulsation in pathologic and normal brain parenchyma, as quantified from in vivo ultrasound data. Ultrasound acquired during surgery of 16 patients with glial tumors was retrospectively processed and analyzed. The tissue velocity was quantified at depths of 1cm, 2cm and 3cm from brain cortex to investigate spatial dependency with depth. Comparison of strain and velocity in tumor and adjacent normal parenchyma was performed by selecting two regions-of-interest in the hyperechoic tumor and two regions in the low-echogenic areas interpreted as mainly normal tissue with some degree of tumor cell infiltration. The absolute maximum tissue velocity is seen to increase with increasing depths in 14 of 16 cases (87.5%). The maximum tissue velocities in the four regions close to the ultrasound visible tumor border are not statistically different (p=0.163 to p=0.975). The strain magnitudes are significantly higher in the regions with expected normal brain parenchyma than in regions with expected glial tumor tissue, both for the two regions being closest to the tumor border (p=0.0004) and for the two regions further away from the tumor border (p=0.0009). We conclude that the velocity of the brain parenchyma imposed by arterial pulsation during a cardiac cycle is generally increasing with increasing depth from cortex. The maximum velocity appears to be similar in regions with expected normal brain and tumor tissue, thus, does not seem to be affected by pathology. Strain magnitude is, however, a suitable parameter for discrimination of glial tumor and normal brain parenchyma. (E-mail: Tormod.Selbekk@sintef.no).
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Affiliation(s)
- Tormod Selbekk
- National Centre for 3D Ultrasound in Surgery, St. Olavs Hospital, Trondheim, Norway.
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81
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Kim C, Qin R, Xu JS, Wang LV, Xu R. Multifunctional microbubbles and nanobubbles for photoacoustic and ultrasound imaging. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:010510. [PMID: 20210423 PMCID: PMC2839794 DOI: 10.1117/1.3302808] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 01/01/2010] [Accepted: 01/06/2010] [Indexed: 05/19/2023]
Abstract
We develop a novel dual-modal contrast agent-encapsulated-ink poly(lactic-co-glycolic acid) (PLGA) microbubbles and nanobubbles-for photoacoustic and ultrasound imaging. Soft gelatin phantoms with embedded tumor simulators of encapsulated-ink PLGA microbubbles and nanobubbles in various concentrations are clearly shown in both photoacoustic and ultrasound images. In addition, using photoacoustic imaging, we successfully image the samples positioned below 1.8-cm-thick chicken breast tissues. Potentially, simultaneous photoacoustic and ultrasound imaging enhanced by encapsulated-dye PLGA microbubbles or nanobubbles can be a valuable tool for intraoperative assessment of tumor boundaries and therapeutic margins.
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82
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Lumenta CB, Gumprecht H, Krammer MJ. Image-Guided Neurosurgery. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gerganov VM, Samii A, Akbarian A, Stieglitz L, Samii M, Fahlbusch R. Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high–field strength MR imaging for tumor resection control: a prospective comparative study. J Neurosurg 2009; 111:512-9. [DOI: 10.3171/2009.2.jns08535] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Ultrasound may be a reliable but simpler alternative to intraoperative MR imaging (iMR imaging) for tumor resection control. However, its reliability in the detection of tumor remnants has not been definitely proven. The aim of the study was to compare high-field iMR imaging (1.5 T) and high-resolution 2D ultrasound in terms of tumor resection control.
Methods
A prospective comparative study of 26 consecutive patients was performed. The following parameters were compared: the existence of tumor remnants after presumed radical removal and the quality of the images. Tumor remnants were categorized as: detectable with both imaging modalities or visible only with 1 modality.
Results
Tumor remnants were detected in 21 cases (80.8%) with iMR imaging. All large remnants were demonstrated with both modalities, and their image quality was good. Two-dimensional ultrasound was not as effective in detecting remnants < 1 cm. Two remnants detected with iMR imaging were missed by ultrasound. In 2 cases suspicious signals visible only on ultrasound images were misinterpreted as remnants but turned out to be a blood clot and peritumoral parenchyma. The average time for acquisition of an ultrasound image was 2 minutes, whereas that for an iMR image was ~ 10 minutes. Neither modality resulted in any procedure-related complications or morbidity.
Conclusions
Intraoperative MR imaging is more precise in detecting small tumor remnants than 2D ultrasound. Nevertheless, the latter may be used as a less expensive and less time-consuming alternative that provides almost real-time feedback information. Its accuracy is highest in case of more confined, deeply located remnants. In cases of more superficially located remnants, its role is more limited.
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84
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Kim SS, McCutcheon IE, Suki D, Weinberg JS, Sawaya R, Lang FF, Ferson D, Heimberger AB, DeMonte F, Prabhu SS. Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 2009; 64:836-45; discussion 345-6. [PMID: 19404147 DOI: 10.1227/01.neu.0000342405.80881.81] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients. METHODS Patients with intracerebral tumors near and/or within eloquent cortices (n = 309) were clinically evaluated before surgery, immediately after, and 1 month and 3 months after surgery. Craniotomy was tailored to encompass tumor plus adjacent areas presumed to contain eloquent cortex. Intraoperative cortical stimulation for language, motor, and/or sensory function was performed in all patients to safely maximize surgical resection. RESULTS A gross total resection (> or =95%) was obtained in 64%, and a resection of 85% or more was obtained in 77% of the procedures. Eloquent areas were identified in 65% of cases, and in that group, worsened neurological deficits were observed in 21% of patients, whereas only 9% with negative mapping sustained such deficits (P < 0.01). Intraoperative neurological deficits occurred in 64 patients (21%); of these, 25 (39%) experienced worsened neurological outcome at 1 month, whereas only 27 of 245 patients (11%) without intraoperative changes had such outcomes (P < 0.001). At 1 month, 83% overall showed improved or stable neurological status, whereas 17% had new or worse deficits; however, at 3 months, 7% of patients had a persistent neurological deficit. Extent of resection less than 95% also predicted worsening of neurological status (P < 0.025). CONCLUSION Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.
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Affiliation(s)
- Stefan S Kim
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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85
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Martinez R, Völter C, Behr R. Parameters assessing neurological status in malignant glioma patients: prognostic value for survival and relapse-free time. Br J Neurosurg 2009; 22:557-62. [DOI: 10.1080/02688690802166424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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86
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Kremer P, Fardanesh M, Ding R, Pritsch M, Zoubaa S, Frei E. Intraoperative fluorescence staining of malignant brain tumors using 5-aminofluorescein-labeled albumin. Neurosurgery 2009; 64:ons53-60; discussion ons60-1. [PMID: 19240573 DOI: 10.1227/01.neu.0000335787.17029.67] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The newly developed conjugate 5-aminofluorescein (AFL)-human serum albumin (HSA) was investigated in a clinical trial for fluorescence-guided surgery of malignant brain tumors to assess its efficacy and tolerability. METHODS AFL, covalently linked to human serum albumin at a molar ratio of 1:1, was administered intravenously 0.5 to 4 days before surgery at 0.5 or 1.0 mg/kg of body weight to 13 patients aged 38 to 71 years who were suspected of having malignant gliomas. Fluorescence guidance using a 488-nm argon laser was performed during surgery at will. The extent of tumor resection was verified by early postoperative magnetic resonance imaging. Fluorescent and nonfluorescent samples were collected for neuropathology. Blood samples for laboratory and pharmacokinetic analyses were taken over the course of 4 weeks. RESULTS Fluorescence staining of tumor tissue was bright in 11 patients (84%), resulting in complete resection of fluorescent tumor tissue in 9 patients (69%). In 2 patients, residual fluorescent tumor tissue was also confirmed by magnetic resonance imaging. Neither bleaching nor penetration of AFL-HSA into the surrounding brain edema or into necrotic tissue was seen. The agreement between fluorescence and histopathology in tumor samples and samples of the tumor border was 83.3%. There were no toxic side effects. The quality of fluorescence was independent of the dose administered. The optimal time for surgery is between 1 and 4 days after AFL-HSA administration. CONCLUSION Tumor fluorescence using AFL-HSA made fluorescence-guided brain tumor resection possible, demonstrating that albumin is a suitable carrier system for selective targeting of aminofluorescein into malignant gliomas.
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Affiliation(s)
- Paul Kremer
- Department of Neurosurgery, Kopfklinikum, University of Heidelberg, Heidelberg, Germany.
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87
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Ji S, Wu Z, Hartov A, Roberts DW, Paulsen KD. Mutual-information-based image to patient re-registration using intraoperative ultrasound in image-guided neurosurgery. Med Phys 2008; 35:4612-24. [PMID: 18975707 DOI: 10.1118/1.2977728] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An image-based re-registration scheme has been developed and evaluated that uses fiducial registration as a starting point to maximize the normalized mutual information (nMI) between intraoperative ultrasound (iUS) and preoperative magnetic resonance images (pMR). We show that this scheme significantly (p<0.001) reduces tumor boundary misalignment between iUS pre-durotomy and pMR from an average of 2.5 mm to 1.0 mm in six resection surgeries. The corrected tumor alignment before dural opening provides a more accurate reference for assessing subsequent intraoperative tumor displacement, which is important for brain shift compensation as surgery progresses. In addition, we report the translational and rotational capture ranges necessary for successful convergence of the nMI registration technique (5.9 mm and 5.2 deg, respectively). The proposed scheme is automatic, sufficiently robust, and computationally efficient (<2 min), and holds promise for routine clinical use in the operating room during image-guided neurosurgical procedures.
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Affiliation(s)
- Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA.
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88
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Rygh OM, Selbekk T, Torp SH, Lydersen S, Hernes TAN, Unsgaard G. Comparison of navigated 3D ultrasound findings with histopathology in subsequent phases of glioblastoma resection. Acta Neurochir (Wien) 2008; 150:1033-41; discussion 1042. [PMID: 18773141 DOI: 10.1007/s00701-008-0017-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of the study was to compare the ability of navigated 3D ultrasound to distinguish tumour and normal brain tissue at the tumour border zone in subsequent phases of resection. MATERIALS AND METHODS Biopsies were sampled in the tumour border zone as seen in the US images before and during surgery. After resection, biopsies were sampled in the resection cavity wall. Histopathology was compared with the surgeon's image findings. RESULTS Before resection, the tumour border was delineated by ultrasound with high specificity and sensitivity (both 95%). During resection, ultrasound had acceptable sensitivity (87%), but poor specificity (42%), due to biopsies falsely classified as tumour by the surgeon. After resection, sensitivity was poor (26%), due to tumour or infiltrated tissue in several biopsies deemed normal by ultrasound, but the specificity was acceptable (88%). CONCLUSIONS Our study shows that although glioblastomas are well delineated prior to resection, there seem to be overestimation of tumour tissue during resection. After resection tumour remnants and infiltrated brain tissue in the resection cavity wall may be undetected. We believe that the benefits of intraoperative ultrasound outweigh the shortcomings, but users of intraoperative ultrasound should keep the limitations shown in our study in mind.
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89
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Senft C, Seifert V, Hermann E, Franz K, Gasser T. Usefulness of Intraoperative Ultra Low-field Magnetic Resonance Imaging in Glioma Surgery. Oper Neurosurg (Hagerstown) 2008; 63:257-66; discussion 266-7. [DOI: 10.1227/01.neu.0000313624.77452.3c] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Objective:
The aim of this study was to demonstrate the usefulness of a mobile, intraoperative 0.15-T magnetic resonance imaging (MRI) scanner in glioma surgery.
Methods:
We analyzed our prospectively collected database of patients with glial tumors who underwent tumor resection with the use of an intraoperative ultra low-field MRI scanner (PoleStar N-20; Odin Medical Technologies, Yokneam, Israel/Medtronic, Louisville, CO). Sixty-three patients with World Health Organization Grade II to IV tumors were included in the study. All patients were subjected to postoperative 1.5-T imaging to confirm the extent of resection.
Results:
Intraoperative image quality was sufficient for navigation and resection control in both high-and low-grade tumors. Primarily enhancing tumors were best detected on T1-weighted imaging, whereas fluid-attenuated inversion recovery sequences proved best for nonenhancing tumors. Intraoperative resection control led to further tumor resection in 12 (28.6%) of 42 patients with contrast-enhancing tumors and in 10(47.6%) of 21 patients with noncontrast-enhancing tumors. In contrast-enhancing tumors, further resection led to an increased rate of complete tumor resection (71.2 versus 52.4%), and the surgical goal of gross total removal or subtotal resection was achieved in all cases (100.0%). In patients with noncontrast-enhancing tumors, the surgical goal was achieved in 19 (90.5%) of 21 cases, as intraoperative MRI findings were inconsistent with postoperative high-field imaging in 2 cases.
Conclusion:
The use of the PoleStar N-20 intraoperative ultra low-field MRI scanner helps to evaluate the extent of resection in glioma surgery. Further tumor resection after intraoperative scanning leads to an increased rate of complete tumor resection, especially in patients with contrast-enhancing tumors. However, in noncontrast-enhancing tumors, the intraoperative visualization of a complete resection seems less specific, when compared with postoperative 1.5-T MRI.
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Affiliation(s)
- Christian Senft
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Elvis Hermann
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Kea Franz
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Thomas Gasser
- Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany
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90
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Koc K, Anik I, Cabuk B, Ceylan S. Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation. Br J Neurosurg 2008; 22:99-103. [PMID: 18224529 DOI: 10.1080/02688690701765524] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We have evaluated the influence of fluorescein-guided resection on gross total resection (GTR) and survival in a series of patients with GBM. Group 1 consisted of 47 patients given fluorescein and group 2 comprised 33 patients, on whom fluorescein was not used. Median survival time was 43.9 weeks in the patients given fluorescein and was 41.8 weeks in the non-fluorescein group. There was no statistically significant difference in survival between the two groups. However, the extent of resection had a powerful influence on the median survival time. Survival was 34.3 weeks after partial resection and 46.5 after GTR. Our data shows that the use of fluorescein injection is a simple procedure, which allows a significant increase in the number of patients having GTR (83 vs. 55%). Our findings are similar to a recently published multicentre Phase III randomized trial in which 5-aminolevulinic acid was used to facilitate resection of malignant glioma.
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Affiliation(s)
- K Koc
- Department of Neurosurgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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91
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Hartov A, Roberts DW, Paulsen KD. A comparative analysis of coregistered ultrasound and magnetic resonance imaging in neurosurgery. Neurosurgery 2008; 62:91-9; discussion 99-101. [PMID: 18424971 DOI: 10.1227/01.neu.0000317377.15196.45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This work presents qualitative and quantitative side-by-side comparisons of oblique coregistered magnetic resonance imaging (MRI) scans and ultrasound images obtained during 35 neurosurgical procedures. METHODS Spatially registered series of ultrasound images were recorded for subsequent off-line evaluation and comparison with corresponding preoperative MRI studies. The degree of misalignment was reduced by reregistering the target volume directly with segmented features. RESULTS The initial apparent spatial misalignment of the target volume after craniotomy ranged from 0.11 to 8.73 mm (mean, 4.01 mm). After reregistration, the mutual information in overlapping segmented features was increased, presumably evidence of a better alignment locally. Additionally, the degree of feature congruence, which was assessed quantitatively through a convex hull approximation, demonstrated that the ultrasound volume was consistently smaller than its MRI counterpart. CONCLUSION Although intraoperative ultrasound tends to be difficult to interpret by itself, when accurately coregistered with preoperative MRI scans, its potential utility as a navigational guide is enhanced.
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Affiliation(s)
- Alex Hartov
- Thayer School of Engineering, Dartmouth College, HB 8000, Hanover, NH 03755, USA.
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92
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Huwyler J, Drewe J, Krähenbuhl S. Tumor targeting using liposomal antineoplastic drugs. Int J Nanomedicine 2008; 3:21-9. [PMID: 18488413 DOI: 10.2217/17435889.3.1.21] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During the last years, liposomes (microparticulate phospholipid vesicles) have been used with growing success as pharmaceutical carriers for antineoplastic drugs. Fields of application include lipid-based formulations to enhance the solubility of poorly soluble antitumor drugs, the use of pegylated liposomes for passive targeting of solid tumors as well as vector-conjugated liposomal carriers for active targeting of tumor tissue. Such formulation and drug targeting strategies enhance the effectiveness of anticancer chemotherapy and reduce at the same time the risk of toxic side-effects. The present article reviews the principles of different liposomal technologies and discusses current trends in this field of research.
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Affiliation(s)
- Jörg Huwyler
- University of Applied Sciences Northwestern Switzerland, Institute of Pharma Technology, Muttenz, Switzerland.
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93
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Ntoukas V, Krishnan R, Seifert V. THE NEW GENERATION POLESTAR N20 FOR CONVENTIONAL NEUROSURGICAL OPERATING ROOMS. Oper Neurosurg (Hagerstown) 2008; 62:82-9; discussion 89-90. [DOI: 10.1227/01.neu.0000317376.38067.8e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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94
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Strowitzki M, Brand S, Ketter R, Steudel WI, Jenderka KV. Ultrasonic radio-frequency spectrum analysis differentiates normal and edematous brain tissue from meningioma intraoperatively. J Neuroimaging 2008; 18:73-80. [PMID: 18190500 DOI: 10.1111/j.1552-6569.2007.00173.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intraoperative ultrasound imaging of the brain is used for tumor localization and resection control. The aim of the present study was to prove whether spectral analysis of radio-frequency (rf) signals is able to improve its diagnostic capabilities by adding quantitative acoustical parameters to pure visual analysis. Meningioma was chosen as a first model because of its distinct borders during surgery as well as in ultrasound imaging. Rf signals were captured intraoperatively. Spectral analysis of rf signals was performed off-line in areas of normal brain, edematous tissue, and meningioma within the bandwidth of the transducer. At 5.0 MHz, attenuation allowed significant differentiation for normal brain versus edema (P= .00002), normal brain versus meningioma (P= .000004), and edema versus meningioma (P= .002). The slope of attenuation reached significant levels among the three groups, too. Backscatter analysis consisted of determination of the power spectral density with a significant difference for edema versus meningioma at 5 MHz (P= .02). The same was true for a relative integrated backscatter coefficient (P= .01). Frequency-dependent backscatter coefficients were estimated using a standard phantom with edema showing the highest values followed by parenchyma and meningioma. Spectral analysis of rf signals has the potential of differentiating intracranial tissues as could be shown exemplarily with meningioma in this study. If this is also true for infiltrating tumors, the method might serve as a tool to better define tumor borders, thus improving the extent of resection.
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Affiliation(s)
- Martin Strowitzki
- Department of Neurosurgery, Saarland University Medical School, Homburg-Saar, Germany.
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95
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López-Hernández F, Martínez-Lage J, Hernández-Palazón J, Reus-Pintado M, Garrido-Gómez J. Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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96
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Abstract
Abstract
TUMORS AND OTHER structural lesions located with and adjacent to the cerebral cortex present certain challenges in terms of the overall management and design of surgical strategies. This comprehensive analysis attempts to define the current understanding of cerebral localization and function and includes the latest advances in functional imaging, as well as surgical technique, including localization of tumors and neurophysiological mapping to maximize extent of resection while minimizing morbidity. Finally, it remains to be seen whether or not stimulation mapping will be the most useful way to identify function within the cortex in the future. Another potential paradigm would be to actually record baseline oscillatory rhythms within the cortex and, following presentation of a given task, determine if those rhythms are disturbed enough to identify eloquent cortex as a means of functional localization. This would be a paradigm shift away from stimulation mapping, which currently deactivates the cortex, as opposed to identifying an activation function which identifies functional cortex.
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Affiliation(s)
- Mitchel S. Berger
- Department of Neurosurgery, University of California at San Francisco, San Francisco, California
| | - Costas G. Hadjipanayis
- Department of Neurosurgery, University of California at San Francisco, San Francisco, California
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97
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Is the image guidance of ultrasonography beneficial for neurosurgical routine? ACTA ACUST UNITED AC 2007; 67:579-87; discussion 587-8. [PMID: 17512324 DOI: 10.1016/j.surneu.2006.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 07/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intraoperative US has been widely used in neurosurgical procedures. However, images are often difficult to read. In the present study, we evaluate whether the image guidance of ultrasonography is helpful for the interpretation of US scans. METHODS Twenty-nine patients with tumor were operated on with the aid of intraoperative US from January to June 2005. Image-guided sonography was used in 13 cases and nonnavigated US technology in the remaining cases. We compared the 2 technologies retrospectively. RESULTS Although image quality was good in most cases, orientation remained difficult in 8 of the 16 patients where conventional sonography was used. With the aid of image fusion for navigated sonography, the orientation was judged superior to nonnavigated US. CONCLUSION In our experience, integration of the US into the navigation system facilitates anatomical understanding. Thus, we feel that this technology is beneficial for neurosurgical routine.
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98
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Strowitzki M, Brand S, Jenderka KV. Ultrasonic radio-frequency spectrum analysis of normal brain tissue. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:522-9. [PMID: 17316962 DOI: 10.1016/j.ultrasmedbio.2006.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 08/29/2006] [Accepted: 09/07/2006] [Indexed: 05/14/2023]
Abstract
Acoustic tissue properties can be estimated using texture and/or spectral parameter analysis. Spectral analysis is based on the rf-signals whose frequency-content is commonly neglected in conventional B-mode imaging. Attenuation and backscatter values of normal brain tissue were analyzed. Unprocessed rf-data of 20 patients were sampled intraoperatively after craniotomy using a modified conventional ultrasonic device (Hitachi CS 9600) and analyzed off-line by a custom-made software routine. Before parameter estimation, influences of the diffraction pattern were compensated by means of a correction function obtained using a tissue-mimicking phantom. Attenuation of white matter showed a linear frequency dependence with a slope of 0.94 +/- 0.13 dB cm(-1) MHz(-1). The spectral slope was determined using 10 distinct frequencies between 2.5 and 5.75 MHz. Backscattering properties were analyzed by determining the power spectral density (PSD) and a relative backscatter coefficient (rel BSC) against the values derived from the tissue-mimicking phantom. PSD and rel BSC values were frequency-dependent, with highest PSD values at the probe's center frequency (-75.69 +/- 8.26 dB V(2) Hz(-1)). The corresponding rel BSC value at 5 MHz was determined as 15.39 +/- 8.26 dB. Finally, backscatter coefficients (BSC) of brain tissue were computed using the known BSC of the phantom. The data provided in this study are meant to serve as a base for intended future characterization of brain tissue that potentially allows intraoperative differentiation between normal and pathologic areas and therefore provides the surgeon with additional information for defining the extent of resection in brain more precisely.
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Affiliation(s)
- Martin Strowitzki
- Department of Neurosurgery, Saarland University Medical School, Homburg-Saar, Germany.
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99
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Lovo EE, Quintana JC, Puebla MC, Torrealba G, Santos JL, Lira IH, Tagle P. A NOVEL, INEXPENSIVE METHOD OF IMAGE COREGISTRATION FOR APPLICATIONS IN IMAGE-GUIDED SURGERY USING AUGMENTED REALITY. Oper Neurosurg (Hagerstown) 2007; 60:366-71; discussion 371-2. [PMID: 17415176 DOI: 10.1227/01.neu.0000255360.32689.fa] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Augmented reality (AR) is a technique in which an overlay of a virtual image to a live picture is performed to create a new image in which both original images coexist as a single image. This results in the visualization of internal structures through overlying tissues. The objective was to describe an easy, inexpensive, and successful method to coregister with AR in an image-guided surgery setting using the resources at hand. METHODS Cortical information was obtained with a volumetric acquisition of 200 0.8-mm thick, cerebral magnetic resonance imaging scans in an axial T1-weighted sequence. For the venous anatomy, a contrast phase at 7 mm/s velocity was used. This data was reconstructed in a three-dimensional fashion using MRIcro software (v. 1.37, freeware, courtesy of Chris Rorden) and was overlaid to a digital image of the cerebral cortex either pre- or intraoperatively. RESULTS Eight patients were studied. There was an adequate coregistration in seven of the patients as confirmed by intraoperative ultrasound, frame-based stereotaxy, or obvious anatomic homology between the three-dimensional magnetic resonance imaging scan virtual reconstruction and the live image obtained during surgery. AR was not possible in one case of a cerebellar lesion. CONCLUSION AR coregistration capabilities are adequate when revised by other intraoperative guidance devices. When performed with "freeware" software and conventional digital cameras, it is relatively inexpensive, which makes it a potential tool for surgical planning and noncontinuous intraoperative guidance in neurosurgery. Its largest drawbacks are the inability to function in deep-seated lesions and its lack of tracking devices, which gives it a noncontinuous coregistration nature.
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Affiliation(s)
- Eduardo E Lovo
- Department of Neurosurgery, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
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100
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Popescu MA, Toms SA. In vivo optical imaging using quantum dots for the management of brain tumors. Expert Rev Mol Diagn 2007; 6:879-90. [PMID: 17140375 DOI: 10.1586/14737159.6.6.879] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The surgical management of brain tumors requires the precise localization of tumor tissues within normal brain parenchyma in order to achieve accurate diagnostic biopsy and complete surgical resection. Quantum dots are optical semiconductor nanocrystals that exhibit stable, bright fluorescence. The intravenous injection of quantum dots is accompanied by reticuloendothelial system and macrophage sequestration. Macrophages infiltrate brain tumors and phagocytize intravenously injected quantum dots, optically labeling the tumors. Macrophage-mediated delivery of quantum dots to brain tumors may represent a novel technique to label tumors preoperatively. Quantum dots within tumors may be detected with optical imaging and optical spectroscopy tools, providing the surgeon with real-time optical feedback during the resection and biopsy of brain tumors.
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Affiliation(s)
- Madalina Alexandra Popescu
- Brain Tumor Institute, Desk R20, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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