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Soltani S, Guang Z, Zhang Z, Olson JJ, Robles FE. Label-free detection of brain tumors in a 9L gliosarcoma rat model using stimulated Raman scattering-spectroscopic optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210043R. [PMID: 34263579 PMCID: PMC8278780 DOI: 10.1117/1.jbo.26.7.076004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/29/2021] [Indexed: 05/22/2023]
Abstract
SIGNIFICANCE In neurosurgery, it is essential to differentiate between tumor and healthy brain regions to maximize tumor resection while minimizing damage to vital healthy brain tissue. However, conventional intraoperative imaging tools used to guide neurosurgery are often unable to distinguish tumor margins, particularly in infiltrative tumor regions and low-grade gliomas. AIM The aim of this work is to assess the feasibility of a label-free molecular imaging tool called stimulated Raman scattering-spectroscopic optical coherence tomography (SRS-SOCT) to differentiate between healthy brain tissue and tumor based on (1) structural biomarkers derived from the decay rate of signals as a function of depth and (2) molecular biomarkers based on relative differences in lipid and protein composition extracted from the SRS signals. APPROACH SRS-SOCT combines the molecular sensitivity of SRS (based on vibrational spectroscopy) with the spatial and spectral multiplexing capabilities of SOCT to enable fast, spatially and spectrally resolved molecular imaging. SRS-SOCT is applied to image a 9L gliosarcoma rat tumor model, a well-characterized model that recapitulates human high-grade gliomas, including high proliferative capability, high vascularization, and infiltration at the margin. Structural and biochemical signatures acquired from SRS-SOCT are extracted to identify healthy and tumor tissues. RESULTS Data show that SRS-SOCT provides light-scattering-based signatures that correlate with the presence of tumors, similar to conventional OCT. Further, nonlinear phase changes from the SRS interaction, as measured with SRS-SOCT, provide an additional measure to clearly separate tumor tissue from healthy brain regions. We also show that the nonlinear phase signals in SRS-SOCT provide a signal-to-noise advantage over the nonlinear amplitude signals for identifying tumors. CONCLUSIONS SRS-SOCT can distinguish both spatial and spectral features that identify tumor regions in the 9L gliosarcoma rat model. This tool provides fast, label-free, nondestructive, and spatially resolved molecular information that, with future development, can potentially assist in identifying tumor margins in neurosurgery.
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Affiliation(s)
- Soheil Soltani
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Zhe Guang
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Zhaobin Zhang
- Emory University, Winship Cancer Institute, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Neurosurgery, Atlanta, Georgia, United States
| | - Jeffrey J. Olson
- Emory University, Winship Cancer Institute, Atlanta, Georgia, United States
- Emory University School of Medicine, Department of Neurosurgery, Atlanta, Georgia, United States
| | - Francisco E. Robles
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University, Winship Cancer Institute, Atlanta, Georgia, United States
- Address all correspondence to Francisco E. Robles,
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Peng T, Kramer DR, Lee MB, Barbaro MF, Ding L, Liu CY, Kellis S, Lee B. Comparison of Intraoperative 3-Dimensional Fluoroscopy With Standard Computed Tomography for Stereotactic Frame Registration. Oper Neurosurg (Hagerstown) 2020; 18:698-709. [PMID: 31584102 PMCID: PMC7225008 DOI: 10.1093/ons/opz296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Three-dimensional fluoroscopy via the O-arm (Medtronic, Dublin, Ireland) has been validated for intraoperative confirmation of successful lead placement in stereotactic electrode implantation. However, its role in registration and targeting has not yet been studied. After frame placement, many stereotactic neurosurgeons obtain a computed tomography (CT) scan and merge it with a preoperative magnetic resonance imaging (MRI) scan to generate planning coordinates; potential disadvantages of this practice include increased procedure time and limited scanner availability. OBJECTIVE To evaluate whether the second-generation O-arm (O2) can be used in lieu of a traditional CT scan to obtain accurate frame-registration scans. METHODS In 7 patients, a postframe placement CT scan was merged with preoperative MRI and used to generate lead implantation coordinates. After implantation, the fiducial box was again placed on the patient to obtain an O2 confirmation scan. Vector, scalar, and Euclidean differences between analogous X, Y, and Z coordinates from fused O2/MRI and CT/MRI scans were calculated for 33 electrode target coordinates across 7 patients. RESULTS Marginal means of difference for vector (X = -0.079 ± 0.099 mm; Y = -0.076 ± 0.134 mm; Z = -0.267 ± 0.318 mm), scalar (X = -0.146 ± 0.160 mm; Y = -0.306 ± 0.106 mm; Z = 0.339 ± 0.407 mm), and Euclidean differences (0.886 ± 0.190 mm) remained within the predefined equivalence margin differences of -2 mm and 2 mm. CONCLUSION This study demonstrates that O2 may emerge as a viable alternative to the traditional CT scanner for generating planning coordinates. Adopting the O2 as a perioperative tool may offer reduced transport risks, decreased anesthesia time, and greater surgical efficiency.
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Affiliation(s)
- Terrance Peng
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Daniel R Kramer
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Morgan B Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael F Barbaro
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Charles Y Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Spencer Kellis
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- T&C Chen BMI Center, Chen Institute for Neuroscience, California Institute of Technology, Pasadena, California
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California
| | - Brian Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Lee S, Park WY, Chang H, Kim B, Jang WH, Kim S, Shin Y, Kim MJ, Lee KH, Kim EH, Chung E, Kim KH. Fast and sensitive delineation of brain tumor with clinically compatible moxifloxacin labeling and confocal microscopy. JOURNAL OF BIOPHOTONICS 2020; 13:e201900197. [PMID: 31368257 DOI: 10.1002/jbio.201900197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 05/09/2023]
Abstract
Delineation of brain tumor margins during surgery is critical to maximize tumor removal while preserving normal brain tissue to obtain optimal clinical outcomes. Although various imaging methods have been developed, they have limitations to be used in clinical practice. We developed a high-speed cellular imaging method by using clinically compatible moxifloxacin and confocal microscopy for sensitive brain tumor detection and delineation. Moxifloxacin is a Food and Drug Administration (FDA) approved antibiotic and was used as a cell labeling agent through topical administration. Its strong fluorescence at short visible excitation wavelengths allowed video-rate cellular imaging. Moxifloxacin-based confocal microscopy (MBCM) was characterized in normal mouse brain specimens and visualized their cytoarchitecture clearly. Then, MBCM was applied to both brain tumor murine models and two malignant human brain tumors of glioblastoma and metastatic cancer. MBCM detected tumors in all the specimens by visualizing dense and irregular cell distributions, and tumor margins were easily delineated based on the cytoarchitecture. An image analysis method was developed for automated detection and delineation. MBCM demonstrated sensitive delineation of brain tumors through cytoarchitecture visualization and would have potentials for human applications, such as a surgery-guiding method for tumor removal.
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Affiliation(s)
- Seunghun Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Won Yeong Park
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Hoonchul Chang
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Bumju Kim
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Won Hyuk Jang
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Seonghan Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
| | - Younghoon Shin
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeonnam, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Euiheon Chung
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Ki Hean Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Republic of Korea
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Alkhalili K, Zenonos G, Tataryn Z, Amankulor N, Engh J. The Utility of Early Postoperative Head Computed Tomography in Brain Tumor Surgery: A Retrospective Analysis of 755 Cases. World Neurosurg 2017; 111:e206-e212. [PMID: 29258936 DOI: 10.1016/j.wneu.2017.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Scheduled early postoperative computed tomography (EPOCT) after craniotomy for brain tumor resection is standard at many institutions. We analyzed utility of preplanned EPOCT after elective craniotomy for brain tumor resection. METHODS We retrospectively analyzed 755 brain tumor resections for which EPOCT was performed within 4 hours of surgery. Postoperative clinical neurologic examination results were classified into expected (baseline or predicted postoperative examination), changed (from baseline examination), and unreliable (sedated or baseline comatose patient). Scans were analyzed for unexpected and/or worrisome findings (e.g., hemorrhagic or ischemic stroke). In cases of unexpected findings, management changes were correlated to patient's neurologic examination. Demographic information, tumor histology, and tumor location were analyzed to determine risk factors for unexpected findings. RESULTS Rate of unexpected EPOCT findings was 4.1%. Patients with expected postoperative examinations were at significantly lower risk of abnormal findings (odds ratio [OR] = 0.074, P < 0.001). Patients with intraventricular tumors (OR = 5.7, P = 0.001) were at higher risk compared with patients with metastatic tumors (OR = 0.24, P = 0.06). No unexpected EPOCT findings led to management changes in patients with expected postoperative neurologic examinations. All unexpected EPOCT findings in patients with changed postoperative neurologic examinations led to management changes. Patients with nonreliable neurologic examinations were at significantly higher risk for unexpected findings on EPOCT (OR = 6.33, P < 0.001) and subsequent management changes. CONCLUSIONS Routine EPOCT is not indicated for patients undergoing brain tumor resection if postoperative neurologic examination is unchanged, as imaging is unlikely to result in management changes. EPOCT should be obtained in all patients with worrisome changes in examination or nonreliable examinations, as both groups have high rates of unexpected findings on imaging that lead to management changes.
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Affiliation(s)
- Kenan Alkhalili
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary Tataryn
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nduka Amankulor
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Johnathan Engh
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Barbagallo GMV, Palmucci S, Visocchi M, Paratore S, Attinà G, Sortino G, Albanese V, Certo F. Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas: Analysis of Technical Feasibility and Impact on Extent of Tumor Resection. Oper Neurosurg (Hagerstown) 2015; 12:19-30. [PMID: 29506245 DOI: 10.1227/neu.0000000000001112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. OBJECTIVE To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. METHODS This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence-guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. RESULTS In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). CONCLUSION No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.
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Affiliation(s)
- Giuseppe M V Barbagallo
- Department of Neurosurgery, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy.,Interdisciplinary Research Centre on Diagnosis and Treatment of Brain Tumors, University of Catania, Catania, Italy
| | - Stefano Palmucci
- Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | | | - Sabrina Paratore
- Department of Anatomic Pathology, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giancarlo Attinà
- Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giuseppe Sortino
- Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | - Vincenzo Albanese
- Department of Neurosurgery, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
| | - Francesco Certo
- Department of Neurosurgery, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
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Lee DJ, Zwienenberg-Lee M, Seyal M, Shahlaie K. Intraoperative computed tomography for intracranial electrode implantation surgery in medically refractory epilepsy. J Neurosurg 2015; 122:526-31. [DOI: 10.3171/2014.9.jns13919] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Accurate placement of intracranial depth and subdural electrodes is important in evaluating patients with medically refractory epilepsy for possible resection. Confirming electrode locations on postoperative CT scans does not allow for immediate replacement of malpositioned electrodes, and thus revision surgery is required in select cases. Intraoperative CT (iCT) using the Medtronic O-arm device has been performed to detect electrode locations in deep brain stimulation surgery, but its application in epilepsy surgery has not been explored. In the present study, the authors describe their institutional experience in using the O-arm to facilitate accurate placement of intracranial electrodes for epilepsy monitoring.
METHODS
In this retrospective study, the authors evaluated consecutive patients who had undergone subdural and/or depth electrode implantation for epilepsy monitoring between November 2010 and September 2012. The O-arm device is used to obtain iCT images, which are then merged with the preoperative planning MRI studies and reviewed by the surgical team to confirm final positioning. Minor modifications in patient positioning and operative field preparation are necessary to safely incorporate the O-arm device into routine intracranial electrode implantation surgery. The device does not obstruct surgeon access for bur hole or craniotomy surgery. Depth and subdural electrode locations are easily identified on iCT, which merge with MRI studies without difficulty, allowing the epilepsy surgical team to intraoperatively confirm lead locations.
RESULTS
Depth and subdural electrodes were implanted in 10 consecutive patients by using routine surgical techniques together with preoperative stereotactic planning and intraoperative neuronavigation. No wound infections or other surgical complications occurred. In one patient, the hippocampal depth electrode was believed to be in a suboptimal position and was repositioned before final wound closure. Additionally, 4 strip electrodes were replaced due to suboptimal positioning. Postoperative CT scans did not differ from iCT studies in the first 3 patients in the series and thus were not obtained in the final 7 patients. Overall, operative time was extended by approximately 10–15 minutes for O-arm positioning, less than 1 minute for image acquisition, and approximately 10 minutes for image transfer, fusion, and intraoperative analysis (total time 21–26 minutes).
CONCLUSIONS
The O-arm device can be easily incorporated into routine intracranial electrode implantation surgery in standard-sized operating rooms. The technique provides accurate 3D visualization of depth and subdural electrode contacts, and the intraoperative images can be easily merged with preoperative MRI studies to confirm lead positions before final wound closure. Intraoperative CT obviates the need for routine postoperative CT and has the potential to improve the accuracy of intracranial electroencephalography recordings and may reduce the necessity for revision surgery.
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Affiliation(s)
| | | | - Masud Seyal
- 2Neurology, UC Davis School of Medicine, Sacramento, California
| | - Kiarash Shahlaie
- 1Departments of Neurological Surgery and
- 2Neurology, UC Davis School of Medicine, Sacramento, California
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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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Kerr EE, Shahlaie K, Schrot RJ. Use of the O-arm® for skull base resection in a sphenoorbital meningioma. J Clin Neurosci 2013; 20:1149-51. [PMID: 23664132 DOI: 10.1016/j.jocn.2012.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/18/2012] [Indexed: 11/25/2022]
Abstract
Intraoperative imaging during skull base surgery allows the surgeon to evaluate surgical results and direct further bone resection prior to closure, avoiding the potential morbidity of inadequate surgical therapy or reoperation. Intraoperative CT (iCT) scanning has become widely available in recent years, but its neurosurgical applications have been limited mostly to spinal and functional operations. We report a patient with a sphenoorbital meningioma with adjacent hyperostosis causing proptosis and optic canal stenosis in which a portable iCT scanner (O-arm(®); Medtronic, Fridley, MN, USA) was used to guide further resection. Postoperatively, the patient experienced resolution of her proptosis, and her vision remains clinically normal. The O-arm(®) can be easily incorporated into standard operating rooms and is useful in tailoring bony skull base resections.
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Affiliation(s)
- Edward E Kerr
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Abstract
PURPOSE OF REVIEW Advances in the neurosurgical management of pituitary tumors have included the refinement of surgical access and significant progress in navigation technology to help further reduce morbidity and improve outcome. Similarly, stereotactic radiosurgery has evolved to become an integral part in pituitary tumors not amenable to medical or surgical treatment. RECENT FINDINGS The evolution of minimally invasive surgery has evolved toward endoscopic versus microscopic trans-sphenoidal approaches for pituitary tumors. Debate exists regarding each approach, with advocates for both championing their cause. Stereotactic and fractional radiosurgery have been shown to be a safe and effective means of controlling tumor growth and ensuring hormonal stabilization, with longer-term data available for GammaKnife compared with CyberKnife. SUMMARY The advances in trans-sphenoidal surgical approaches, navigation technological improvements and the current results of stereotactic radiosurgery are discussed.
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Shahlaie K, Larson PS, Starr PA. Intraoperative computed tomography for deep brain stimulation surgery: technique and accuracy assessment. Neurosurgery 2011; 68:114-24; discussion 124. [PMID: 21206322 DOI: 10.1227/neu.0b013e31820781bc] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement. OBJECTIVE To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique. METHODS Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI. RESULTS iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI. CONCLUSION iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.
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Affiliation(s)
- Kiarash Shahlaie
- Department of Neurological Surgery, University of California, San Francisco, and Parkinson's Disease Research, Education, and Care Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Integrated intra-operative room design. ACTA NEUROCHIRURGICA. SUPPLEMENT 2010. [PMID: 20960343 DOI: 10.1007/978-3-211-99651-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The design of intraoperative suites require significant inputs from the neurosurgeons. Prior consideration of specific surgical objectives before investment of capital resources will enable to surgeon to yield maximum value from the project. We describe the setup of the integrated neurosurgical centre at our institution which comprises of a hybrid high field MRI suite, an OR's consisting of a multi-slice CT scanner and iso-C 3D respectively. The iCT and ioMRI OR's carry ICG angiography capabilities. These ORs are linked to also the Novalis radiosurgery suites and outpatient clinics and offices to facilitate pre-surgical review, planning as well as treatment plans on a common interface via the BRAINSUITE net.Design considerations include right sit-ing of imaging equipment as well as a focus of ergonomics and design features to maximize workflow. Whenever possible, standard neurosurgical instrumentation is utilized. With widespread availability of technology, neuro-imaging in the operating room may become more prevalent. The surgeon is the lead individual in the team with regards to planning and designing the ORs to accommodate the new imaging equipment.
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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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14
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Ardeshiri A, Radina C, Edlauer M, Ardeshiri A, Riepertinger A, Nerlich A, Tonn JC, Winkler PA. Evaluation of new radiolucent polymer headholder pins for use in intraoperative computed tomography. J Neurosurg 2009; 111:1168-74. [DOI: 10.3171/2009.1.jns08862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
With the introduction of intraoperative CT (iCT) scanning, neurosurgeons can now obtain images of the brain during surgery, offering the possibility of intraoperative resection control and monitoring of potential intraoperative complications. The combination of iCT with neuronavigation makes it possible to update the reference scans intraoperatively when necessary. However, the headholder pins normally used for iCT scanning still show artifacts. In the present study, new polymer pins, producing nearly no artifacts in laboratory tests, are compared with the usual pins with regard to their mechanical and artifact behavior to evaluate their potential use in the clinical routine.
Methods
Pins made of different materials (titanium, Macor, silicon nitride, zirconium oxide, sapphire, polyetheretherketone, and polyparaphenylene copolymer) were used for the fixation of 10 cadaveric heads. Special force sensors measured the fixation pressure of the pins, and histological analysis revealed the penetration depth. Computed tomography scans of a head phantom, fixed with the different pins, were obtained to reveal artifact behavior.
Results
All pins were biocompatible. Pins did not differ significantly in fixation pressures and mechanical behavior. Penetration depths were comparable (maximum 1.4 mm) and did not cause opening of the diploe. Polymer pins made of polyparaphenylene showed the best results in artifact behavior in CT scans.
Conclusions
The authors' results demonstrate that the new polymer pins are comparable in their mechanical behavior to the usual pins but superior in artifact behavior. Therefore, their use in the clinical routine of iCT scanning will be beneficial for the surgeon.
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Affiliation(s)
- Ardeshir Ardeshiri
- 1Laboratory for Neurosurgical Microanatomy, Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University, Munich
| | | | | | - Ardavan Ardeshiri
- 1Laboratory for Neurosurgical Microanatomy, Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University, Munich
| | | | - Andreas Nerlich
- 3Department of Pathology, Krankenhaus Schwabing, Munich, Germany
| | - Jörg-Christian Tonn
- 1Laboratory for Neurosurgical Microanatomy, Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University, Munich
| | - Peter A. Winkler
- 1Laboratory for Neurosurgical Microanatomy, Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University, Munich
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15
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Uhl E, Zausinger S, Morhard D, Heigl T, Scheder B, Rachinger W, Schichor C, Tonn JC. Intraoperative computed tomography with integrated navigation system in a multidisciplinary operating suite. Neurosurgery 2009; 64:231-9; discussion 239-40. [PMID: 19404103 DOI: 10.1227/01.neu.0000340785.51492.b5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We report our preliminary experience in a prospective series of patients with regard to feasibility, work flow, and image quality using a multislice computed tomographic (CT) scanner combined with a frameless neuronavigation system (NNS). METHODS A sliding gantry 40-slice CT scanner was installed in a preexisting operating room. The scanner was connected to a frameless infrared-based NNS. Image data was transferred directly from the scanner into the navigation system. This allowed updating of the NNS during surgery by automated image registration based on the position of the gantry. Intraoperative CT angiography was possible. The patient was positioned on a radiolucent operating table that fits within the bore of the gantry. During image acquisition, the gantry moved over the patient. This table allowed all positions and movements like any normal operating table without compromising the positioning of the patient. For cranial surgery, a carbon-made radiolucent head clamp was fixed to the table. RESULTS Experience with the first 230 patients confirms the feasibility of intraoperative CT scanning (136 patients with intracranial pathology, 94 patients with spinal lesions). After a specific work flow, interruption of surgery for intraoperative scanning can be limited to 10 to 15 minutes in cranial surgery and to 9 minutes in spinal surgery. Intraoperative imaging changed the course of surgery in 16 of the 230 cases either because control CT scans showed suboptimal screw position (17 of 307 screws, with 9 in 7 patients requiring correction) or that tumor resection was insufficient (9 cases). Intraoperative CT angiography has been performed in 7 cases so far with good image quality to determine residual flow in an aneurysm. Image quality was excellent in spinal and cranial base surgery. CONCLUSION The system can be installed in a preexisting operating environment without the need for special surgical instruments. It increases the safety of the patient and the surgeon without necessitating a change in the existing surgical protocol and work flow. Imaging and updating of the NNS can be performed at any time during surgery with very limited time and modification of the surgical setup. Multidisciplinary use increases utilization of the system and thus improves the cost-efficiency relationship.
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Affiliation(s)
- Eberhard Uhl
- Department of Neurosurgery, Klinikum Grosshadern, University of Munich, Munich, Germany. eberhard.uhl@ lkh- klu.at
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16
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Cash DM, Sinha TK, Chapman WC, Terawaki H, Dawant BM, Galloway RL, Miga MI. Incorporation of a laser range scanner into image-guided liver surgery: surface acquisition, registration, and tracking. Med Phys 2003; 30:1671-82. [PMID: 12906184 PMCID: PMC4445740 DOI: 10.1118/1.1578911] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As image guided surgical procedures become increasingly diverse, there will be more scenarios where point-based fiducials cannot be accurately localized for registration and rigid body assumptions no longer hold. As a result, procedures will rely more frequently on anatomical surfaces for the basis of image alignment and will require intraoperative geometric data to measure and compensate for tissue deformation in the organ. In this paper we outline methods for which a laser range scanner may be used to accomplish these tasks intraoperatively. A laser range scanner based on the optical principle of triangulation acquires a dense set of three-dimensional point data in a very rapid, noncontact fashion. Phantom studies were performed to test the ability to link range scan data with traditional modes of image-guided surgery data through localization, registration, and tracking in physical space. The experiments demonstrate that the scanner is capable of localizing point-based fiducials to within 0.2 mm and capable of achieving point and surface based registrations with target registration error of less than 2.0 mm. Tracking points in physical space with the range scanning system yields an error of 1.4 +/- 0.8 mm. Surface deformation studies were performed with the range scanner in order to determine if this device was capable of acquiring enough information for compensation algorithms. In the surface deformation studies, the range scanner was able to detect changes in surface shape due to deformation comparable to those detected by tomographic image studies. Use of the range scanner has been approved for clinical trials, and an initial intraoperative range scan experiment is presented. In all of these studies, the primary source of error in range scan data is deterministically related to the position and orientation of the surface within the scanner's field of view. However, this systematic error can be corrected, allowing the range scanner to provide a rapid, robust method of acquiring anatomical surfaces intraoperatively.
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Affiliation(s)
- David M Cash
- Department of Biomedical Engineering, Vanderbilt University, Box 351631, Station B, Nashville, Tennessee 37235, USA.
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17
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Ebmeier K, Giest K, Kalff R. Intraoperative computerized tomography for improved accuracy of spinal navigation in pedicle screw placement of the thoracic spine. ACTA NEUROCHIRURGICA. SUPPLEMENT 2003; 85:105-13. [PMID: 12570145 DOI: 10.1007/978-3-7091-6043-5_15] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We report on our experiences with the use of intraoperative CT imaging in surgery of the thoracic spine and on our results of pedicle screw insertion using spinal navigation and implantable fiducial markers. For our operations we used the Tomoscan M-EG and the EasyGuideSpine (Philips Medical Systems). During the operation the patient was positioned on the mobile CT table. Following dorsal preparation, small titanium screws were implanted in the vertebrae so as to serve as fiducial markers. Image data were obtained by performing a spiral CT scan. Ventilation was suspended for the duration of the CT scan. Screw insertion as well as vertebral biopsies were performed using spinal navigation. Intraoperative CT scans were obtained to confirm the position of the implants and to assess the amount of bony decompression as well as the realignment. Since 1998, 112 patients with various disorders of the thoracic spine have been operated on using the described technique. 365 screws were inserted in the area of T1 to T12. There were 23 (6.3%) misplacements of pedicle screws. In 42 cases (11.5%) we observed a minimal lateral perforation (<2 mm) of the pedicle wall. No neurological, cardiovascular, or pulmonary injury occurred. Intraoperative CT imaging influenced surgical decisions as well as the final result of surgery. Despite the use of intraoperative imaging and accurate spinal navigation, pedicle screw placement in the thoracic spine remains extremely challenging.
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Affiliation(s)
- K Ebmeier
- Department of Neurological Surgery, University Hospital, Friedrich-Schiller-University, Jena, Germany
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18
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Hentschel SJ, Sawaya R. Optimizing outcomes with maximal surgical resection of malignant gliomas. Cancer Control 2003; 10:109-14. [PMID: 12712005 DOI: 10.1177/107327480301000202] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aggressive surgical resection of malignant gliomas is a controversial issue in neurosurgery. Studies with rigorous methodology that fully address this issue have only recently become available. METHODS The controversy regarding the role of maximal surgical resection of malignant gliomas is reviewed. The authors discuss surgical techniques and adjunctive technologies that can be utilized to assist in resection of these lesions. RESULTS Using current microneurosurgical techniques, it is possible to resect malignant gliomas in gross total fashion. An aggressive approach in which 98% or more of the tumor mass is resected results in a statistically significant survival advantage. CONCLUSIONS An aggressive surgical procedure for malignant gliomas can result in increased survival duration for selected groups of patients.
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Affiliation(s)
- Stephen J Hentschel
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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19
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Abstract
Surgical resection is a critical aspect of the management of a patient with a glioblastoma (GBM). An intimate knowledge of the anatomy of a GBM, as well as familiarity with particular surgical techniques and adjunctive technologies is required for safe surgical resection. The goals of resection include diagnosis, relief of mass effect, and cytoreduction. A recent study showed that resection of 98% or more of the tumor mass can result in a statistically significant survival advantage. Even in functionally critical areas, "gross total" resections are possible if proper techniques are employed. It is recommended that a "gross total" resection of the enhancing portion of a GBM be performed whenever possible. With this philosophy, the mortality rate is 3% and the rate of major neurologic morbidity is less than 10%.
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Affiliation(s)
- Stephen J Hentschel
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA
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20
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Bohinski RJ, Kokkino AK, Warnick RE, Gaskill-Shipley MF, Kormos DW, Lukin RR, Tew JM. Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 2001; 48:731-42; discussion 742-4. [PMID: 11322433 DOI: 10.1097/00006123-200104000-00007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We describe a shared-resource intraoperative magnetic resonance imaging (MRI) design that allocates time for both surgical procedures and routine diagnostic imaging. We investigated the safety and efficacy of this design as applied to the detection of residual glioma immediately after an optimal image-guided frameless stereotactic resection (IGFSR). METHODS Based on the twin operating rooms (ORs) concept, we installed a commercially available Hitachi AIRIS II, 0.3-tesla, vertical field, open MRI unit in its own specially designed OR (designated the magnetic resonance OR) immediately adjacent to a conventional neurosurgical OR. Between May 1998 and October 1999, this facility was used for both routine diagnostic imaging (969 diagnostic scans) and surgical procedures (50 craniotomies for tumor resection, 27 transsphenoidal explorations, and 5 biopsies). Our study group, from which prospective data were collected, consisted of 40 of these patients who had glioma (World Health Organization Grades II-IV). These 40 patients first underwent optimal IGFSRs in the adjacent conventional OR, where resection continued until the surgeon believed that all of the accessible tumor had been removed. Patients were then transferred to the magnetic resonance OR to check the completeness of the resection. If accessible residual tumor was observed, then a biopsy and an additional resection were performed. To validate intraoperative MRI findings, early postoperative MRI using a 1.5-tesla magnet was performed. RESULTS Intraoperative images that were suitable for interpretation were obtained for all 40 patients after optimal IGFSRs. In 19 patients (47%), intraoperative MRI studies confirmed that adequate resection had been achieved after IGFSR alone. Intraoperative MRI studies showed accessible residual tumors in the remaining 21 patients (53%), all of whom underwent additional resections. Early postoperative MRI studies were obtained in 39 patients, confirming that the desired final extent of resection had been achieved in all of these patients. One patient developed a superficial wound infection, and no hazardous equipment or instrumentation problems occurred. CONCLUSION Use of an intraoperative MRI facility that permits both diagnostic imaging and surgical procedures is safe and may represent a more cost-effective approach than dedicated intraoperative units for some hospital centers. Although we clearly demonstrate an improvement in volumetric glioma resection as compared with IGFSR alone, further study is required to determine the impact of this approach on patient survival.
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Affiliation(s)
- R J Bohinski
- Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati College of Medicine, Ohio 45267-0515, USA
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21
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Bohinski RJ, Kokkino AK, Warnick RE, Gaskill-Shipley MF, Kormos DW, Lukin RR, Tew JM. Glioma Resection in a Shared-resource Magnetic Resonance Operating Room after Optimal Image-guided Frameless Stereotactic Resection. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00007] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Bernstein M, Al-Anazi AR, Kucharczyk W, Manninen P, Bronskill M, Henkelman M. Brain Tumor Surgery with the Toronto Open Magnetic Resonance Imaging System: Preliminary Results for 36 Patients and Analysis of Advantages, Disadvantages, and Future Prospects. Neurosurgery 2000. [DOI: 10.1227/00006123-200004000-00023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Bernstein M, Al-Anazi AR, Kucharczyk W, Manninen P, Bronskill M, Henkelman M. Brain tumor surgery with the Toronto open magnetic resonance imaging system: preliminary results for 36 patients and analysis of advantages, disadvantages, and future prospects. Neurosurgery 2000; 46:900-7; discussion 907-9. [PMID: 10764263 DOI: 10.1097/00006123-200004000-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Frameless navigation systems represent a huge step forward in the surgical treatment of intracranial pathological conditions but lack the ability to provide real-time imaging feedback for assessment of postoperative results, such as catheter positions and the extent of tumor resections. An open magnetic resonance imaging system for intracranial surgery was developed in Toronto, by a multidisciplinary team, to provide real-time intraoperative imaging. METHODS The preliminary experience with a 0.2-T, vertical-gap, magnetic resonance imaging system for intraoperative imaging, which was developed at the University of Toronto for the surgical treatment of patients with intracranial lesions, is described. The system is known as the image-guided minimally invasive therapy unit. RESULTS Between February 1998 and March 1999, 36 procedures were performed, including 21 tumor resections, 12 biopsies, 1 transsphenoidal endoscopic resection, and 2 catheter placements for Ommaya reservoirs. Three complications were observed. All biopsies were successful, and the surgical goals were achieved for all resections. Problems included restricted access resulting from the confines of the magnet and the imaging coil design, difficulties in working in an operating room that is less spacious and familiar, inconsistent image quality, and a lack of nonmagnetic tools that are as effective as standard neurosurgical tools. Advantages included real-time imaging to facilitate surgical planning, to confirm entry into lesions, and to assess the extent of resection and intraoperative and immediate postoperative imaging to confirm the extent of resections, catheter placement, and the absence of postoperative complications. CONCLUSION Intraoperative magnetic resonance imaging has great potential as an aid for intracranial surgery, but a number of logistic problems require resolution.
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Affiliation(s)
- M Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Ontario, Canada
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A Mobile Computed Tomographic Scanner with Intraoperative and Intensive Care Unit Applications. Neurosurgery 1998. [DOI: 10.1097/00006123-199806000-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Okudera H, Kobayashi S, Kyoshima K, Tokushige K, Sugita K. New radiolucent head fixation made of engineering plastics for intraoperative CT scanning. Acta Neurochir (Wien) 1994; 127:121-3. [PMID: 7942172 DOI: 10.1007/bf01808559] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A newly developed head fixation for intraoperative computerized tomographic (IOCT) scanning is presented. The system is developed based on the head holder of multipurpose head frame and is made of two kinds of advanced engineering material; carbon fiber reinforced plastic for head holder and frames, polyamide-imide polymer for joints, screws, and head pin. Clinical tests including autoclaving and sterilization were performed and revealed all materials had sufficient strength for clinical use. This fixation system enables us to increase the efficacy of IOCT scanning during open-field neurosurgery.
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Affiliation(s)
- H Okudera
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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26
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Okudera H, Kobayashi S, Kyoshima K, Gibo H, Takemae T, Sugita K. Development of the operating computerized tomographic scanner system for neurosurgery. Acta Neurochir (Wien) 1991; 111:61-3. [PMID: 1927626 DOI: 10.1007/bf01402515] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A computerized tomographic (CT) scanner system for intraoperative imaging is presented. The system consists of the following: 1) CT scanner with a mobile gantry, 2) digitally controlled operating table with central processing unit (CPU) and encoder unit; the table can be controlled by the scanner computer as accurately as the scanner bed, and 3) exclusively designed head fixation devices. It allows us to scan the patient on the operating table in the operating room pre-operatively, intra-operatively and immediately after surgery.
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Affiliation(s)
- H Okudera
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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