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Wang Y, Fu T, Wu C, Xiao J, Fan J, Song H, Liang P, Yang J. Multimodal registration of ultrasound and MR images using weighted self-similarity structure vector. Comput Biol Med 2023; 155:106661. [PMID: 36827789 DOI: 10.1016/j.compbiomed.2023.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PROPOSE Multimodal registration of 2D Ultrasound (US) and 3D Magnetic Resonance (MR) for fusion navigation can improve the intraoperative detection accuracy of lesion. However, multimodal registration remains a challenge because of the poor US image quality. In the study, a weighted self-similarity structure vector (WSSV) is proposed to registrate multimodal images. METHOD The self-similarity structure vector utilizes the normalized distance of symmetrically located patches in the neighborhood to describe the local structure information. The texture weights are extracted using the local standard deviation to reduce the speckle interference in the US images. The multimodal similarity metric is constructed by combining a self-similarity structure vector with a texture weight map. RESULTS Experiments were performed on US and MR images of the liver from 88 groups of data including 8 patients and 80 simulated samples. The average target registration error was reduced from 14.91 ± 3.86 mm to 4.95 ± 2.23 mm using the WSSV-based method. CONCLUSIONS The experimental results show that the WSSV-based registration method could robustly align the US and MR images of the liver. With further acceleration, the registration framework can be potentially applied in time-sensitive clinical settings, such as US-MR image registration in image-guided surgery.
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Affiliation(s)
- Yifan Wang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, 100081, PR China
| | - Tianyu Fu
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, PR China.
| | - Chan Wu
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, 100081, PR China
| | - Jian Xiao
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, PR China
| | - Jingfan Fan
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, 100081, PR China
| | - Hong Song
- School of Software, Beijing Institute of Technology, Beijing, 100081, PR China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, PR China.
| | - Jian Yang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, 100081, PR China.
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Automatic 3D MRI-Ultrasound Registration for Image Guided Arthroscopy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Registration of partial view intra-operative ultrasound (US) to pre-operative MRI is an essential step in image-guided minimally invasive surgery. In this paper, we present an automatic, landmark-free 3D multimodal registration of pre-operative MRI to 4D US (high-refresh-rate 3D-US) for enabling guidance in knee arthroscopy. We focus on the problem of initializing registration in the case of partial views. The proposed method utilizes a pre-initialization step of using the automatically segmented structures from both modalities to achieve a global geometric initialization. This is followed by computing distance maps of the procured segmentations for registration in the distance space. Following that, the final local refinement between the MRI-US volumes is achieved using the LC2 (Linear correlation of linear combination) metric. The method is evaluated on 11 cases spanning six subjects, with four levels of knee flexion. A best-case error of 1.41 mm and 2.34∘ and an average registration error of 3.45 mm and 7.76∘ is achieved in translation and rotation, respectively. An inter-observer variability study is performed, and a mean difference of 4.41 mm and 7.77∘ is reported. The errors obtained through the developed registration algorithm and inter-observer difference values are found to be comparable. We have shown that the proposed algorithm is simple, robust and allows for the automatic global registration of 3D US and MRI that can enable US based image guidance in minimally invasive procedures.
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Reinertsen I, Collins DL, Drouin S. The Essential Role of Open Data and Software for the Future of Ultrasound-Based Neuronavigation. Front Oncol 2021; 10:619274. [PMID: 33604299 PMCID: PMC7884817 DOI: 10.3389/fonc.2020.619274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023] Open
Abstract
With the recent developments in machine learning and modern graphics processing units (GPUs), there is a marked shift in the way intra-operative ultrasound (iUS) images can be processed and presented during surgery. Real-time processing of images to highlight important anatomical structures combined with in-situ display, has the potential to greatly facilitate the acquisition and interpretation of iUS images when guiding an operation. In order to take full advantage of the recent advances in machine learning, large amounts of high-quality annotated training data are necessary to develop and validate the algorithms. To ensure efficient collection of a sufficient number of patient images and external validity of the models, training data should be collected at several centers by different neurosurgeons, and stored in a standard format directly compatible with the most commonly used machine learning toolkits and libraries. In this paper, we argue that such effort to collect and organize large-scale multi-center datasets should be based on common open source software and databases. We first describe the development of existing open-source ultrasound based neuronavigation systems and how these systems have contributed to enhanced neurosurgical guidance over the last 15 years. We review the impact of the large number of projects worldwide that have benefited from the publicly available datasets “Brain Images of Tumors for Evaluation” (BITE) and “Retrospective evaluation of Cerebral Tumors” (RESECT) that include MR and US data from brain tumor cases. We also describe the need for continuous data collection and how this effort can be organized through the use of a well-adapted and user-friendly open-source software platform that integrates both continually improved guidance and automated data collection functionalities.
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Affiliation(s)
- Ingerid Reinertsen
- Department of Health Research, SINTEF Digital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - D Louis Collins
- NIST Laboratory, McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Simon Drouin
- Laboratoire Multimédia, École de Technologie Supérieure, Montréal, QC, Canada
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Gueziri HE, Yan CXB, Collins DL. Open-source software for ultrasound-based guidance in spinal fusion surgery. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3353-3368. [PMID: 32907772 DOI: 10.1016/j.ultrasmedbio.2020.08.005] [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: 02/11/2020] [Revised: 07/10/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
Spinal instrumentation and surgical manipulations may cause loss of navigation accuracy requiring an efficient re-alignment of the patient anatomy with pre-operative images during surgery. While intra-operative ultrasound (iUS) guidance has shown clear potential to reduce surgery time, compared with clinical computed tomography (CT) guidance, rapid registration aiming to correct for patient misalignment has not been addressed. In this article, we present an open-source platform for pedicle screw navigation using iUS imaging. The alignment method is based on rigid registration of CT to iUS vertebral images and has been designed for fast and fully automatic patient re-alignment in the operating room. Two steps are involved: first, we use the iUS probe's trajectory to achieve an initial coarse registration; then, the registration transform is refined by simultaneously optimizing gradient orientation alignment and mean of iUS intensities passing through the CT-defined posterior surface of the vertebra. We evaluated our approach on a lumbosacral section of a porcine cadaver with seven vertebral levels. We achieved a median target registration error of 1.47 mm (100% success rate, defined by a target registration error <2 mm) when applying the probe's trajectory initial alignment. The approach exhibited high robustness to partial visibility of the vertebra with success rates of 89.86% and 88.57% when missing either the left or right part of the vertebra and robustness to initial misalignments with a success rate of 83.14% for random starts within ±20° rotation and ±20 mm translation. Our graphics processing unit implementation achieves an efficient registration time under 8 s, which makes the approach suitable for clinical application.
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Affiliation(s)
- Houssem-Eddine Gueziri
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
| | - Charles X B Yan
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - D Louis Collins
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
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5
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Machado I, Toews M, George E, Unadkat P, Essayed W, Luo J, Teodoro P, Carvalho H, Martins J, Golland P, Pieper S, Frisken S, Golby A, Wells Iii W, Ou Y. Deformable MRI-Ultrasound registration using correlation-based attribute matching for brain shift correction: Accuracy and generality in multi-site data. Neuroimage 2019; 202:116094. [PMID: 31446127 PMCID: PMC6819249 DOI: 10.1016/j.neuroimage.2019.116094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/18/2019] [Accepted: 08/09/2019] [Indexed: 11/16/2022] Open
Abstract
Intraoperative tissue deformation, known as brain shift, decreases the benefit of using preoperative images to guide neurosurgery. Non-rigid registration of preoperative magnetic resonance (MR) to intraoperative ultrasound (iUS) has been proposed as a means to compensate for brain shift. We focus on the initial registration from MR to predurotomy iUS. We present a method that builds on previous work to address the need for accuracy and generality of MR-iUS registration algorithms in multi-site clinical data. High-dimensional texture attributes were used instead of image intensities for image registration and the standard difference-based attribute matching was replaced with correlation-based attribute matching. A strategy that deals explicitly with the large field-of-view mismatch between MR and iUS images was proposed. Key parameters were optimized across independent MR-iUS brain tumor datasets acquired at 3 institutions, with a total of 43 tumor patients and 758 reference landmarks for evaluating the accuracy of the proposed algorithm. Despite differences in imaging protocols, patient demographics and landmark distributions, the algorithm is able to reduce landmark errors prior to registration in three data sets (5.37±4.27, 4.18±1.97 and 6.18±3.38 mm, respectively) to a consistently low level (2.28±0.71, 2.08±0.37 and 2.24±0.78 mm, respectively). This algorithm was tested against 15 other algorithms and it is competitive with the state-of-the-art on multiple datasets. We show that the algorithm has one of the lowest errors in all datasets (accuracy), and this is achieved while sticking to a fixed set of parameters for multi-site data (generality). In contrast, other algorithms/tools of similar performance need per-dataset parameter tuning (high accuracy but lower generality), and those that stick to fixed parameters have larger errors or inconsistent performance (generality but not the top accuracy). Landmark errors were further characterized according to brain regions and tumor types, a topic so far missing in the literature.
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Affiliation(s)
- Inês Machado
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Matthew Toews
- Department of Systems Engineering, École de Technologie Supérieure, Montreal, Canada
| | - Elizabeth George
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walid Essayed
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jie Luo
- Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
| | - Pedro Teodoro
- Escola Superior Náutica Infante D. Henrique, Lisbon, Portugal
| | - Herculano Carvalho
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Jorge Martins
- Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
| | - Steve Pieper
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Isomics, Inc., Cambridge, MA, USA
| | - Sarah Frisken
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William Wells Iii
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, USA
| | - Yangming Ou
- Department of Pediatrics and Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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6
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Toward real-time rigid registration of intra-operative ultrasound with preoperative CT images for lumbar spinal fusion surgery. Int J Comput Assist Radiol Surg 2019; 14:1933-1943. [DOI: 10.1007/s11548-019-02020-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
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8
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Gerard IJ, Kersten-Oertel M, Drouin S, Hall JA, Petrecca K, De Nigris D, Di Giovanni DA, Arbel T, Collins DL. Combining intraoperative ultrasound brain shift correction and augmented reality visualizations: a pilot study of eight cases. J Med Imaging (Bellingham) 2018; 5:021210. [PMID: 29392162 DOI: 10.1117/1.jmi.5.2.021210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/08/2018] [Indexed: 11/14/2022] Open
Abstract
We present our work investigating the feasibility of combining intraoperative ultrasound for brain shift correction and augmented reality (AR) visualization for intraoperative interpretation of patient-specific models in image-guided neurosurgery (IGNS) of brain tumors. We combine two imaging technologies for image-guided brain tumor neurosurgery. Throughout surgical interventions, AR was used to assess different surgical strategies using three-dimensional (3-D) patient-specific models of the patient's cortex, vasculature, and lesion. Ultrasound imaging was acquired intraoperatively, and preoperative images and models were registered to the intraoperative data. The quality and reliability of the AR views were evaluated with both qualitative and quantitative metrics. A pilot study of eight patients demonstrates the feasible combination of these two technologies and their complementary features. In each case, the AR visualizations enabled the surgeon to accurately visualize the anatomy and pathology of interest for an extended period of the intervention. Inaccuracies associated with misregistration, brain shift, and AR were improved in all cases. These results demonstrate the potential of combining ultrasound-based registration with AR to become a useful tool for neurosurgeons to improve intraoperative patient-specific planning by improving the understanding of complex 3-D medical imaging data and prolonging the reliable use of IGNS.
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Affiliation(s)
- Ian J Gerard
- McGill University, Montreal Neurological Institute and Hospital, Department of Biomedical Engineering, Montreal, Québec, Canada
| | - Marta Kersten-Oertel
- Concordia University, PERFORM Centre, Department of Computer Science and Software Engineering, Montreal, Québec, Canada
| | - Simon Drouin
- McGill University, Montreal Neurological Institute and Hospital, Department of Biomedical Engineering, Montreal, Québec, Canada
| | - Jeffery A Hall
- McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, Montreal, Québec, Canada
| | - Kevin Petrecca
- McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, Montreal, Québec, Canada
| | - Dante De Nigris
- McGill University, Centre for Intelligent Machines, Department of Electrical and Computer Engineering, Montreal, Québec, Canada
| | - Daniel A Di Giovanni
- McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, Montreal, Québec, Canada
| | - Tal Arbel
- McGill University, Centre for Intelligent Machines, Department of Electrical and Computer Engineering, Montreal, Québec, Canada
| | - D Louis Collins
- McGill University, Montreal Neurological Institute and Hospital, Department of Biomedical Engineering, Montreal, Québec, Canada.,McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, Montreal, Québec, Canada.,McGill University, Centre for Intelligent Machines, Department of Electrical and Computer Engineering, Montreal, Québec, Canada
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9
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Drouin S, Kochanowska A, Kersten-Oertel M, Gerard IJ, Zelmann R, De Nigris D, Bériault S, Arbel T, Sirhan D, Sadikot AF, Hall JA, Sinclair DS, Petrecca K, DelMaestro RF, Collins DL. IBIS: an OR ready open-source platform for image-guided neurosurgery. Int J Comput Assist Radiol Surg 2016; 12:363-378. [DOI: 10.1007/s11548-016-1478-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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10
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Gerard IJ, Kersten-Oertel M, Drouin S, Hall JA, Petrecca K, De Nigris D, Arbel T, Louis Collins D. Improving Patient Specific Neurosurgical Models with Intraoperative Ultrasound and Augmented Reality Visualizations in a Neuronavigation Environment. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-31808-0_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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11
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Askeland C, Solberg OV, Bakeng JBL, Reinertsen I, Tangen GA, Hofstad EF, Iversen DH, Våpenstad C, Selbekk T, Langø T, Hernes TAN, Olav Leira H, Unsgård G, Lindseth F. CustusX: an open-source research platform for image-guided therapy. Int J Comput Assist Radiol Surg 2015; 11:505-19. [PMID: 26410841 PMCID: PMC4819973 DOI: 10.1007/s11548-015-1292-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/31/2015] [Indexed: 12/14/2022]
Abstract
Purpose CustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research. Methods CustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency. Results The validation experiments show a navigation system accuracy of \documentclass[12pt]{minimal}
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\begin{document}$$<$$\end{document}<1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy. Conclusions CustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.
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Affiliation(s)
- Christian Askeland
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway. .,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
| | - Ole Vegard Solberg
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | | | - Ingerid Reinertsen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - Geir Arne Tangen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | | | - Daniel Høyer Iversen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Cecilie Våpenstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tormod Selbekk
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Toril A Nagelhus Hernes
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Geirmund Unsgård
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Frank Lindseth
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
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Wolbers JG. Novel strategies in glioblastoma surgery aim at safe, supra-maximum resection in conjunction with local therapies. CHINESE JOURNAL OF CANCER 2014; 33:8-15. [PMID: 24384236 PMCID: PMC3905085 DOI: 10.5732/cjc.013.10219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The biggest challenge in neuro-oncology is the treatment of glioblastoma, which exhibits poor prognosis and is increasing in incidence in an increasing aging population. Diverse treatment strategies aim at maximum cytoreduction and ensuring good quality of life. We discuss multimodal neuronavigation, supra-maximum tumor resection, and the postoperative treatment gap. Multimodal neuronavigation allows the integration of preoperative anatomic and functional data with intraoperative information. This approach includes functional magnetic resonance imaging (MRI) and diffusion tensor imaging in preplanning and ultrasound, computed tomography (CT), MRI and direct (sub)cortical stimulation during surgery. The practice of awake craniotomy decreases postoperative neurologic deficits, and an extensive supra-maximum resection appears to be feasible, even in eloquent areas of the brain. Intraoperative MRI- and fluorescence-guided surgery assist in achieving this goal of supra-maximum resection and have been the subject of an increasing number of reports. Photodynamic therapy and local chemotherapy are properly positioned to bridge the gap between surgery and chemoradiotherapy. The photosensitizer used in fluorescence-guided surgery persists in the remaining peripheral tumor extensions. Additionally, blinded randomized clinical trials showed firm evidence of extra cytoreduction by local chemotherapy in the tumor cavity. The cutting-edge promise is gene therapy although both the delivery and efficacy of the numerous transgenes remain under investigation. Issues such as the choice of (cell) vector, the choice of therapeutic transgene, the optimal route of administration, and biosafety need to be addressed in a systematic way. In this selective review, we present various evidence and promises to improve survival of glioblastoma patients by supra-maximum cytoreduction via local procedures while minimizing the risk of new neurologic deficit.
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Affiliation(s)
- John G Wolbers
- Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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13
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D'Amico RS, Kennedy BC, Bruce JN. Neurosurgical oncology: advances in operative technologies and adjuncts. J Neurooncol 2014; 119:451-63. [PMID: 24969924 DOI: 10.1007/s11060-014-1493-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/22/2014] [Indexed: 12/31/2022]
Abstract
Modern glioma surgery has evolved around the central tenet of safely maximizing resection. Recent surgical adjuncts have focused on increasing the maximum extent of resection while minimizing risk to functional brain. Technologies such as cortical and subcortical stimulation mapping, intraoperative magnetic resonance imaging, functional neuronavigation, navigable intraoperative ultrasound, neuroendoscopy, and fluorescence-guided resection have been developed to augment the identification of tumor while preserving brain anatomy and function. However, whether these technologies offer additional long-term benefits to glioma patients remains to be determined. Here we review advances over the past decade in operative technologies that have offered the most promising benefits for glioblastoma patients.
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Affiliation(s)
- Randy S D'Amico
- Department of Neurological Surgery, Neurological Institute, Columbia University Medical Center, 4th Floor, 710 West 168th Street, New York, NY, 10032, USA,
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