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Di Bonaventura R, Albanese A, Brunasso L, Latour K, Siciliano L, Stifano V, Livi S, Sturiale CL, Iacopino DG, Maugeri R, Olivi A, Marchese E. Neurologic and Neuropsychological Outcomes for Treatment of Unruptured Middle Cerebral Artery Aneurysms: Standard Pterional Versus Minipterional Approach in a Retrospective Single-Center Analysis. World Neurosurg 2024:S1878-8750(24)00942-2. [PMID: 38843971 DOI: 10.1016/j.wneu.2024.05.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND In accordance with technique advancement and minimal invasiveness surgical approaches, the minipterional has progressively replaced the standard pterional approach for treatment of unruptured middle cerebral artery (MCA) aneurysms. Nowadays, multimodal intraoperative resources including microDoppler and microflow probes, indocyanine green videoangiography, and neurophysiologic monitoring constitute a fundamental prerequisite for increasing the safety of the clipping procedure. Our study investigated and compared in a single-center experience the effect of the evolution of a minimally invasive and multimodal approach in unruptured MCA aneurysm surgery by measuring postoperative complication rate, recovery time, and long-term neuropsychological and functional outcomes. METHODS One hundred and thirty-one patients who underwent surgical treatment for unruptured MCA aneurysms at our institution were evaluated retrospectively. Patients' clinical, radiologic, and surgical reports were collected. Cognitive evaluation and quality of life were assessed through validated tests in telephone interviews. Patients who met the inclusion criteria were divided into 2 groups: "PT (pterional)" and "MPT (minipterional)." RESULTS Ninety-two patients were included in the analysis. A significant reduction of postoperative complication rates and new-onset postoperative seizures was recorded in the MPT group (P value = 0.006). Severe cognitive deficits were lower in the MPT group, although without a clear statistical correlation. CONCLUSIONS Decreased complication rates, faster recovery time, and a trend toward better cognitive and functional performances were documented for the MPT group of patients. In our experience, the minipterional approach with multimodality-assisted microsurgery reduced neurologic complications and recovery time and improved long-term cognitive outcome and quality of life.
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Affiliation(s)
- Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy.
| | - Kristy Latour
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Luisa Siciliano
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of the Humanities and Life Sciences, University School for Advanced Studies, Pavia, Italy
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Serena Livi
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Postgraduate Residency Program in NeurologiSurgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Marchese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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Brunasso L, Di Bonaventura R, Albanese A. Letter to the Editor Regarding "Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note". World Neurosurg 2024; 185:446-448. [PMID: 38741295 DOI: 10.1016/j.wneu.2024.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Lara Brunasso
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, School of Medicine, University of Palermo, Palermo, Italy.
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCSt, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCSt, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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Mattogno PP, Menna G, Pennisi G, Corbi L, Sturiale CL, Polli FM, Olivi A, Della Pepa GM. Comparison of Effectiveness, Feasibility, Indications, and Limitations of Different Intraoperative Dyes in Spinal Neuro-Oncologic Surgery. A Systematic Review. World Neurosurg 2022; 168:146-153. [DOI: 10.1016/j.wneu.2022.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
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Zoli M, Daniele B, Giovanni R, Teresa S, Cesare Z, Giuseppe Maria DP. Young Neurosurgeons and Technology: Survey of Young Neurosurgeons Section of Italian Society of Neurosurgery (SINch). World Neurosurg 2022; 162:e436-e456. [DOI: 10.1016/j.wneu.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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Niizawa T, Hachiya R, Sugashi T, Terao S, Nagai M, Ishikawa M, Masamoto K. Mapping of flow velocity using spatiotemporal changes in time-intensity curves from indocyanine green videoangiography. Microcirculation 2021; 28:e12685. [PMID: 33586295 DOI: 10.1111/micc.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study developed an image-based analysis method that uses indocyanine green videoangiography (ICG-VA) to measure flow velocity in the arteries and veins of the cortical surface in patients undergoing neurosurgery. METHODS MATLAB-based code was used to correct motion artifacts in the ICG-VA and determine the time-intensity curve of the ICG. The slope of the initial increase in ICG intensity following the bolus injection was measured and normalized using the predicted input function in the imaging field. Flow velocity over a certain distance determined by the user was measured based on a time shift of the time-intensity curves along the centerline of the vessels. RESULTS The normalized slope of ICG intensity represented the expected differences in the flow velocity among the artery (0.67 ± 0.05 s-1 ), parenchymal tissue (0.49 ± 0.10 s-1 ), and vein (0.44 ± 0.11 s-1 ). The flow velocities measured along the vessel centerline were 2.5 ± 1.1 cm/s and 1.1 ± 0.3 cm/s in the arteries (0.5 ± 0.2 mm in diameter) and veins (0.6 ± 0.2 mm in diameter), respectively. CONCLUSIONS An image-based analysis method for ICG-VA was developed to map the expected differences in the flow velocity based on the rising slope of ICG intensity and to measure the absolute flow velocities using the flexible zone and cross-correlation methods.
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Affiliation(s)
- Tomoya Niizawa
- Faculty of Informatics and Engineering, University of Electro-Communications, Chofu, Japan
| | - Ryota Hachiya
- Faculty of Informatics and Engineering, University of Electro-Communications, Chofu, Japan
| | - Takuma Sugashi
- Faculty of Informatics and Engineering, University of Electro-Communications, Chofu, Japan
| | - Satoshi Terao
- Department of Neurosurgery, Saiseikai Central Hospital, Minato City, Japan
| | - Mutsumi Nagai
- Department of Neurosurgery, International University of Health and Welfare, Otawara, Japan
| | - Mami Ishikawa
- Department of Neurosurgery, Tachikawa Hospital, Tachikawa, Japan
| | - Kazuto Masamoto
- Faculty of Informatics and Engineering, University of Electro-Communications, Chofu, Japan.,Center for Neuroscience and Biomedical Engineering, University of Electro-Communications, Chofu, Japan
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Della Pepa GM, Di Bonaventura R, Latour K, Sturiale CL, Marchese E, Puca A, Sabatino G, Albanese A. Combined Use of Color Doppler Ultrasound and Contrast-Enhanced Ultrasound in the Intraoperative Armamentarium for Arteriovenous Malformation Surgery. World Neurosurg 2021; 147:150-156. [PMID: 33359527 DOI: 10.1016/j.wneu.2020.12.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Safety and efficacy in surgical treatment of cerebral arteriovenous malformations (AVMs) are dictated by thorough understanding of angioarchitectural features, intraoperative identification of feeding vessels, and appreciation of surrounding eloquent areas. Our aim was to describe the preliminary results of combined application of color Doppler ultrasound (CDUS) and contrast-enhanced ultrasound (CEUS) in a consecutive surgical series of AVM. We pointed out the tool's efficacy in distinguishing feeding from bystander vessels and in identifying pattern of venous drainage. We examined its role as an adjunct for semiquantitative evaluation of the nidus inflow. METHODS We used combined CDUS and CEUS in patients surgically treated for cerebral AVMs. We adopted these techniques following a designed protocol to guide safer AVM resection as an adjunct to indocyanine green videoangiography. Intraoperative assessment by ultrasound was performed before, during, and following nidus resection. RESULTS Four surgically treated cerebral AVMs availed of the ultrasound protocol. Postoperative conventional angiography showed complete resection of the AVMs. CDUS and CEUS proved to be valuable adjunctive tools to indocyanine green videoangiography and micro-Doppler in properly navigating and discerning vascular structures, especially vessel feeders from bystanders. The protocol allows us to identify flow direction, estimate blood velocity within the nidus, and appreciate flow modifications following temporary clipping. Ultimately, it allows us to evaluate the degree of nidus deafferentation, residual flow, restoration of venous drainage and absence of arteriovenous shunts. CONCLUSIONS The CDUS and CEUS protocol is safe and repeatable and works as real-time imaging, further supporting complete surgical resection of AVMs.
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Affiliation(s)
- Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.
| | - Kristy Latour
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Enrico Marchese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alfredo Puca
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy; Neurosurgery Unit, Mater Olbia Hospital, Olbia, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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Velz J, Esposito G, Regli L. Traumatic Distal Anterior Cerebral Artery Aneurysms - Pathomechanism and Revascularisation Strategies. J Stroke Cerebrovasc Dis 2021; 30:105578. [PMID: 33401141 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/15/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022] Open
Abstract
Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA - radial artery - A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.
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Affiliation(s)
- Julia Velz
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Giuseppe Esposito
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland;.
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La Rocca G, Della Pepa GM, Menna G, Altieri R, Ius T, Rapisarda A, Olivi A, Sabatino G. State of the art of fluorescence guided techniques in neurosurgery. J Neurosurg Sci 2020; 63:619-624. [PMID: 31961115 DOI: 10.23736/s0390-5616.19.04854-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Achieving a safe and extensive neoplasm resection can be considered the main goal of brain tumor surgery. This paper is first aimed at providing an overview of the evolution of those tools serving the purpose. From the dawn of neurosurgery to the present days, major innovations have followed one another. However, those techniques may frequently lack of an instant biological feedback on the true extension and the infiltration of the tumor. Intraoperative fluorescence modalities could indeed fill this gap. Fluorescence guided surgery will be therefore introduced and discussed in this context. Our focus will be on the most common fluorescence techniques used in neurosurgery, namely 5-aminolevulinic acid, sodium fluorescein and in indocyanine green. Mode of action, strengths and weaknesses and level of evidence of each modality will be discussed.
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Affiliation(s)
- Giuseppe La Rocca
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy - .,Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy -
| | - Giuseppe M Della Pepa
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Grazia Menna
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Roberto Altieri
- Department of Neurological Surgery, G. Rodolico Policlinic University Hospital, Catania, Italy.,Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Tamara Ius
- Unit of Neurosurgery, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
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Della Pepa GM, Ius T, Menna G, La Rocca G, Battistella C, Rapisarda A, Mazzucchi E, Pignotti F, Alexandre A, Marchese E, Olivi A, Sabatino G. "Dark corridors" in 5-ALA resection of high-grade gliomas: combining fluorescence-guided surgery and contrast-enhanced ultrasonography to better explore the surgical field. J Neurosurg Sci 2020; 63:688-696. [PMID: 31961118 DOI: 10.23736/s0390-5616.19.04862-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Increasing the extent of resection (EOR) is considered a main goal in high grade glioma (HGG) surgery. Significant advancements have been recently made to assist surgery: namely the use of 5-aminolevulinic acid (5ALA) and the application of contrast-enhanced ultrasound (CEUS) embody two of the most recently introduced tools in the neuro-oncology field. A combined approach including the two techniques has been suggested in literature. Our primary aim is to identify in which conditions CEUS final survey has a real impact in a 5-ALA guided context and assess which preoperative tumor characteristics, with specific attention to working corridors can predict strains of the fluorescence guided procedure and hence recommend the use of the combined technique. METHODS Forty-nine HGG glioma surgeries were performed at our institution with the abovementioned protocol between January 2016 and June 2016. Based on preoperative MRI, we stratified glioma characteristics according to three determinants: localization (deep versus superficial), size (<3.5 versus >3.5 cm) and shape (regular versus irregular). RESULTS CEUS modified 5-ALA guided resection in 11 cases (22.45%): this appeared to be associated with statistically significance to deep tumor localization (P=0.04) and irregular/multi-lobulated margins (P=0.003). On the other hand, tumor size alone did not appear as a statistically significant determinant. CONCLUSIONS When dark corridors are presents or when overlying brain parenchyma hinders illumination, drawbacks to the 5-ALA assistance can be expected, hence CEUS final survey has a crucial role of 'refinement'. In those selected cases, an integrated 5ALA+CEUS protocol was shown as advisable in EOR improvement.
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Affiliation(s)
- Giuseppe M Della Pepa
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Grazia Menna
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | | | - Alessandro Rapisarda
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Andrea Alexandre
- Institute of Neuroradiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Della Pepa GM, Ius T, La Rocca G, Gaudino S, Isola M, Pignotti F, Rapisarda A, Mazzucchi E, Giordano C, Dragonetti V, Chiesa S, Balducci M, Gessi M, Skrap M, Olivi A, Marchese E, Sabatino G. 5-Aminolevulinic Acid and Contrast-Enhanced Ultrasound: The Combination of the Two Techniques to Optimize the Extent of Resection in Glioblastoma Surgery. Neurosurgery 2020; 86:E529-E540. [PMID: 32186345 DOI: 10.1093/neuros/nyaa037] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The survival benefit in maximizing resection in glioblastomas (GBMs) has been demonstrated by numerous studies. The true limit of infiltration of GBMs has been an overwhelming obstacle, and several technological advances have been introduced to improve the identification of residual tumors. OBJECTIVE To evaluate whether the integration of 5-aminolevulinic acid (5-ALA) with microbubble contrast-enhanced ultrasound (CEUS) improves residual tumor identification and has an impact on the extent of resection (EOR), overall survival (OS), and progression-free survival (PFS). METHODS A total of 230 GBM procedures were retrospectively studied. Cases were stratified according to the surgical procedure into 4 groups: 5-ALA- and CEUS-guided surgeries, 5-ALA-guided surgeries, CEUS-guided surgeries, and conventional microsurgical procedures. RESULTS Patients undergoing conventional microsurgical procedures showed the worst EORs compared to the assisted techniques (5-ALA and CEUS procedures). Both 5-ALA and CEUS techniques improved the EOR compared to conventional microsurgical procedures. However, their combination gave the best results in terms of the EOR (P = .0003). The median EOR% and the number of supramarginal resections are hence superior in the 5-ALA + CEUS + group compared to the others; this observation had consequences on PFS and OS in our series. CONCLUSION In terms of the EOR, the best results can be achieved through a combination of both techniques, where the 5-ALA-guided procedure is followed by a final survey with CEUS. Compared with other intraoperative imaging techniques, CEUS is a real-time, readily repeatable, safe, and inexpensive technique that provides valuable information to the surgeon before, during, and after resection.
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Affiliation(s)
- Giuseppe Maria Della Pepa
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Simona Gaudino
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Edoardo Mazzucchi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Carolina Giordano
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Valentino Dragonetti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Silvia Chiesa
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Mario Balducci
- Department of Radiation Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCSSl, Catholic University of Rome, Rome, Italy
| | - Marco Gessi
- Department of Neuro-Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Catholic University of Rome, Rome, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital, Udine, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Catholic University of Rome, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Konovalov NA, Nazarenko AG, Asyutin DS, Onoprienko RA, Schul'ts MA, Korolishin VA, Kaprovoy SV, Brinyuk ES, Zakirov BA, Timonin SY, Pogosyan AL. [Intraoperative video-angiography in surgery for spinal intramedullary cavernous malformations: first experience of its application at the Burdenko Neurosurgical Center]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 83:58-63. [PMID: 32031168 DOI: 10.17116/neiro20198306158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spinal intramedullary cavernous malformations are a rare vascular pathology of the central nervous system. They account for 3-5% of spinal cord diseases. The clinical picture in patients with cavernous malformations varies from an asymptomatic course to gross neurological deficit in the case of bleeding from a malformation. Due to the lack of reliable methods for predicting the development of bleeding, the need for surgical treatment of asymptomatic patients remains a relevant and open topic for discussion. The goal of surgical treatment of cavernous malformations is to minimize the risk of repeated hemorrhages and gross neurological deficits in patients. Intraoperative indocyanine green video angiography is a promising technique for intraoperative visualization of the size and adherence area of a cavernous malformation to the spinal cord tissue. This increases the radicality of cavernous malformation resection and minimizes intraoperative risks for the patient.
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Affiliation(s)
| | | | - D S Asyutin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | | | - E S Brinyuk
- Burdenko Neurosurgical Center, Moscow, Russia
| | - B A Zakirov
- Burdenko Neurosurgical Center, Moscow, Russia
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Caffo M, Cardali SM, Raffa G, Caruso G, Barresi V, Ricciardo G, Gorgoglione N, Granata F, Germanò A. The Value of Preoperative Planning Based on Navigated Transcranical Magnetic Stimulation for Surgical Treatment of Brain Metastases Located in the Perisylvian Area. World Neurosurg 2020; 134:e442-e452. [DOI: 10.1016/j.wneu.2019.10.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
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Foster CH, Morone PJ, Tomlinson SB, Cohen-Gadol AA. Application of Indocyanine Green During Arteriovenous Malformation Surgery: Evidence, Techniques, and Practical Pearls. Front Surg 2019; 6:70. [PMID: 31921884 PMCID: PMC6917574 DOI: 10.3389/fsurg.2019.00070] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
Indocyanine green (ICG) is a fluorescent molecule that enables visualization of hemodynamic flow through blood vessels. The first description of its application to the resection of arteriovenous malformations (AVMs) did not occur until 2007. Since then, industry leaders have rapidly integrated this optical technology into the intraoperative microscope, and the use of ICG videoangiography (VA) has since become routine in AVM surgery among some academic centers. A number of case series have been published since the introduction of ICG VA to AVM neurosurgery. These early reports with small sample sizes were largely qualitative, assigning to the technology “usefulness” and “benefit” scores as perceived by the operators. This lack of objectivity prompted the development of FLOW 800 software, a proprietary technology of Carl Zeiss Meditec AG (Oberkochen, Germany) that can quantify relative fluorescence intensity under the microscope to generate color maps and intensity curves for ad hoc and post hoc analyses, respectively. However, subsequent case series have done little to quantify the effect of ICG VA on outcomes. The available literature predominately concludes that ICG VA, although intuitive to deploy and interpret, is limited by its dependence on direct illumination and visualization. The subcortical components of AVMs represent a natural challenge to ICG-based flow analysis, and the scope of ICG VA has therefore been limited to AVMs with a high proportion of superficial angioarchitecture. As a result, digital subtraction angiography has remained the gold standard for confirming AVM obliteration. In this review, we provide an overview of the existing literature on ICG VA in AVM resection surgery. In addition, we describe our own experiences with ICG VA and AVMs and offer the senior author's surgical pearls for optimizing the marriage of fluorescence flow technology and AVM resection surgery.
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Affiliation(s)
- Chase H Foster
- Department of Neurological Surgery, George Washington University Hospital, Washington, DC, United States
| | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, United States
| | - Samuel B Tomlinson
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, Indianapolis, IN, United States
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“Enhancing Vision” in High Grade Glioma Surgery: A Feasible Integrated 5-ALA + CEUS Protocol to Improve Radicality. World Neurosurg 2019; 129:401-403. [DOI: 10.1016/j.wneu.2019.06.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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15
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Della Pappa GM, Marchese E, Pedicelli A, Olivi A, Ricciardi L, Rapisarda A, Skrap B, Sabatino G, La Rocca G. Contrast-Enhanced Ultrasonography and Color Doppler: Guided Intraoperative Embolization of Intracranial Highly Vascularized Tumors. World Neurosurg 2019; 128:547-555. [DOI: 10.1016/j.wneu.2019.05.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
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16
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Davoodzadeh N, Cano-Velázquez MS, Halaney DL, Jonak CR, Binder DK, Aguilar G. Optical Access to Arteriovenous Cerebral Microcirculation Through a Transparent Cranial Implant. Lasers Surg Med 2019; 51:920-932. [PMID: 31236997 DOI: 10.1002/lsm.23127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Microcirculation plays a critical role in physiologic processes and several disease states. Laser speckle imaging (LSI) is a full-field, real-time imaging technique capable of mapping microvessel networks and providing relative flow velocity within the vessels. In this study, we demonstrate that LSI combine with multispectral reflectance imaging (MSRI), which allows for distinction between veins and arteries in the vascular flow maps produced by LSI. We apply this combined technique to mouse cerebral vascular network in vivo, comparing imaging through the skull, to the dura mater and brain directly through a craniectomy, and through a transparent cranial "Window to the Brain" (WttB) implant. STUDY DESIGN/MATERIALS AND METHODS The WttB implant used in this study is made of a nanocrystalline Yttria-Stabilized-Zirconia ceramic. MSRI was conducted using white-light illumination and filtering the reflected light for 560, 570, 580, 590, 600, and 610 nm. LSI was conducted using an 810 nm continuous wave near-infrared laser with incident power of 100 mW, and the reflected speckle pattern was captured by a complementary metal-oxide-semiconductor (CMOS) camera. RESULTS Seven vessel branches were analyzed and comparison was made between imaging through the skull, craniectomy, and WttB implant. Through the skull, MSRI did not detect any vessels, and LSI could not image microvessels. Imaging through the WttB implant, MSRI was able to identify veins versus arteries, and LSI was able to image microvessels with only slightly higher signal-to-noise ratio and lower sharpness than imaging the brain through a craniectomy. CONCLUSIONS This study demonstrates the ability to perform MSRI-LSI across a transparent cranial implant, to allow for cerebral vascular networks to be mapped, including microvessels. These images contain additional information such as vein-artery separation and relative blood flow velocities, information which is of value scientifically and medically. The WttB implant provides substantial improvements over imaging through the murine cranial bone, where microvessels are not visible and MSRI cannot be performed. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Nami Davoodzadeh
- Department of Mechanical Engineering, University of California, Bourns Hall A342 900 University Ave., Riverside, California, 92521
| | - Mildred S Cano-Velázquez
- Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Coyoacán, Mexico City, 04510, Mexico
| | - David L Halaney
- Department of Mechanical Engineering, University of California, Bourns Hall A342 900 University Ave., Riverside, California, 92521
| | - Carrie R Jonak
- Division of Biomedical Sciences, School of Medicine, University of California, 1126 Webber Hall 900 University Ave., Riverside, California, 92521
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, 1126 Webber Hall 900 University Ave., Riverside, California, 92521
| | - Guillermo Aguilar
- Department of Mechanical Engineering, University of California, Bourns Hall A342 900 University Ave., Riverside, California, 92521
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17
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Multimodal Monitoring Strategy Is Decisive in Elective Middle Cerebral Artery Aneurysm Clipping: A Case Report. World Neurosurg 2019; 122:43-47. [PMID: 31108065 DOI: 10.1016/j.wneu.2018.10.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The intraoperative use of neurophysiological monitoring (IONM) and indocyanine green video angiography (ICGVA) for aneurysm clipping have evolved during the last years. Both modalities are useful and safe by allowing greater rates of complete aneurysm occlusion with less intraoperative complications and postoperative neurologic deficits. We report a case of attempted aneurysm clipping in which the combined use of ICGVA and IONM was crucial for intraoperative decision-making. CASE DESCRIPTION A 62-year-old woman was operated for an incidental 6-mm aneurysm at the origin of the right fronto-opercular branch. During aneurysm clipping, IONM amplitudes dropped drastically, despite patency of the parent artery and perforators in ICGVA. Several attempts for clipping were made with recurring drops in IONM amplitudes, which forced us to leave the aneurysm untreated. The patient had a postoperative left-sided hemiparesis that improved on follow-up. Thereafter, the aneurysm was treated with stent-assisted coiling. CONCLUSIONS The combination of IONM and ICGVA during aneurysm surgery allows for a better assessment of vascular integrity and patient's postoperative outcome than ICGVA alone. Simultaneous evaluation of vessel patency and integrity of the somatosensory and motor pathways illustrates the complementarity of testing different modalities for intraoperative decision-making and for maximizing safeness in aneurysm clipping.
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18
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Dasenbrock HH, See AP, Smalley RJ, Bi WL, Dolati P, Frerichs KU, Golby AJ, Chiocca EA, Aziz-Sultan MA. Frameless Stereotactic Navigation during Insular Glioma Resection using Fusion of Three-Dimensional Rotational Angiography and Magnetic Resonance Imaging. World Neurosurg 2019; 126:322-330. [PMID: 30898738 DOI: 10.1016/j.wneu.2019.03.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Perioperative cerebral infarction is a potential complication of glioma resection, of which insular tumors are at higher risk because of the proximity of middle cerebral artery branches, including the lateral lenticulostriates and long insular arteries. In this study, 3 patients received three-dimensional rotational angiography, which was fused with magnetic resonance imaging (MRI) for frameless stereotactic navigation during dominant-hemisphere insular glioma resection. METHODS All patients obtained a preoperative catheter angiogram with a three-dimensional rotational acquisition of the ipsilateral internal carotid artery. The pixel-based axial three-dimensional angiography data, thin-cut structural MRI, tractography from diffusion tensor imaging, and expressive language activation from functional MRI were uploaded into the iPlan software (Brainlab, Heimstetten, Germany) and fused. The target tumor, regional blood vessels, adjacent functional areas, and their associated fiber tracts were segmented and overlaid on the appropriate MRI sequence. This image fusion was used preoperatively to visualize the relationship of the mass with the adjacent vasculature and intraoperatively for frameless stereotactic navigation to optimize preservation of arterial structures. RESULTS Three patients aged 27-60 years with excellent baseline functional status presented with seizures and were found to have a large dominant-hemisphere T2 hyperintense nonenhancing insular mass. Surgical resection was performed using multimodality neuronavigation. None sustained a postoperative arterial infarction or a perioperative neurologic deficit. CONCLUSIONS Neuronavigation using a fusion of three-dimensional rotational angiography with MRI is a technique that can be used for preoperative planning and during resection of insular gliomas to optimize preservation of adjacent arteries.
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Affiliation(s)
- Hormuzdiyar H Dasenbrock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Alfred P See
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Smalley
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parviz Dolati
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Hoesli R, Brennan JR, Rosko AJ, Birkeland AC, Malloy KM, Moyer JS, Prince MEP, Shuman AG, Chinn SB, Stucken CL, Casper KA, Spector ME. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 2019; 26:1320-1325. [PMID: 30805812 DOI: 10.1245/s10434-019-07262-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technology to assess tissue perfusion is exciting with translational potential, although data supporting its clinical applications have been lagging. Patients who have undergone radiation are at particular risk of poor tissue perfusion and would benefit from this expanding technology. We designed a prospective clinical trial using intraoperative indocyanine green angiography to evaluate for wound-healing complications in patients undergoing salvage laryngectomy after radiation failure. PATIENTS AND METHODS This prospective trial included patients undergoing salvage laryngectomy at a National Cancer Institute-designated tertiary cancer center between 2016 and 2018. After tumor extirpation and prior to reconstruction, 10 mg indocyanine green dye was infused and the fluorescence (FHYPO) and ingress rate of the pharyngeal mucosa recorded. The primary outcome measure was formation of a pharyngocutaneous fistula (PCF). RESULTS Patients who developed a PCF had significantly lower FHYPO (87 vs 172, p < 0.001) and ingress rates (6.7 vs 15.8, p = 0.043) compared with those who did not develop a fistula. There were no fistulas in patients with FHYPO > 150 (n = 21) or ingress > 15 (n = 15). There was a 50% fistula rate in patients with FHYPO ≤ 103 (n = 10) and ingress rate ≤ 6 (n = 6). CONCLUSIONS Intraoperative indocyanine green angiography can assess hypoperfusion in patients and predict risk of PCFs after salvage laryngectomy, and can thus intraoperatively risk-stratify patients for postoperative wound-healing complications.
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Affiliation(s)
- Rebecca Hoesli
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, MI, USA.
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Hameed S, Chen H, Irfan M, Bajwa SZ, Khan WS, Baig SM, Dai Z. Fluorescence Guided Sentinel Lymph Node Mapping: From Current Molecular Probes to Future Multimodal Nanoprobes. Bioconjug Chem 2018; 30:13-28. [DOI: 10.1021/acs.bioconjchem.8b00812] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sadaf Hameed
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Hong Chen
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
| | - Muhammad Irfan
- Department of Medicines, Gujranwala Medical College, Gujranwala 52250, Pakistan
| | - Sadia Zafar Bajwa
- National Institute of Biotechnology and Genetic Engineering, Faisalabad 38000, Pakistan
| | - Waheed S Khan
- National Institute of Biotechnology and Genetic Engineering, Faisalabad 38000, Pakistan
| | - Shahid Mahmood Baig
- National Institute of Biotechnology and Genetic Engineering, Faisalabad 38000, Pakistan
| | - Zhifei Dai
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing 100871, China
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21
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Ricciardi L, Della Pepa GM, Izzo A, Simboli GA, Polli FM, La Rocca G, Sabatino G. Use of Neuronavigation System for Superficial Vein Identification: Safe and Quick Method to Avoid Intraoperative Bleeding and Vein Closure: Technical Note. World Neurosurg 2018; 117:92-96. [DOI: 10.1016/j.wneu.2018.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 11/30/2022]
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22
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Munakomi S, Poudel D. A pilot study on assessing the role of intra-operative Flow 800 vascular map model in predicting onset of vasospasm following micro vascular clipping of ruptured intracranial aneurysms. F1000Res 2018; 7:1188. [PMID: 30271586 PMCID: PMC6124383 DOI: 10.12688/f1000research.15627.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To ascertain the predictive value of intra-operative FLOW 800 vascular map model in predicting onset of post-operative clinical vasospasm and delayed cerebral ischemia among patients undergoing micro-vascular clipping of ruptured intracranial aneurysms. Material and methods A total of 40 patients were enrolled in the study and their variables such as age, World Federation of Neurological Surgeons (WFNS) grade at presentation, Computerized Tomography (CT) Fisher grading, location of the aneurysms, and Indocyanine Green (ICG) flow status were compared and statistically analyzed along with differences in Absorption Intensities (AI) and difference in time lag values obtained from the FLOW 800 vascular map studies for predicting onset of vasospasm. Results The Receiver Operating curve (ROC) of the model for predicting post-operative vasospasm was highest (.892) for difference in the AI followed by CT Fisher grading (.778), difference in time lag (.700) and WFNS grading (.699).Analysis of variance for different variables studied in our model for predicting vasospasm was significant for all except for age (.991) and the ICG flow through the parent vessel (.079).Multivariate analysis done for predicting the vasospasm was significant for all variables except for age (.869) and ICG main flow (.196) Conclusion Our study confirmed the role of FLOW 800 study model in predicting clinical vasospasm. Inclusion of this entity would therefore help in taking timely and correct therapeutics measures to ensure better patient outcomes.
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Affiliation(s)
- Sunil Munakomi
- Neurosurgery, Nobel Teaching Hospital, Biratnagar, 0977, Nepal
| | - Deepak Poudel
- Neurosurgery, Nobel Teaching Hospital, Biratnagar, 0977, Nepal
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23
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Esposito G, Regli L. Intraoperative tools for cerebral bypass surgery. Acta Neurochir (Wien) 2018; 160:775-778. [PMID: 29322266 DOI: 10.1007/s00701-017-3455-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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24
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Integration of Real-Time Intraoperative Contrast-Enhanced Ultrasound and Color Doppler Ultrasound in the Surgical Treatment of Spinal Cord Dural Arteriovenous Fistulas. World Neurosurg 2018; 112:138-142. [DOI: 10.1016/j.wneu.2018.01.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022]
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25
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Lee JYK, Pierce JT, Thawani JP, Zeh R, Nie S, Martinez-Lage M, Singhal S. Near-infrared fluorescent image-guided surgery for intracranial meningioma. J Neurosurg 2018; 128:380-390. [PMID: 28387632 PMCID: PMC10985532 DOI: 10.3171/2016.10.jns161636] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Meningiomas are the most common primary tumor of the central nervous system. Complete resection can be curative, but intraoperative identification of dural tails and tumor remnants poses a clinical challenge. Given data from preclinical studies and previous clinical trials, the authors propose a novel method of localizing tumor tissue and identifying residual disease at the margins via preoperative systemic injection of a near-infrared (NIR) fluorescent contrast dye. This technique, what the authors call "second-window indocyanine green" (ICG), relies on the visualization of ICG approximately 24 hours after intravenous injection. METHODS Eighteen patients were prospectively identified and received 5 mg/kg of second-window ICG the day prior to surgery. An NIR camera was used to localize the tumor prior to resection and to inspect the margins following standard resection. The signal to background ratio (SBR) of the tumor to the normal brain parenchyma was measured in triplicate. Gross tumor and margin specimens were qualitatively reported with respect to fluorescence. Neuropathological diagnosis served as the reference gold standard to calculate the sensitivity and specificity of the imaging technique. RESULTS Eighteen patients harbored 15 WHO Grade I and 3 WHO Grade II meningiomas. Near-infrared visualization during surgery ranged from 18 to 28 hours (mean 23 hours) following second-window ICG infusion. Fourteen of the 18 tumors demonstrated a markedly elevated SBR of 5.6 ± 1.7 as compared with adjacent brain parenchyma. Four of the 18 patients showed an inverse pattern of NIR signal, that is, stronger in the adjacent normal brain than in the tumor (SBR 0.31 ± 0.1). The best predictor of inversion was time from injection, as the patients who were imaged earlier were more likely to demonstrate an appropriate SBR. The second-window ICG technique demonstrated a sensitivity of 96.4%, specificity of 38.9%, positive predictive value of 71.1%, and a negative predictive value of 87.5% for tumor. CONCLUSIONS Systemic injection of NIR second-window ICG the day before surgery can be used to visualize meningiomas intraoperatively. Intraoperative NIR imaging provides higher sensitivity in identifying meningiomas than the unassisted eye. In this study, 14 of the 18 patients with meningioma demonstrated a strong SBR compared with adjacent brain. In the future, reducing the time interval from dye injection to intraoperative imaging may improve fluorescence at the margins, though this approach requires further investigation. Clinical trial registration no.: NCT02280954 ( clincialtrials.gov ).
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Affiliation(s)
- John Y. K. Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John T. Pierce
- Department of Neurosurgery, Hospital of the University of Pennsylvania
| | - Jayesh P. Thawani
- Department of Neurosurgery, Hospital of the University of Pennsylvania
| | - Ryan Zeh
- Department of Neurosurgery, Hospital of the University of Pennsylvania
| | - Shuming Nie
- Department of Chemistry, Emory University School of Medicine, Atlanta, Georgia
| | | | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania
- Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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26
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Esposito G, Dias S, Burkhardt JK, Bozinov O, Regli L. Role of Indocyanine Green Videoangiography in Identification of Donor and Recipient Arteries in Cerebral Bypass Surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2018; 129:85-89. [PMID: 30171318 DOI: 10.1007/978-3-319-73739-3_12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The identification and preparation of a very good quality donor artery is a crucial step in every superficial temporal artery to middle cerebral artery (STA-MCA) bypass.For flow-preservation bypass performed for trapping of complex MCA aneurysms, the key element is the correct target of the recipient artery. When a cortical recipient artery (M4 segment of the MCA) is selected, this vessel must be a terminal branch of the artery whose sacrifice is necessary for definitive aneurysmal treatment.In this chapter we report on two techniques for (1) intraoperative mapping and preparation of good quality STA branch as the donor artery for STA-MCA bypass (mostly in the case the frontal branch of the STA needs to be used) and (2) selective identification of the correct superficial (M4 cortical) "recipient" artery in flow-preservation STA-MCA bypass performed for managing complex MCA aneurysms.Both techniques are based on the use of microscope-integrated indocyanine green videoangiography (ICG-VA), an intraoperative tool allowing observation and real-time assessment of blood flow in large and small vessels, with distinct evaluation of arterial, capillary, and venous phases.The two techniques contribute, respectively, to (1) reduce the risk of erroneous identification or injury of the donor artery in STA-MCA bypass procedures and (2) eliminate the risk of erroneous revascularization of a non-involved arterial territory in flow-preservation bypass surgery for managing complex MCA aneurysms.
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Affiliation(s)
- Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Sandra Dias
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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27
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Lee JYK, Pierce JT, Zeh R, Cho SS, Salinas R, Nie S, Singhal S. Intraoperative Near-Infrared Optical Contrast Can Localize Brain Metastases. World Neurosurg 2017; 106:120-130. [PMID: 28669877 PMCID: PMC11073792 DOI: 10.1016/j.wneu.2017.06.128] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Approximately 100,000 brain metastases are diagnosed annually in the United States. Our laboratory has pioneered a novel technique, second window indocyanine green (SWIG), which allows for real-time intraoperative visualization of brain metastasis through normal brain parenchyma and intact dura. METHODS Thirteen patients with intraparenchymal brain metastases were administered indocyanine green (ICG) at 5 mg/kg the day before surgery. A near-infrared (NIR)- capable camera was used intraoperatively to identify the tumor and to inspect surgical margins. Neuropathology was used to assess the accuracy and precision of the fluorescent dye for identifying tumor. RESULTS ICG was infused at 24.7 ± 3.45 hours before visualization. All 13 metastases fluoresced with an average signal-to-background ratio (SBR) of 6.62. The SBR with the dura intact was 67.2% of the mean SBR once the dura was opened. The NIR signal could be visualized through normal brain parenchyma up to 7 mm. For the 39 total specimens, the mean SBR for tumor specimens (n = 28) was 6.9, whereas the SBR for nontumor specimens (n = 11) was 3.7. The sensitivity, specificity, positive predictive value, and negative predictive value of NIR imaging for tumor was 96.4%, 27.3%, 77.1%, and 75.0%. DISCUSSION SWIG relies on the passive accumulation of dye in abnormal tumor tissue via the enhanced permeability and retention effect. It provides strong NIR optical contrast, which can be used to localize tumors before dural opening. The use of SWIG for margin assessment remains limited by its lack of specificity (high false-positive rate); however, ongoing improvements in imaging parameters show great potential to reduce false-positive results.
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Affiliation(s)
- John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - John T Pierce
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Zeh
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steve S Cho
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Salinas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shuming Nie
- Department of Biochemistry, Emory University, Atlanta, Georgia, USA
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ferrauto G, Carniato F, Di Gregorio E, Tei L, Botta M, Aime S. Large photoacoustic effect enhancement for ICG confined inside MCM-41 mesoporous silica nanoparticles. NANOSCALE 2017; 9:99-103. [PMID: 27934996 DOI: 10.1039/c6nr08282c] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Indocyanine green was encapsulated inside the pores of pegylated amino-functionalized MCM-41 Mesoporous Silica Nanoparticles (ICG-MSNs). In addition to a greater stability and a decrease of toxicity, the photoacoustic effect of ICG-MSNs increases by nearly 400% compared to free ICG due to fluorescence quenching and high photothermal conversion of the encapsulated dyes. Upon i.v. administration in tumor-bearing mice, an overall photoacoustic enhancement of ca. 25% was measured in the tumor region.
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Affiliation(s)
- Giuseppe Ferrauto
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza 52, 10126 Turin, Italy.
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Abstract
OBJECT The authors report their personal experience with brain arterio-venous malformations (bAVMs) surgery with a multimodal flow-assisted approach. METHODS Data from patients who consecutively underwent bAVM resection with the assistance of indocyanine green video-angiography (ICG-VA), micro-flow probe flowmetry, and temporary arterial clipping test under intra-operative monitoring, were retrospectively analyzed. RESULTS Twenty seven patients were enrolled in the study. Re-operation for residual nidus was needed in one case (3 %). Average mRS change 1 month after surgery was +0.02. In our experience, the multimodal flow-assisted approach enabled surgeons to shift from one technique to another, according to the stage of resection, AVM location, or specific issues to be addressed. Before resection, the value of ICG-VA and flowmetry in showing AVM angio-architecture and guiding surgical strategy was related to AVM features. The temporary arterial clipping-test presented a 100 % sensitivity to differentiate between an AVM feeder and a transit artery to the sensi-motor area. At the final stage of resection, flowmetry was more effective than ICG-VA in detecting residual nidus missed at dissection. CONCLUSIONS Multimodal flow-assisted approach in AVM surgery proved a feasible, safe, and reliable methodology to achieve AVM resection with high radicality and low morbidity rate.
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Porcu EP, Salis A, Gavini E, Rassu G, Maestri M, Giunchedi P. Indocyanine green delivery systems for tumour detection and treatments. Biotechnol Adv 2016; 34:768-789. [PMID: 27090752 DOI: 10.1016/j.biotechadv.2016.04.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 01/16/2023]
Abstract
Indocyanine green (ICG) is a cyanine compound that displays fluorescent properties in the near infrared region. This dye is employed for numerous indications but nowadays its major application field regards tumour diagnosis and treatments. Optical imaging by near infrared fluorescence provides news opportunities for oncologic surgery. The imaging of ICG can be useful for intraoperative identification of several solid tumours and metastases, and sentinel lymph node detection. In addition, ICG can be used as an agent for the destruction of malignant tissue, by virtue of the production of reactive oxygen species and/or induction of a hyperthermia effect under irradiation. Nevertheless, ICG shows several drawbacks, which limit its clinical application. Several formulative strategies have been studied to overcome these problems. The rationale of the development of ICG containing drug delivery systems is to enhance the in vivo stability and biodistribution profile of this dye, allowing tumour accumulation and resulting in better efficacy. In this review, ICG containing nano-sized carriers are classified based on their chemical composition and structure. In addition to nanosystems, different formulations including hydrogel, microsystems and others loaded with ICG will be illustrated. In particular, this report describes the preparation, in vitro characterization and in vivo application of ICG platforms for cancer imaging and treatment. The promising results of all systems confirm their clinical utility but further studies are required prior to evaluating the formulations in human trials.
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Affiliation(s)
- Elena P Porcu
- PhD in Experimental Medicine, Department of Diagnostic, Paediatric, Clinical and Surgical Science, Pavia, Italy
| | - Andrea Salis
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | - Elisabetta Gavini
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | - Giovanna Rassu
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | | | - Paolo Giunchedi
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy.
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31
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Esposito G, Burkhardt JK, Bozinov O, Regli L. Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery. Acta Neurochir (Wien) 2016; 158:565-70. [PMID: 26783025 DOI: 10.1007/s00701-016-2703-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass remains an essential tool for managing complex cerebrovascular conditions. A crucial surgical step is the identification and safe dissection of the bypass donor artery. If the frontal branch of the STA is used, a curvilinear fronto-temporal scalp flap generally allows for a clean dissection from the underside of the scalp flap. This dissection is sometimes tedious, since the frontal branch is not always easily visible and due to variability of its anatomy. With this article, we report on the feasibility and effectiveness of a simple indocyanine green videoangiography (ICG-VA)-assisted technique for the identification of the STA branches from the underside of a fronto-temporal scalp flap in bypass surgery. METHODS The technique is based on the analysis of the difference in timing of filling of scalp vessels illuminated via ICG-VA from the underside of a scalp flap. Three illustrative cases are reported. RESULTS ICG-VA permitted the correct identification and safe dissection of the donor vessels (STA branches) in all three patients. There were no complications due to the ICG-VA. CONCLUSIONS This technique allows reliable visualization of the STA and its branches at once before microsurgical dissection. The information provided by ICG-VA enables precise mapping and preparation of the STA. The simplicity and safety of this technique make it an effective tool for intraoperative identification of the STA and its branches.
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Affiliation(s)
- Giuseppe Esposito
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091.
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32
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Burgess L, Chen J, Wolter NE, Wilson B, Zheng G. Topical MMP beacon enabled fluorescence-guided resection of oral carcinoma. BIOMEDICAL OPTICS EXPRESS 2016; 7:1089-99. [PMID: 27231609 PMCID: PMC4866449 DOI: 10.1364/boe.7.001089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
Each year almost 300,000 individuals worldwide are diagnosed with oral cancer, more than 90% of these being oral carcinoma [N. Engl. J. Med.328, 1841993]. Surgical resection is the standard of care, but accurate delineation of the tumor boundaries is challenging, resulting in either under-resection with risk of local recurrence or over-resection with increased functional loss and negative impact on quality of life. This study evaluates, in two pre-clinical in vivo tumor models, the potential of fluorescence-guided resection using molecular beacons activated by metalloproteinases, which are frequently upregulated in human oral cancer. In both models there was rapid (<15 min) beacon activation upon local application, allowing clear fluoresecence imaging in vivo and confirmed by ex vivo fluorescence microscopy and HPLC, with minimal activation in normal oral tissues. Although the tissue penetration was limited using topical application, these findings support further development of this approach towards translation to first-in-human trials.
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Affiliation(s)
- Laura Burgess
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto ON M5G 1L7, Canada
| | - Juan Chen
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto ON M5G 1L7, Canada
| | - Nikolaus E. Wolter
- Department of Otolaryngology – Head & Neck Surgery, University of Toronto, 190 Elizabeth St, Rm 3S438, RFE Building Toronto, ON, M5G 2N2, Canada
| | - Brian Wilson
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto ON M5G 1L7, Canada
| | - Gang Zheng
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto ON M5G 1L7, Canada
- Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto ON M5G 1L7, Canada
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Watson JR, Gainer CF, Martirosyan N, Skoch J, Lemole GM, Anton R, Romanowski M. Augmented microscopy: real-time overlay of bright-field and near-infrared fluorescence images. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:106002. [PMID: 26440760 PMCID: PMC4881285 DOI: 10.1117/1.jbo.20.10.106002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/02/2015] [Indexed: 05/10/2023]
Abstract
Intraoperative applications of near-infrared (NIR) fluorescent contrast agents can be aided by instrumentation capable of merging the view of surgical field with that of NIR fluorescence. We demonstrate augmented microscopy, an intraoperative imaging technique in which bright-field (real) and electronically processed NIR fluorescence (synthetic) images are merged within the optical path of a stereomicroscope. Under luminance of 100,000 lx, representing typical illumination of the surgical field, the augmented microscope detects 189 nM concentration of indocyanine green and produces a composite of the real and synthetic images within the eyepiece of the microscope at 20 fps. Augmentation described here can be implemented as an add-on module to visualize NIR contrast agents, laser beams, or various types of electronic data within the surgical microscopes commonly used in neurosurgical, cerebrovascular, otolaryngological, and ophthalmic procedures.
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Affiliation(s)
- Jeffrey R. Watson
- University of Arizona, Department of Biomedical Engineering, 1657 E. Helen Street, Tucson, Arizona 85721, United States
| | - Christian F. Gainer
- University of Arizona, Department of Biomedical Engineering, 1657 E. Helen Street, Tucson, Arizona 85721, United States
| | - Nikolay Martirosyan
- University of Arizona, Division of Neurosurgery, Department of Surgery, 1501 N. Campbell Avenue, Tucson, Arizona 85721, United States
| | - Jesse Skoch
- University of Arizona, Division of Neurosurgery, Department of Surgery, 1501 N. Campbell Avenue, Tucson, Arizona 85721, United States
| | - G. Michael Lemole
- University of Arizona, Division of Neurosurgery, Department of Surgery, 1501 N. Campbell Avenue, Tucson, Arizona 85721, United States
| | - Rein Anton
- University of Arizona, Division of Neurosurgery, Department of Surgery, 1501 N. Campbell Avenue, Tucson, Arizona 85721, United States
| | - Marek Romanowski
- University of Arizona, Department of Biomedical Engineering, 1657 E. Helen Street, Tucson, Arizona 85721, United States
- Address all correspondence to: Marek Romanowski, E-mail:
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Pahl FH, Oliveira MFD, Brock RS, Lucio JED. Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms. ARQUIVOS DE NEURO-PSIQUIATRIA 2015. [DOI: 10.1590/0004-282x20150069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%–38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.
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Della Puppa A, Rustemi O, Scienza R. Intraoperative Flow Measurement by Microflow Probe During Surgery for Brain Arteriovenous Malformations. Oper Neurosurg (Hagerstown) 2015; 11 Suppl 2:268-73. [DOI: 10.1227/neu.0000000000000741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Intraoperative quantitative flow measurement by a microvascular ultrasonic flow probe is an established methodology in aneurysm surgery.
OBJECTIVE
To test the present flow measurement procedure in brain arteriovenous malformation (AVM) surgery.
METHODS
Data from 25 patients with brain AVMs who consecutively underwent microsurgical resection with the assistance of flow measurement by a microflow probe were retrospectively analyzed. Flowmetry was performed on arterial feeders, potentially transit arteries, and venous drainage of AVM in different phases of resection.
RESULTS
A quantitative flow measurement was performed 203 times on 92 vessels. Flowmetry was able to define the flow direction of AVM vessels in all cases, thereby discriminating between arterial feeders and venous drainages, both superficially and deeply located. During AVM dissection, flowmetry identified a transit artery in 12% of cases by detecting a flow drop between 2 points of the same vessel. At the final stage of resection, a residual nidus, potentially missed at surgical dissection, was detected when the flow value of venous drainage was greater than 4 mL/min (20% of patients). Pre-resection microflow probe measurements were concordant with indocyanine green videoangiography data on AVM angioarchitecture in all cases. No microflow probe–induced AVM vessel injury was reported. Complete AVM resection was achieved in all cases with a low morbidity (modified Rankin Scale score ⩽1).
CONCLUSION
Multistage intraoperative quantitative flow measurement proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of AVM resection. Further studies are needed to assess the impact of this approach on AVM patient outcomes.
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Affiliation(s)
| | - Oriela Rustemi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Renato Scienza
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
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36
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Intraoperative assessment of a quality of microneurosurgical clipping: role of indocyanine green videoangiography. World Neurosurg 2014; 82:e589-90. [PMID: 25195106 DOI: 10.1016/j.wneu.2014.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/29/2014] [Indexed: 11/23/2022]
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37
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Zaidi HA, Spetzler RF. In reply: can the efficacy of indocyanine green videoangiography in cerebral arteriovenous malformations surgery be further improved? Neurosurgery 2014; 75:E734. [PMID: 25181439 DOI: 10.1227/neu.0000000000000532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hasan A Zaidi
- Division of Neurological Surgery Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix, Arizona
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