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Kaijser M, Frisk H, Persson O, Burström G, Suneson A, El-Hajj VG, Fagerlund M, Edström E, Elmi-Terander A. Two years of neurosurgical intraoperative MRI in Sweden - evaluation of use and costs. Acta Neurochir (Wien) 2024; 166:80. [PMID: 38349473 PMCID: PMC10864221 DOI: 10.1007/s00701-024-05978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The current shortage of radiology staff in healthcare provides a challenge for departments all over the world. This leads to more evaluation of how the radiology resources are used and a demand to use them in the most efficient way. Intraoperative MRI is one of many recent advancements in radiological practice. If radiology staff is performing intraoperative MRI at the operation ward, they may be impeded from performing other examinations at the radiology department, creating costs in terms of exams not being performed. Since this is a kind of cost whose importance is likely to increase, we have studied the practice of intraoperative MRI in Sweden. METHODS The study includes data from the first four hospitals in Sweden that installed MRI scanners adjacent to the operating theaters. In addition, we included data from Karolinska University Hospital in Solna where intraoperative MRI is carried out at the radiology department. RESULTS Scanners that were moved into the operation theater and doing no or few other scans were used 11-12% of the days. Stationary scanners adjacent to the operation room were used 35-41% of the days. For scanners situated at the radiology department doing intraoperative scans interspersed among all other scans, the proportion was 92%. CONCLUSION Our study suggests that performing exams at the radiology department rather than at several locations throughout the hospital may be an efficient approach to tackle the simultaneous trends of increasing demands for imaging and increasing staff shortages at radiology departments.
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Affiliation(s)
- Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Annika Suneson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Michael Fagerlund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Orebro, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Orebro, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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2
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Wu O, Clift GW, Hilliard S, Ip M. Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review. J Med Radiat Sci 2023; 70:479-490. [PMID: 37434551 PMCID: PMC10715358 DOI: 10.1002/jmrs.707] [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: 10/15/2022] [Accepted: 07/02/2023] [Indexed: 07/13/2023] Open
Abstract
Brain tumours are the most common solid neoplasm in children, posing a significant challenge in oncology due to the limited range of treatment. Intraoperative magnetic resonance imaging (iMRI) has recently emerged to aid surgical intervention in neurosurgery resection with the potential to delineate tumour boundaries. This narrative literature review aimed to provide an updated evaluation of the clinical implementation of iMRI in paediatric neurosurgical resection, with an emphasis on the extent of brain tumour resection, patient outcomes and its drawbacks. Databases including MEDLINE, PubMed, Scopus and Web of Science were used to investigate this topic with key terms: paediatric, brain tumour, and iMRI. Exclusion criteria included literature comprised of adult populations and the use of iMRI in neurosurgery in the absence of brain tumours. The limited body of research evaluating the clinical implementation of iMRI in paediatric cohorts has been predominantly positive. Current evidence demonstrates the potential for iMRI use to increase rates of gross total resection (GTR), assess the extent of resection, and improve patient outcomes, such as progression-free survival. Limitations regarding the use of iMRI include prolonged operation times and complications associated with head immobilisation devices. iMRI has the potential to aid in the achievement of maximal brain tumour resection in paediatric patients. Future prospective randomised controlled trials are necessary to determine the clinical significance and benefits of using iMRI during neurosurgical resection for clinical management of brain neoplasms in children.
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Affiliation(s)
- Olivia Wu
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Georgina Williamson Clift
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Sonia Hilliard
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Miranda Ip
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
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3
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Bsat S, Alshareef M, Pazniokas J, Handler MH. Technical evolution of pediatric neurosurgery: the evolution of intraoperative imaging. Childs Nerv Syst 2023; 39:2605-2611. [PMID: 37518061 DOI: 10.1007/s00381-023-06040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/17/2023] [Indexed: 08/01/2023]
Abstract
Imaging has always been fundamental to neurosurgery, and its evolution over the last century has made a dramatic transformation in the ability of neurosurgeons to define pathology and preserve normal tissue during their operations. In the mid-70 s, the development of computerized cross-sectional imaging with CT scan and subsequently MRI have revolutionized the practice of neurosurgery. Later, further advances in computer technology and medical engineering have allowed the combination of many modalities to bring them into the operating theater. This evolution has allowed real-time intraoperative imaging, in the hope of helping neurosurgeons achieve accuracy, maximal safe resection, and the implementation of minimally invasive techniques in brain and spine pathologies. Augmented reality and robotic technologies are also being applied as useful intra-operative techniques that will improve surgical planning and outcomes in the future. In this article, we will review imaging modalities and provide our institutional perspective on how we have integrated them into our practice.
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Affiliation(s)
- Shadi Bsat
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Mohammed Alshareef
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Julia Pazniokas
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael H Handler
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
- Children's Hospital Colorado, Aurora, CO, USA.
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4
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Shamim M, Dinh J, Yang C, Nomura S, Kashiwagi S, Kang H, Choi HS, Henary M. Synthesis, Optical Properties, and In Vivo Biodistribution Performance of Polymethine Cyanine Fluorophores. ACS Pharmacol Transl Sci 2023; 6:1192-1206. [PMID: 37588753 PMCID: PMC10425993 DOI: 10.1021/acsptsci.3c00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Indexed: 08/18/2023]
Abstract
Near-infrared (NIR) cyanine dyes showed enhanced properties for biomedical imaging. A systematic modification within the cyanine skeleton has been made through a facile design and synthetic route for optimal bioimaging. Herein, we report the synthesis of 11 NIR cyanine fluorophores and an investigation of their physicochemical properties, optical characteristics, photostability, and in vivo performance. All synthesized fluorophores absorb and emit within 610-817 nm in various solvents. These dyes also showed high molar extinction coefficients ranging from 27,000 to 270,000 cm-1 M-1, quantum yields 0.01 to 0.33, and molecular brightness 208-79,664 cm-1 M-1 in the tested solvents. Photostability data demonstrate that all tested fluorophores 28, 18, 20, 19, 25, and 24 are more photostable than the FDA-approved indocyanine green. In the biodistribution study, most compounds showed tissue-specific targeting to selectively accumulate in the adrenal glands, lymph nodes, or gallbladder while excreted to the hepatobiliary clearance route. Among the tested, compound 23 showed the best targetability to the bone marrow and lymph nodes. Since the safety of cyanine fluorophores is well established, rationally designed cyanine fluorophores established in the current study will expand an inventory of contrast agents for NIR imaging of not only normal tissues but also cancerous regions originating from these organs/tissues.
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Affiliation(s)
- Md Shamim
- Department
of Chemistry, Center of Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Jason Dinh
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Chengeng Yang
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Shinsuke Nomura
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Satoshi Kashiwagi
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Homan Kang
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Hak Soo Choi
- Gordon
Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Maged Henary
- Department
of Chemistry, Center of Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
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5
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Kilbride BF, Narsinh KH, Jordan CD, Mueller K, Moore T, Martin AJ, Wilson MW, Hetts SW. MRI-guided endovascular intervention: current methods and future potential. Expert Rev Med Devices 2022; 19:763-778. [PMID: 36373162 PMCID: PMC9869980 DOI: 10.1080/17434440.2022.2141110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges. AREAS COVERED In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed. EXPERT OPINION MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.
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Affiliation(s)
- Bridget F. Kilbride
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Kazim H. Narsinh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Teri Moore
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Alastair J. Martin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Mark W. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Steven W. Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Uribe-Cardenas R, Giantini-Larsen AM, Garton A, Juthani RG, Schwartz TH. Innovations in the Diagnosis and Surgical Management of Low-Grade Gliomas. World Neurosurg 2022; 166:321-327. [PMID: 36192864 DOI: 10.1016/j.wneu.2022.06.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022]
Abstract
Low-grade gliomas are a broad category of tumors that can manifest at different stages of life. As a group, their prognosis has historically been considered to be favorable, and surgery is a mainstay of treatment. Advances in the molecular characterization of individual lesions has led to newer classification systems, a better understanding of the biological behavior of different neoplasms, and the identification of previously unrecognized entities. New prospective genetic and molecular data will help delineate better treatment paradigms and will continue to change the taxonomy of central nervous system tumors in the coming years. Advances in the field of radiomics will help predict the molecular profile of a particular tumor through noninvasive testing. Similarly, more precise methods of intraoperative tumor tissue analysis will aid surgical planning. Improved surgical outcomes propelled by novel surgical techniques and intraoperative adjuncts and emerging forms of medical treatment in the field of immunotherapy have enriched the management of these lesions. We review the contemporary management and innovations in the treatment of low-grade gliomas.
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Affiliation(s)
- Rafael Uribe-Cardenas
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Alexandra M Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Andrew Garton
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Rupa Gopalan Juthani
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
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7
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Lam FC, Tsedev U, Kasper EM, Belcher AM. Forging the Frontiers of Image-Guided Neurosurgery—The Emerging Uses of Theranostics in Neurosurgical Oncology. Front Bioeng Biotechnol 2022; 10:857093. [PMID: 35903794 PMCID: PMC9315239 DOI: 10.3389/fbioe.2022.857093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fred C. Lam
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Division of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, MA, United States
- *Correspondence: Fred C. Lam,
| | - Uyanga Tsedev
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ekkehard M. Kasper
- Division of Neurosurgery, Saint Elizabeth’s Medical Center, Brighton, MA, United States
| | - Angela M. Belcher
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
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8
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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9
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Naik A, Smith EJ, Barreau A, Nyaeme M, Cramer SW, Najafali D, Krist DT, Arnold PM, Hassaneen W. Comparison of fluorescein sodium, 5-ALA, and intraoperative MRI for resection of high-grade gliomas: A systematic review and network meta-analysis. J Clin Neurosci 2022; 98:240-247. [PMID: 35219089 DOI: 10.1016/j.jocn.2022.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/08/2022] [Accepted: 02/17/2022] [Indexed: 12/31/2022]
Abstract
High grade gliomas (HGGs) are aggressive brain tumors associated with poor prognosis despite advances in surgical treatment and therapy. Navigated tumor resection has yielded improved outcomes for patients. We compare 5-ALA, fluorescein sodium (FS), and intraoperative MRI (IMRI) with no image guidance to determine the best intraoperative navigation method to maximize rates of gross total resection (GTR) and outcomes. A frequentist network meta-analysis was performed following standard PRISMA guidelines (PROSPERO registration CRD42021268659). Surface-under-the-cumulative ranking (SUCRA) analysis was executed to hierarchically rank modalities by the outcomes of interest. Heterogeneity was measured by the I2 statistic. Publication bias was assessed by funnel plots and the use of Egger's test. Statistical significance was determined by p < 0.05. Twenty-three studies were included for analysis with a total of 2,643 patients. Network meta-analysis comparing 5-ALA, IMRI, and FS was performed. The primary outcome assessed was the rate of GTR. Analysis revealed the superiority of all intraoperative navigation to control (no navigation). SUCRA analysis revealed the superiority of IMRI + 5-ALA, IMRI alone, followed by FS, and 5-ALA. Overall survival (OS) and progression free survival (PFS) were also examined. FS (vs. control) was associated with improved OS, while IMRI was associated with improved PFS (vs. control, FS, and 5-ALA). Intraoperative navigation using IMRI, FS, and 5-ALA lead to greater rates of GTR in HGGs. FS and 5-ALA also yielded improvement in OS and PFS. Further studies are needed to evaluate differences in survival benefit, operative duration, and cost.
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Affiliation(s)
- Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Emily J Smith
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Ariana Barreau
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Mark Nyaeme
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Samuel W Cramer
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN, 55455, United States
| | - Daniel Najafali
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - David T Krist
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States; Department of Neurosurgery, Carle Foundation Hospital, Urbana IL 61801, United States
| | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States; Department of Neurosurgery, Carle Foundation Hospital, Urbana IL 61801, United States.
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10
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Limpo H, Díez R, Albisua J, Tejada S. Intraoperative high-field resonance: How to optimize its use in our healthcare system. ACTA ACUST UNITED AC 2021; 33:261-268. [PMID: 34625382 DOI: 10.1016/j.neucie.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Intraoperative MRI (ioMRI) consists of performing a MRI during brain or spinal surgery. Although it is a safe and useful technique, it is available in a few hospitals. This means some aspects are not perfectly defined or standardized, forcing each center to develop its own solutions. Our goal is to describe the technique, evaluate the changes made to optimize its use and thus be able to facilitate the intraoperative resonance implementation in other neurosurgery departments. METHODS A prospective analysis of patients consecutively operated using high-field ioMRI guidance was carried out, describing the type of tumor, clinical data, time and sequences of ioMR, use of intraoperative neurophysiology, preoperative tumor volume, after ioMR, and postoperative, as well as complications. RESULTS ioMR was performed in 38 patients selected from among 425 brain tumors (9%) operated on in this interval. The tumor types were: 11 glioblastomas, 8 anaplastic astrocytomas, 5 diffuse astrocytomas, 4 meningiomas, 3 oligodendrogliomas, 2 metastases, 2 epidermoid cysts, 1 astroblastoma, 1 arachnoid cyst and 1 pituitary adenoma. The mean age was 45 years. The mean preoperative tumor volume was 45.22cc, after the ioMR 5.08cc and postoperative 1.28cc. Resection was extended after ioMR in 76%. Gross total resection was achieved in 15 patients and residual tumor of less than 1cc was observed in 8. An intentional tumor tissue was left in an eloquent brain region (mean volume 7cc) in 13 patients. Bleeding and ischemia complications were detected early on ioMR in 5%. MRI length was 47 min on average. CONCLUSIONS Intraoperative MRI was a useful and safe technique, and no associated complications were registered.
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Affiliation(s)
- Hiria Limpo
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | - Ricardo Díez
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Julio Albisua
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Sonia Tejada
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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11
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Peruzzi P, Valdes PQ, Aghi MK, Berger M, Chiocca EA, Golby AJ. The Evolving Role of Neurosurgical Intervention for Central Nervous System Tumors. Hematol Oncol Clin North Am 2021; 36:63-75. [PMID: 34565649 DOI: 10.1016/j.hoc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Since its inception, greater than a century ago, neurosurgery has represented the fundamental trait-d'union between clinical management, scientific investigation, and therapeutic advancements in the field of brain tumors. During the years, oncological neurosurgery has evolved as a self-standing subspecialty, due to technical progress, equipment improvement, evolution of therapeutic paradigms, and the progressively crucial role that it plays in the execution of complex therapeutic strategies and modern clinical trials.
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Affiliation(s)
- Pierpaolo Peruzzi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Pablo Q Valdes
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA
| | - Manish K Aghi
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA
| | - Mitchel Berger
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA
| | - Ennio Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA; Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Boston, MA 02115, USA
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12
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Cho SS, Salinas R, De Ravin E, Teng CW, Li C, Abdullah KG, Buch L, Hussain J, Ahmed F, Dorsey J, Mohan S, Brem S, Singhal S, Lee JYK. Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging. Mol Imaging Biol 2021; 22:1427-1437. [PMID: 31712948 DOI: 10.1007/s11307-019-01455-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively. PROCEDURES Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5-5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging. RESULTS All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm3. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value < 0.0001). CONCLUSIONS Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.
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Affiliation(s)
- Steve S Cho
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Salinas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emma De Ravin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Clare W Teng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Love Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin Hussain
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Fahad Ahmed
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Dorsey
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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13
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Yahanda AT, Chicoine MR. Intraoperative MRI for Glioma Surgery: Present Overview and Future Directions. World Neurosurg 2021; 149:267-268. [PMID: 33940675 DOI: 10.1016/j.wneu.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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14
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Resonancia intraoperatoria de alto campo: cómo optimizar su uso en nuestro modelo sanitario. Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases. Langenbecks Arch Surg 2020; 405:373-379. [PMID: 32458140 PMCID: PMC7272488 DOI: 10.1007/s00423-020-01890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/30/2020] [Indexed: 11/06/2022]
Abstract
Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.
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Multani KM, Balasubramaniam A, Rajesh BJ, Kumar MS, Manohara N, Kumar A. Utility and pitfalls of high field 3 tesla intraoperative MRI in neurosurgery: A single centre experience of 100 cases. Neurol India 2020; 68:413-418. [PMID: 32415017 DOI: 10.4103/0028-3886.284359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective In India, few centers are using 1.5 Tesla intraoperative MRI systems. We are using a 3 Tesla iMRI system. We share our initial experience of 3T iMRI in neurosurgical procedures with evaluation of its utility and pitfalls. Methods A prospective observational study conducted between August 2017 to July 2018 at Yashoda Hospital, Secunderabad. All patients undergoing iMRI guided resection of intracranial SOL were included. Results First 100 patients with various intracranial SOLs were included. The mean time required in shifting and image acquisition was 85.6 minutes in first 20 cases which was reduced to 37.4 minutes in next the next cases. Primary GTR was achieved in 44% cases, and residues were detected in 56%, secondary GTR was achieved in 37% cases, and surgery was discontinued in 19%. Maximum residues were detected in intraaxial sols and pituitary macroadenomas. No major iMRI associated complications were seen, minor issues involving transportation and minor contact burns were seen in 4 cases, insignificant anesthetic procedure related complications in 19 cases. Conclusion As per our experience iMRI is an excellent tool to guide and improve the extent of safe resection by 37% in brain tumor surgeries. Good image quality, less time for image acquisition was observed advantages of 3T system. iMRI success depends on multidepartment coordinated teamwork and multiple iterations of the process to smoothen the workflow.
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Affiliation(s)
- Kartik Manoj Multani
- Department of Neurosurgery, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
| | - Anandh Balasubramaniam
- Department of Neurosurgery, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
| | | | - Maila Sharath Kumar
- Department of Neurosurgery, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
| | - Nitin Manohara
- Department of Neuroanesthesia, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
| | - Anjani Kumar
- Department of Radiodiagnosis, Yashoda Superspeciality Hospital, Secunderabad, Telangana, India
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Evolving Strategies for Resection of Sellar/Parasellar Synchronous Tumors via Endoscopic Endonasal Approach: A Technical Case Report and Systematic Review of the Literature. World Neurosurg 2020; 133:381-391.e2. [DOI: 10.1016/j.wneu.2019.08.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
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18
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Low SYY, Lim EHL, Loh LE, Mok YH, Siow YN, Ng LP, Seow WT, Kirollos RW, Low DCY. Use of an Offsite Intraoperative MRI Operating Theater for Pediatric Brain Tumor Surgery: Experience from a Singapore Children's Hospital. World Neurosurg 2019; 135:e28-e35. [PMID: 31655229 DOI: 10.1016/j.wneu.2019.10.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (iMRI) has been recognized as a useful adjunct for brain tumor surgery in pediatric patients. There is minimal data on the use of an offsite intraoperative magnetic resonance imaging operating theater (iMRI OT), whereby vehicle transfer of patients is involved. The primary aim of this study is to validate the feasibility of perioperative patient transfer to use an offsite iMRI OT for patients with pediatric brain tumor. Secondary objectives include the assessment of tumor resection efficacy and perioperative outcomes in our patient cohort. METHODS This is a retrospective, single-institution clinical study of prospectively collected data from Singapore's largest children hospital. Variables of interest include issues encountered during interhospital transfer, achievement of surgical aims, length of stay in hospital, and postoperative complications. Our findings were compared with results of related studies published in the literature. RESULTS From January 1, 2009 to December 31, 2018, a total of 35 pediatric operative cases were performed in our offsite iMRI OT. Within this cohort, 24 of these were brain tumor surgery cases. For all the patients in this study, use of the iMRI OT influenced intraoperative decisions. Average ambulance transport time from parent hospital to the iMRI OT was 30.5 minutes, and from iMRI OT back to the parent hospital after surgery was 27.7 minutes. The average length of hospitalization stay was 7.9 days per patient. There were no ferromagnetic accidents during perioperative iMRI scanning and no airway/hemodynamic incidents in patients encountered during interhospital transfer. CONCLUSIONS In our local context, the use of interhospital transfers for access to iMRI OT is a safe and feasible option in ensuring good patient outcomes for a select group of patients with pediatric brain tumors.
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Affiliation(s)
- Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore.
| | - Evangeline H L Lim
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Lik Eng Loh
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Yee Hui Mok
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Yew Nam Siow
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - Ramez W Kirollos
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
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Harary M, Segar DJ, Huang KT, Tafel IJ, Valdes PA, Cosgrove GR. Focused ultrasound in neurosurgery: a historical perspective. Neurosurg Focus 2019; 44:E2. [PMID: 29385919 DOI: 10.3171/2017.11.focus17586] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Focused ultrasound (FUS) has been under investigation for neurosurgical applications since the 1940s. Early experiments demonstrated ultrasound as an effective tool for the creation of intracranial lesions; however, they were limited by the need for craniotomy to avoid trajectory damage and wave distortion by the skull, and they also lacked effective techniques for monitoring. Since then, the development and hemispheric distribution of phased arrays has resolved the issue of the skull and allowed for a completely transcranial procedure. Similarly, advances in MR technology have allowed for the real-time guidance of FUS procedures using MR thermometry. MR-guided FUS (MRgFUS) has primarily been investigated for its thermal lesioning capabilities and was recently approved for use in essential tremor. In this capacity, the use of MRgFUS is being investigated for other ablative indications in functional neurosurgery and neurooncology. Other applications of MRgFUS that are under active investigation include opening of the blood-brain barrier to facilitate delivery of therapeutic agents, neuromodulation, and thrombolysis. These recent advances suggest a promising future for MRgFUS as a viable and noninvasive neurosurgical tool, with strong potential for yet-unrealized applications.
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Affiliation(s)
- Maya Harary
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - David J Segar
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin T Huang
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian J Tafel
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pablo A Valdes
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - G Rees Cosgrove
- Harvard Medical School and Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
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20
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He P, Su S, Fang C, He K, Chi C, Xia X, Tian J, Li B. Residual cancerous lesion and vein tumour thrombus identified intraoperatively using a fluorescence navigation system in liver surgery. ANZ J Surg 2019; 89:E308-E314. [PMID: 31218810 DOI: 10.1111/ans.15282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 01/06/2023]
Abstract
AIM The main aims of this study are to investigate the clinical application value of using indocyanine green fluorescence imaging for ensuring complete resection of tumour tissue during hepatectomy and to evaluate the diagnostic efficacy of near-infrared (NIR) fluorescence imaging system using indocyanine green in hepatectomy. METHODS After undergoing liver resection at the Affiliated Hospital of Southwest Medical University from July 2017 to May 2018, 35 eligible patients were included in this study. The liver surface and resection margin were intraoperatively assessed by intraoperative ultrasonography and NIR fluorescence imaging, after intravenous administration of indocyanine green (0.5 mg/kg) 72-96 h prior to surgery. The intraoperative observations were compared with the pathological findings in the liver. RESULTS In the 35 patients, a total of 53 lesions were found, of which 42 were malignant lesions. The analysis results showed that the sensitivity and accuracy of detection using NIR fluorescence imaging were significantly higher than with intraoperative ultrasonography (P < 0.05). However, there was no difference between contrast-enhanced helical computed tomography and NIR fluorescence imaging in finding lesions (P > 0.05). In addition, 11 new suspicious lesions were detected only by NIR fluorescence imaging in the liver surface and resection margin during surgery, four of which were hepatocellular carcinoma. We also detected four vein tumour thrombi using the NIR fluorescence navigation system. CONCLUSIONS The NIR fluorescence navigation system enables the identification of small tumours, residual cancer tissues in resection margin and venous tumour embolies in real time and enhances the accuracy and integrity of liver resection.
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Affiliation(s)
- Pan He
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Song Su
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cheng Fang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kai He
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chongwei Chi
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Beijing Digital Precision Medicine Technology Co. Ltd., Beijing, China
| | - Xianming Xia
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Bo Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
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21
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Azmi H, Gibbons M, DeVito MC, Schlesinger M, Kreitner J, Freguletti T, Banovic J, Ferrell D, Horton M, Pierce S, Roth P. The interventional magnetic resonance imaging suite: Experience in the design, development, and implementation in a pre-existing radiology space and review of concepts. Surg Neurol Int 2019; 10:101. [PMID: 31528439 PMCID: PMC6744761 DOI: 10.25259/sni-209-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (ioMRI) has led to significant advancements in neurosurgery with improved accuracy, assessment of the extent of resection, less invasive surgical alternatives, and real-time confirmation of targeting as well delivery of therapies. The costs associated with developing ioMRI units in the surgical suite have been obstacles to the expansion of their use. More recently, the development of hybrid interventional MRI (iMRI) units has become a viable alternative. The process of designing, developing, and implementing operations for these units requires the careful integration of environmental, technical, and safety elements of both surgical and MR practices. There is a paucity of published literature providing guidance for institutions looking to develop a hybrid iMRI unit, especially with a limited footprint in the radiology department. METHODS The experience of designing, developing, and implementing an iMRI in a preexisting space for neurosurgical procedures at a single institution in light of available options and the literature is described. RESULTS The development of the unit was accomplished through the engagement of a multidisciplinary team of stakeholders who utilized existing guidelines and recommendations and their own professional experience to address issues including physical layout, equipment selection, operations planning, infection control, and oversight/review, among others. CONCLUSION Successful creation of an iMRI program requires multidisciplinary collaboration in integrating surgical and MR practice. The authors' aim is that the experience described in this article will serve as an example for facilities or neurosurgical departments looking to navigate the same process.
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Affiliation(s)
- Hooman Azmi
- Departments of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Mary Gibbons
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Michele C. DeVito
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Mark Schlesinger
- Departments of Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Jason Kreitner
- Departments of Operations, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Terri Freguletti
- Departments of Perioperative Services, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Joan Banovic
- Departments of Perioperative Services, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Donald Ferrell
- Departments of Operations, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Michael Horton
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Sean Pierce
- Departments of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Patrick Roth
- Departments of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, United States
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22
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Chowdhury T, Zeiler FA, Singh GP, Hailu A, Loewen H, Schaller B, Cappellani RB, West M. The Role of Intraoperative MRI in Awake Neurosurgical Procedures: A Systematic Review. Front Oncol 2018; 8:434. [PMID: 30364103 PMCID: PMC6191486 DOI: 10.3389/fonc.2018.00434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Awake craniotomy for brain tumors remains an important tool in the arsenal of the treating neurosurgeon working in eloquent areas of the brain. Furthermore, with the implementation of intraoperative magnetic resonance imaging (I-MRI), one can afford the luxury of imaging to assess surgical resection of the underlying gross imaging defined neuropathology and the surrounding eloquent areas. Ideally, the combination of I-MRI and awake craniotomy could provide the maximal lesion resection with the least morbidity and mortality. However, more resection with the aid of real time imaging and awake craniotomy techniques might give opposite outcome results. The goal of this systematic review.is to identify the available literature on combined I-MRI and awake craniotomy techniques, to better understand the potential morbidity and mortality associated. Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception up to December 2016. A total of 10 articles met inclusion in to the review, with a total of 324 adult patients. Results: All studies showed transient neurological deficits between 2.9 to 76.4%. In regards to persistent morbidity, the mean was ~10% (ranges from zero to 35.3%) with a follow up period between 5 days and 6 months. Conclusion: The preliminary results of this review also suggest this combined technique may impose acceptable post-operative complication profiles and morbidity. However, this is based on low quality evidence, and is therefore questionable. Further, well-designed future trials with the long-term follow-up are needed to provide various aspects of feasibility and outcome data for this approach.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick A Zeiler
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Clincian Investigator Program, University of Manitoba, Winnipeg, MB, Canada.,Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology & Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abseret Hailu
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hal Loewen
- College of Rehabilitation Sciences Librarian, Neil John Maclean Health Science Library, University of Manitoba, Winnipeg, MB, Canada
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Ronald B Cappellani
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Michael West
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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23
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Wang P, Fan Y, Lu L, Liu L, Fan L, Zhao M, Xie Y, Xu C, Zhang F. NIR-II nanoprobes in-vivo assembly to improve image-guided surgery for metastatic ovarian cancer. Nat Commun 2018; 9:2898. [PMID: 30042434 PMCID: PMC6057964 DOI: 10.1038/s41467-018-05113-8] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/15/2018] [Indexed: 12/21/2022] Open
Abstract
Local recurrence is a common cause of treatment failure for patients with solid tumors. Tumor-specific intraoperative fluorescence imaging may improve staging and debulking efforts in cytoreductive surgery and, thereby improve prognosis. Here, we report in vivo assembly of the second near-infrared window (NIR-II) emitting downconversion nanoparticles (DCNPs) modified with DNA and targeting peptides to improve the image-guided surgery for metastatic ovarian cancer. The NIR-II imaging quality with DCNPs is superior to that of clinically approved ICG with good photostability and deep tissue penetration (8 mm). Stable tumor retention period experienced 6 h by in vivo assembly of nanoprobes can be used for precise tumor resection. Superior tumor-to-normal tissue ratio is successfully achieved to facilitate the abdominal ovarian metastases surgical delineation. Metastases with ≤1 mm can be completely excised under NIR-II bioimaging guidance. This novel technology provides a general new basis for the future design of nanomaterials for medical applications.
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Affiliation(s)
- Peiyuan Wang
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China
| | - Yong Fan
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China
| | - Lingfei Lu
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China
| | - Lu Liu
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China
| | - Lingling Fan
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200032, P.R. China.
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, P.R. China.
| | - Mengyao Zhao
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China
| | - Yang Xie
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, 200433, P.R. China
| | - Congjian Xu
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200032, P.R. China
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, P.R. China
| | - Fan Zhang
- Department of Chemistry, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, State Key Laboratory of Molecular Engineering of Polymers and iChem, Fudan University, Shanghai, 200433, P.R. China.
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Boone CE, Wojtasiewicz T, Moukheiber E, Butala A, Jordao L, Mills KA, Sair H, Anderson WS. MR-Guided Functional Neurosurgery: Laser Ablation and Deep Brain Stimulation. Top Magn Reson Imaging 2018; 27:171-177. [PMID: 29870469 DOI: 10.1097/rmr.0000000000000152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is increasingly implemented for image-guided procedures in functional neurosurgery. iMRI facilitates accurate electrode implantation for deep brain stimulation (DBS) and is currently an alternative method for DBS electrode targeting. The application of iMRI also allows for greater accuracy and precision in laser-induced thermal therapy (LITT). The expanding use of functional neurosurgical procedures makes safety and feasibility of iMRI important considerations, particularly in patients with comorbidities or complex medical histories. We review here the applications of iMRI and discuss its safety, feasibility, and limitations in functional neurosurgery.To motivate discussion of this topic, we also present a 52-year-old patient with an implanted cardioverter-defibrillator (ICD) who successfully underwent iMRI-guided DBS electrode implantation for advanced Parkinson disease (PD). Neither iMRI nor the passage of electrical current through the implanted DBS electrodes demonstrated detectable interference in ICD function. This case demonstrates that, even in complex clinical contexts, iMRI is a promising tool that merits further exploration for procedures requiring highly accurate and precise identification of target structures.
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Affiliation(s)
| | | | | | | | | | | | - Haris Sair
- Department of Radiology, Neuroradiology, The Johns Hopkins University, Baltimore, MD
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25
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Nikova A, Birbilis T. The Basic Steps of Evolution of Brain Surgery. MAEDICA 2017; 12:297-305. [PMID: 29610595 PMCID: PMC5879592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE AND CONCLUSION Neurosurgery is probably the most constantly developing specialty of all times. Its dimension is enormous and its history, Ancient. The evolution of neurosurgery from the Mayan and Egyptian periods to the Renaissance and the 21st century was the result of many physicians and patients whose experiences lead to the revolution of modernization. Today, the field of neurosurgery is continuously expanding, aiming to introduce knowledge and technologies that could provide a new futuristic wave of medicine. METHODS Given this background, our team selected relevant data from Medline published between 1936 and 2017. RESULTS We included 91 articles on this topic, all of them providing enough information about the revolution and progress of brain surgery through the centuries as well as its potential expansion in the future.
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Affiliation(s)
- Alexandrina Nikova
- Democritus University of Thrace Medical School, Department of Neurosurgery, University Hospital of Alexandroupolis, Greece
| | - Theodossios Birbilis
- Democritus University of Thrace Medical School, Department of Neurosurgery, University Hospital of Alexandroupolis, Greece
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26
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Nimsky C, Carl B. Historical, Current, and Future Intraoperative Imaging Modalities. Neurosurg Clin N Am 2017; 28:453-464. [DOI: 10.1016/j.nec.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Luo M, Frisken SF, Weis JA, Clements LW, Unadkat P, Thompson RC, Golby AJ, Miga MI. Retrospective study comparing model-based deformation correction to intraoperative magnetic resonance imaging for image-guided neurosurgery. J Med Imaging (Bellingham) 2017; 4:035003. [PMID: 28924573 PMCID: PMC5596210 DOI: 10.1117/1.jmi.4.3.035003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
Brain shift during tumor resection compromises the spatial validity of registered preoperative imaging data that is critical to image-guided procedures. One current clinical solution to mitigate the effects is to reimage using intraoperative magnetic resonance (iMR) imaging. Although iMR has demonstrated benefits in accounting for preoperative-to-intraoperative tissue changes, its cost and encumbrance have limited its widespread adoption. While iMR will likely continue to be employed for challenging cases, a cost-effective model-based brain shift compensation strategy is desirable as a complementary technology for standard resections. We performed a retrospective study of [Formula: see text] tumor resection cases, comparing iMR measurements with intraoperative brain shift compensation predicted by our model-based strategy, driven by sparse intraoperative cortical surface data. For quantitative assessment, homologous subsurface targets near the tumors were selected on preoperative MR and iMR images. Once rigidly registered, intraoperative shift measurements were determined and subsequently compared to model-predicted counterparts as estimated by the brain shift correction framework. When considering moderate and high shift ([Formula: see text], [Formula: see text] measurements per case), the alignment error due to brain shift reduced from [Formula: see text] to [Formula: see text], representing [Formula: see text] correction. These first steps toward validation are promising for model-based strategies.
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Affiliation(s)
- Ma Luo
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Sarah F. Frisken
- Brigham and Women’s Hospital, Department of Radiology, Boston, Massachusetts, United States
| | - Jared A. Weis
- Wake Forest School of Medicine, Department of Biomedical Engineering, Winston-Salem, North Carolina, United States
| | - Logan W. Clements
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Prashin Unadkat
- Brigham and Women’s Hospital, Department of Radiology, Boston, Massachusetts, United States
| | - Reid C. Thompson
- Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee, United States
| | - Alexandra J. Golby
- Brigham and Women’s Hospital, Department of Radiology, Boston, Massachusetts, United States
| | - Michael I. Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee, United States
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
- Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States
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Markowitz D, Lin D, Salas S, Kohn N, Schulder M. Compact Intraoperative MRI: Stereotactic Accuracy and Future Directions. Stereotact Funct Neurosurg 2017; 95:197-204. [PMID: 28614824 DOI: 10.1159/000475673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intraoperative imaging must supply data that can be used for accurate stereotactic navigation. This information should be at least as accurate as that acquired from diagnostic imagers. OBJECTIVES The aim of this study was to compare the stereotactic accuracy of an updated compact intraoperative MRI (iMRI) device based on a 0.15-T magnet to standard surgical navigation on a 1.5-T diagnostic scan MRI and to navigation with an earlier model of the same system. METHODS The accuracy of each system was assessed using a water-filled phantom model of the brain. Data collected with the new system were compared to those obtained in a previous study assessing the older system. The accuracy of the new iMRI was measured against standard surgical navigation on a 1.5-T MRI using T1-weighted (W) images. RESULTS The mean error with the iMRI using T1W images was lower than that based on images from the 1.5-T scan (1.24 vs. 2.43 mm). T2W images from the newer iMRI yielded a lower navigation error than those acquired with the prior model (1.28 vs. 3.15 mm). CONCLUSIONS Improvements in magnet design can yield progressive increases in accuracy, validating the concept of compact, low-field iMRI. Avoiding the need for registration between image and surgical space increases navigation accuracy.
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Affiliation(s)
- Daniel Markowitz
- Department of Neurosurgery, Northwell Health, Manhasset, NY, USA
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Vermilyea SC, Emborg ME. The role of nonhuman primate models in the development of cell-based therapies for Parkinson's disease. J Neural Transm (Vienna) 2017; 125:365-384. [PMID: 28326445 PMCID: PMC5847191 DOI: 10.1007/s00702-017-1708-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/12/2017] [Indexed: 12/23/2022]
Abstract
Through the course of over three decades, nonhuman primate (NHP) studies on cell-based therapies (CBTs) for Parkinson’s disease (PD) have provided insight into the feasibility, safety and efficacy of the approach, methods of cell collection and preparation, cell viability, as well as potential brain targets. Today, NHP research continues to be a vital source of information for improving cell grafts and analyzing how the host affects graft survival, integration and function. Overall, this article aims to discuss the role that NHP models of PD have played in CBT development and highlights specific issues that need to be considered to maximize the value of NHP studies for the successful clinical translation of CBTs.
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Affiliation(s)
- Scott C Vermilyea
- Neuroscience Training Program, University of Wisconsin, Madison, 1220 Capitol Court, Madison, WI, 53715, USA.,Wisconsin National Primate Research Center, University of Wisconsin, Madison, USA
| | - Marina E Emborg
- Neuroscience Training Program, University of Wisconsin, Madison, 1220 Capitol Court, Madison, WI, 53715, USA. .,Wisconsin National Primate Research Center, University of Wisconsin, Madison, USA. .,Department of Medical Physics, University of Wisconsin, Madison, USA.
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Darcey TM, Kobylarz EJ, Pearl MA, Krauss PJ, Ferri SA, Roberts DW, Bauer DF. Safe use of subdermal needles for intraoperative monitoring with MRI. Neurosurg Focus 2016; 40:E19. [DOI: 10.3171/2015.12.focus15555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The purpose of this study was to develop safe, site-specific procedures for placing and leaving subdermal needle leads for intraoperative monitoring (IOM) during intraoperative MRI procedures.
METHODS
The authors tested a variety of standard subdermal needle electrodes designed and FDA-approved for IOM in the conventional operating room. Testing was used to determine the conditions necessary to avoid thermal injury and significant image artifacts with minimal disruption of IOM and MRI procedures. Phantom testing was performed with a fiber optic (lead) temperature monitoring system and was followed by testing of leads placed in a healthy volunteer. The volunteer testing used electrode placements typical of standard IOM cases, together with radiofrequency (RF) coil placement and imaging sequences routinely employed for these case types. Lead length was investigated to assess heating effects for electrodes placed within the RF coil.
RESULTS
The authors found that conventional stainless steel (SS) and platinum/iridium (Pt/Ir) subdermal needles can be used safely without significant heating when placed outside the RF coil, and this accounts for the majority or entirety of electrode placements. When placed within the RF coil, Pt/Ir leads produced minimal image artifacts, while SS leads produced potentially significant artifacts. In phantom testing, significant heating was demonstrated in both SS and Pt/Ir leads placed within the RF coil, but only during high-resolution T2-weighted scanning. This problem was largely, but not completely, eliminated when leads were shortened to 25 cm. Human testing was unremarkable except for nonpainful heating detected in a few electrodes during thin-slice (1.5 mm) FLAIR scanning. Transient irritation (skin reddening along the needle tract) was noted at 2 of the electrodes with detectable heating.
CONCLUSIONS
The authors were satisfied with the safety of their site-specific procedures and have begun with off-label use (following institutional review board approval and obtaining patient informed consent) of tested monitoring leads in cases that combine IOM and MRI. The authors recommend that all facilities perform their own site-specific testing of monitoring leads before proceeding with their routine use.
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Affiliation(s)
| | | | - Michael A. Pearl
- 3Center for Surgical Innovation, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Inflection Points in Magnetic Resonance Imaging Technology—35 Years of Collaborative Research and Development. Invest Radiol 2015; 50:645-56. [DOI: 10.1097/rli.0000000000000167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Meyer A, Lasso A, Ungi T, Fichtinger G. Live ultrasound volume reconstruction using scout scanning. ACTA ACUST UNITED AC 2015; 9415. [PMID: 26005249 DOI: 10.1117/12.2081488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Ultrasound-guided interventions often necessitate scanning of deep-seated anatomical structures that may be hard to visualize. Visualization can be improved using reconstructed 3D ultrasound volumes. High-resolution 3D reconstruction of a large area during clinical interventions is challenging if the region of interest is unknown. We propose a two-stage scanning method allowing the user to perform quick low-resolution scouting followed by high-resolution live volume reconstruction. METHODS Scout scanning is accomplished by stacking 2D tracked ultrasound images into a low-resolution volume. Then, within a region of interest defined in the scout scan, live volume reconstruction can be performed by continuous scanning until sufficient image density is achieved. We implemented the workflow as a module of the open-source 3D Slicer application, within the SlicerIGT extension and building on the PLUS toolkit. RESULTS Scout scanning is performed in a few seconds using 3 mm spacing to allow region of interest definition. Live reconstruction parameters are set to provide good image quality (0.5 mm spacing, hole filling enabled) and feedback is given during live scanning by regularly updated display of the reconstructed volume. DISCUSSION Use of scout scanning may allow the physician to identify anatomical structures. Subsequent live volume reconstruction in a region of interest may assist in procedures such as targeting needle interventions or estimating brain shift during surgery.
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Affiliation(s)
- Amelie Meyer
- Telecom Physique Strasbourg, University of Strasbourg, France ; Queen's University, Kingston, Canada
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Childs S, Bruch P. Successful management of risk in the hybrid OR. AORN J 2015; 101:223-34; quiz 235-7. [PMID: 25645039 DOI: 10.1016/j.aorn.2014.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
Abstract
The advent of intraoperative magnetic resonance imaging (MRI) surgery has resulted in numerous advances in minimally invasive procedures. This progress has also revealed serious environmental hazards for the patient and perioperative team. At one facility, implementation of an MRI/OR intervention suite has enhanced surgical care and outcomes. Achieving the benefits of intraoperative MRI can occur with a multidisciplinary, interdepartmental approach to the design and layout of the hybrid environment and through implementation of education and safety protocols, including patient screening and prep for scanning. Personnel, including perioperative nurses, must receive expert hands-on training to successfully mitigate risk and provide care in the hybrid OR setting.
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Moteabbed M, Schuemann J, Paganetti H. Dosimetric feasibility of real-time MRI-guided proton therapy. Med Phys 2014; 41:111713. [PMID: 25370627 PMCID: PMC4209014 DOI: 10.1118/1.4897570] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/06/2014] [Accepted: 09/15/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is a prime candidate for image-guided radiotherapy. This study was designed to assess the feasibility of real-time MRI-guided proton therapy by quantifying the dosimetric effects induced by the magnetic field in patients' plans and identifying the associated clinical consequences. METHODS Monte Carlo dose calculation was performed for nine patients of various treatment sites (lung, liver, prostate, brain, skull-base, and spine) and tissue homogeneities, in the presence of 0.5 and 1.5 T magnetic fields. Dose volume histogram (DVH) parameters such as D95, D5, and V20 as well as equivalent uniform dose were compared for the target and organs at risk, before and after applying the magnetic field. The authors further assessed whether the plans affected by clinically relevant dose distortions could be corrected independent of the planning system. RESULTS By comparing the resulting dose distributions and analyzing the respective DVHs, it was determined that despite the observed lateral beam deflection, for magnetic fields of up to 0.5 T, neither was the target coverage jeopardized nor was the dose to the nearby organs increased in all cases except for prostate. However, for a 1.5 T magnetic field, the dose distortions were more pronounced and of clinical concern in all cases except for spine. In such circumstances, the target was severely underdosed, as indicated by a decrease in D95 of up to 41% of the prescribed dose compared to the nominal situation (no magnetic field). Sites such as liver and spine were less affected due to higher tissue homogeneity, typically smaller beam range, and the choice of beam directions. Simulations revealed that small modifications to certain plan parameters such as beam isocenter (up to 19 mm) and gantry angle (up to 10°) are sufficient to compensate for the magnetic field-induced dose disturbances. The authors' observations indicate that the degree of required corrections strongly depends on the beam range and direction relative to the magnetic field. This method was also applicable to more heterogeneous scenarios such as skull-base tumors. CONCLUSIONS This study confirmed the dosimetric feasibility of real-time MRI-guided proton therapy and delivering a clinically acceptable dose to patients with various tumor locations within magnetic fields of up to 1.5 T. This work could serve as a guide and encouragement for further efforts toward clinical implementation of hybrid MRI-proton gantry systems.
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Affiliation(s)
- M Moteabbed
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - J Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - H Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
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White MJ, Thornton JS, Hawkes DJ, Hill DL, Kitchen N, Mancini L, McEvoy AW, Razavi R, Wilson S, Yousry T, Keevil SF. Design, Operation, and Safety of Single-Room Interventional MRI Suites: Practical Experience From Two Centers. J Magn Reson Imaging 2014; 41:34-43. [DOI: 10.1002/jmri.24577] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/10/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mark J. White
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - John S. Thornton
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | | | | | - Neil Kitchen
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - Laura Mancini
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - Andrew W. McEvoy
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | | | - Sally Wilson
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
| | - Tarek Yousry
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
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Abstract
Medical imaging plays a critical role in cancer diagnosis and planning. Many of these patients rely on surgical intervention for curative outcomes. This requires a careful identification of the primary and microscopic tumors, and the complete removal of cancer. Although there have been efforts to adapt traditional-imaging modalities for intraoperative image guidance, they suffer from several constraints such as large hardware footprint, high-operation cost, and disruption of the surgical workflow. Because of the ease of image acquisition, relatively low-cost devices and intuitive operation, optical imaging methods have received tremendous interests for use in real-time image-guided surgery. To improve imaging depth under low interference by tissue autofluorescence, many of these applications utilize light in the near-infrared (NIR) wavelengths, which is invisible to human eyes. With the availability of a wide selection of tumor-avid contrast agents, advancements in imaging sensors, electronic and optical designs, surgeons are able to combine different attributes of NIR optical imaging techniques to improve treatment outcomes. The emergence of diverse commercial and experimental image guidance systems, which are in various stages of clinical translation, attests to the potential high impact of intraoperative optical imaging methods to improve speed of oncologic surgery with high accuracy and minimal margin positivity.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shengkui Gao
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nan Zhu
- College of Optical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Rongguang Liang
- College of Optical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Viktor Gruev
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Samuel Achilefu
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA.
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Abstract
Paradigm shifts in surgery arise when surgeons are empowered to perform surgery faster, better and less expensively than current standards. Optical imaging that exploits invisible near-infrared (NIR) fluorescent light (700-900 nm) has the potential to improve cancer surgery outcomes, minimize the time patients are under anaesthesia and lower health-care costs largely by way of its improved contrast and depth of tissue penetration relative to visible light. Accordingly, the past few years have witnessed an explosion of proof-of-concept clinical trials in the field. In this Review, we introduce the concept of NIR fluorescence imaging for cancer surgery, examine the clinical trial literature to date and outline the key issues pertaining to imaging system and contrast agent optimization. Although NIR seems to be superior to many traditional imaging techniques, its incorporation into routine care of patients with cancer depends on rigorous clinical trials and validation studies.
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Liang D, Schulder M. The role of intraoperative magnetic resonance imaging in glioma surgery. Surg Neurol Int 2012; 3:S320-7. [PMID: 23230537 PMCID: PMC3514913 DOI: 10.4103/2152-7806.103029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/04/2012] [Indexed: 11/04/2022] Open
Abstract
For patients with gliomas, the goal of surgery is to maximize the extent of tumor resection while avoiding injury to functional tissue. The hope is to improve patients' survival and maintain the highest quality of life as possible. However, because of the infiltrative nature of gliomas these two goals often oppose each other so a compromise must be met. Many tools have been developed to help with this challenge of glioma surgery. Over the past two decades, intraoperative-magnetic resonance imaging (iMRI) has emerged as an increasingly important modality to enhance surgical safety while providing the surgeon with updated information to guide their resection. Here the authors review the studies that demonstrate a positive correlation between extent of resection (EOR) and overall survival (OS), although the data is clearer in patients with low-grade gliomas (LGG) and still somewhat controversial in those with higher-grade tumors. We will then review some of the studies that support the role of iMRI and how it has impacted glioma surgery by increasing the EOR. The value of iMRI usage in regards to overall patient outcome can be extrapolated through its effect on EOR. Overall, available data support the safe use of iMRI and as an effective adjunct in glioma surgery.
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Affiliation(s)
- Danny Liang
- Department of Neurological Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA
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40
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Colen RR, Kekhia H, Jolesz FA. Multimodality intraoperative MRI for brain tumor surgery. Expert Rev Neurother 2011; 10:1545-58. [PMID: 20945538 DOI: 10.1586/ern.10.145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative MRI has already fundamentally changed the way current brain tumor surgery is performed. The ability to integrate high-field MRI into the operating room has allowed intraoperative MRI to emerge as an important adjunct to CNS tumor treatment. Furthermore, the ability of MRI to successfully couple with molecular imaging (PET and/or optical imaging), neuroendoscopy and therapeutic devices, such as focused ultrasound, will allow it to emerge as an important image-guidance modality for improving brain tumor therapy and outcomes.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Zada G, Laws ER. Future directions for surgery of the pituitary region. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pituitary surgery has evolved tremendously over the past century amidst a rapidly changing landscape of medical and radiosurgical therapies. One of the principal driving forces behind this transformation has been the benefit of minimal invasiveness, which is likely to further advance the specialty as higher-definition and more miniature optic systems and cameras, the use of robotics, and enhanced neuroimaging and neuronavigation, are further translated into the operating room. The emergence of nanotechnology will likely allow tumor-specific molecular ligands and nanoparticles to identify and differentiate tumors, and may permit manipulation of neural structures on the micron level with tools currently being developed, including the nanoknife, nanotweezers and femtosecond laser. Further advances in stereotactic radiosurgery may increase the prominence and safety associated with this technique for the treatment of pituitary pathology.
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Affiliation(s)
- Gabriel Zada
- Department of Neurosurgery, Brigham & Women’s Hospital, Harvard Medical School, 15 Francis Street, PBB3, Boston, MA, 02115, USA
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