Clinical application of the mirror irradiation technique in photodynamic therapy for malignant glioma

Photodynamic therapy using talaporfin sodium for non-totally resectable malignant glioma

BACKGROUND

For malignant glioma, intraoperative photodynamic therapy (PDT) using talaporfin sodium is a powerful tool for local tumor control, when gross total removal is performed. However, the efficacy of PDT for non-totally resectable malignant glioma has not been clearly confirmed. Therefore, the purpose of this study was to clarify the usefulness of PDT using talaporfin sodium for non-totally resectable malignant glioma.

METHODS

Eighteen patients with malignant glioma (16 new onset, 2 recurrent) in whom gross total removal was judged to be difficult from the images obtained before surgery were evaluated. Fifteen patients had glioblastoma (14 newly diagnosed, 1 recurrent), and 3 patients had anaplastic oligodendroglioma (2 newly diagnosed, 1 recurrent). The whole resection cavity was subjected to PDT during the surgery. For newly diagnosed glioblastoma, postoperative therapy involved the combined use of radiation and temozolomide. Bevacizumab treatment was also started at an early stage after surgery.

RESULTS

In some patients, reduction of the residual tumor was observed at an early stage of chemoradiotherapy after the surgery, suggesting the positive effect of PDT. Recurrence occurred in 15 of the 18 patients during the course of treatment. Distant recurrence occurred in 8 of these 15 patients, despite good local tumor control. In the 14 patients with newly diagnosed glioblastoma, the median progression-free survival was almost 10.5 months, and the median overall survival was almost 16.9 months.

CONCLUSIONS

PDT for malignant glioma is expected to slightly improve local tumor control for non-totally resectable lesions.

Laser Needle Knife's Effects on Rabbits Cervical Spondylopathy of Vertebral Artery, Fibrinogen, and Blood Viscosity

Objective

To determine the effect of laser needle-knife on vertebroarterial morphology, fibrinogen and blood viscosity in a rabbit model of cervical spondylotic arteriopathy (CSA) and the mechanism of action involved.

Methods

A number of 40 healthy common grade rabbits were divided into four groups: normal control, model, acupuncture, and laser needle knife group. The normal control group does not establish a CSA rabbit model, and the other groups all establish a CSA rabbit model, but they are treated in different ways. CSA model rabbits were treated with acupuncture and moxibustion at “fengchi” and “cervical Jiaji” points, rabbits in the laser needle knife group were treated with “Jiaji” points, and the acupuncture points were punctured with the laser needle knife. The location of the acupuncture points is determined according to the acupoint map of the experimental map. The right vertebroarterial morphology before and after the treatment was analyzed by scanning electron microscope, and FIB concentration and blood viscosity were determined using the coagulation method.

Results

After the treatment, the capillary and micropore hyperplasia in the laser needle knife group were more evident than that in the model group. Acupuncture and laser needle knife therapy can reduce whole blood viscosity (1/s, 5/s), and that the distinction between the two treatments is not statistically evident.

Conclusion

Acupuncture and laser needle knife can regulate the coagulation and fibrinolysis system in CSA, stimulate capillary and micropore hyperplasia, reduce blood viscosity, and improve blood circulation, which may be one of the therapeutic mechanisms behind the laser needle knife treatment of CSA.

Intraoperative MR Imaging during Glioma Resection

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.