1
|
Neurosurgery at the crossroads of immunology and nanotechnology. New reality in the COVID-19 pandemic. Adv Drug Deliv Rev 2022; 181:114033. [PMID: 34808227 PMCID: PMC8604570 DOI: 10.1016/j.addr.2021.114033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
Neurosurgery as one of the most technologically demanding medical fields rapidly adapts the newest developments from multiple scientific disciplines for treating brain tumors. Despite half a century of clinical trials, survival for brain primary tumors such as glioblastoma (GBM), the most common primary brain cancer, or rare ones including primary central nervous system lymphoma (PCNSL), is dismal. Cancer therapy and research have currently shifted toward targeted approaches, and personalized therapies. The orchestration of novel and effective blood-brain barrier (BBB) drug delivery approaches, targeting of cancer cells and regulating tumor microenvironment including the immune system are the key themes of this review. As the global pandemic due to SARS-CoV-2 virus continues, neurosurgery and neuro-oncology must wrestle with the issues related to treatment-related immune dysfunction. The selection of chemotherapeutic treatments, even rare cases of hypersensitivity reactions (HSRs) that occur among immunocompromised people, and number of vaccinations they have to get are emerging as a new chapter for modern Nano neurosurgery.
Collapse
|
2
|
Rohilla S, Garg HK, Singh I, Yadav RK, Dhaulakhandi DB. rCBV- and ADC-based Grading of Meningiomas With Glimpse Into Emerging Molecular Diagnostics. Basic Clin Neurosci 2018; 9:417-428. [PMID: 30719256 PMCID: PMC6359681 DOI: 10.32598/bcn.9.6.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/25/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction This study was conducted to grade meningiomas based on relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC) to help surgeons plan the approach and extent of operation as well as decide on the need of any adjuvant radio/chemo therapy. The current and evolving genomic, proteomic, and spectroscopic technologies are also discussed which can supplement the current radiologic methods and procedures in grading meningiomas. Methods A total of 35 patients with meningioma prospectively underwent basic MR sequences (T1W, T2W, T2W/FLAIR) in axial, sagittal and coronal planes followed by Diffusion Weighted (DW) imaging having b value of 1000 (minimum ADC values used for analysis). Then, gadobenate dimeglumine/meglumine gadoterate was administered (0.1 mmol/kg at a rate of 4 mL/s) followed by saline flush (20 mL at a rate of 4 mL/s). Next, T2*W/FFE dynamic images were acquired; dynamics showing maximum fall in intensity was used for creating rCBV and relative Cerebral Blood Flow (rCBF) maps and calculating rCBV. Results Both maximum rCBV and minimum ADC within the tumor were not significant for differentiating benign from malignant meningiomas. A cut-off maximum rCBV of 2.5 mL/100 g in peritumoral edema was 75% sensitive, 84.6% specific, and 83.3% accurate in differentiating benign from malignant meningiomas. Conclusion Benign and malignant meningiomas can be differentiated based on maximum rCBV in peritumoral edema but ADC values within the tumor are insignificant in differentiating benign and malignant tumors. rCBV values within tumor, however, may be helpful in subtyping meningiomas, especially transitional and meningothelial meningiomas.
Collapse
Affiliation(s)
- Seema Rohilla
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Harender K Garg
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Ishwar Singh
- Department of Neurosurgery, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Rohtas K Yadav
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Dhara B Dhaulakhandi
- Department of Biotechnology & Molecular Medicine, Post Graduate Institute of Medical Sciences, Regional Cancer Centre, Sharma University of Health Sciences, Rohtak, Haryana, India
| |
Collapse
|
3
|
Abstract
Nanotechnology has the power to transform neurosurgery by facilitating intervention at the cellular and subcellular level. The unique properties of nanomaterials will not only improve the management of conditions traditionally treated through neurosurgery, but also make neurosurgical intervention possible for diseases where there are currently limited treatment options. Specifically, nanotechnology appears to be a promising tool for improving molecular imaging, seamlessly integrating diagnosis and therapy in neuro-oncology, identifying targets for selective neuromodulation, as well as promoting neuroregeneration. Despite the vast potential benefits of nanotechnology in neurosurgery, problems related to neurotoxicity and the long-term medical and social consequences must be adequately addressed before nanotechnology becomes a component of surgical care.
Collapse
Affiliation(s)
- Aaron Tan
- a UCL Medical School , University College London (UCL) , London , UK.,b Biomaterials and Advanced Drug Delivery (BioADD) Laboratory, Stanford University School of Medicine , Stanford University , Stanford , CA , USA
| | - Rebecca Jeyaraj
- a UCL Medical School , University College London (UCL) , London , UK
| | - Keyoumars Ashkan
- c Department of Neurosurgery , King's College Hospital NHS Foundation Trust, King's College London , London , UK
| |
Collapse
|
4
|
Mattei TA, Rehman AA. Technological developments and future perspectives on graphene-based metamaterials: a primer for neurosurgeons. Neurosurgery 2014; 74:499-516; discussion 516. [PMID: 24476906 DOI: 10.1227/neu.0000000000000302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Graphene, a monolayer atomic-scale honeycomb lattice of carbon atoms, has been considered the greatest revolution in metamaterials research in the past 5 years. Its developers were awarded the Nobel Prize in Physics in 2010, and massive funding has been directed to graphene-based experimental research in the last years. For instance, an international scientific collaboration has recently received a €1 billion grant from the European Flagship Initiative, the largest amount of financial resources ever granted for a single research project in the history of modern science. Because of graphene's unique optical, thermal, mechanical, electronic, and quantum properties, the incorporation of graphene-based metamaterials to biomedical applications is expected to lead to major technological breakthroughs in the next few decades. Current frontline research in graphene technology includes the development of high-performance, lightweight, and malleable electronic devices, new optical modulators, ultracapacitors, molecular biodevices, organic photovoltaic cells, lithium-ion microbatteries, frequency multipliers, quantum dots, and integrated circuits, just to mention a few. With such advances, graphene technology is expected to significantly impact several areas of neurosurgery, including neuro-oncology, neurointensive care, neuroregeneration research, peripheral nerve surgery, functional neurosurgery, and spine surgery. In this topic review, the authors provide a basic introduction to the main electrophysical properties of graphene. Additionally, future perspectives of ongoing frontline investigations on this new metamaterial are discussed, with special emphasis on those research fields that are expected to most substantially impact experimental and clinical neurosurgery in the near future.
Collapse
Affiliation(s)
- Tobias A Mattei
- *Invision Health Brain and Spine Center, Williamsville, New York; ‡University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | | |
Collapse
|
5
|
Li Y, Rey-Dios R, Roberts DW, Valdés PA, Cohen-Gadol AA. Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies. World Neurosurg 2013; 82:175-85. [PMID: 23851210 DOI: 10.1016/j.wneu.2013.06.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/15/2013] [Accepted: 06/29/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Fluorescence guidance has a demonstrated potential in maximizing the extent of high-grade glioma resection. Different fluorophores (fluorescent biomarkers), including 5-aminolevulinic acid (5-ALA) and fluorescein, have been examined with the use of several imaging techniques. Our goal was to review the state of this technology and discuss strategies for more widespread adoption. METHODS We performed a Medline search using the key words "fluorescence," "intraoperative fluorescence-guided resection," "intraoperative image-guided resection," and "brain glioma" for articles from 1960 until the present. This initial search revealed 267 articles. Each abstract and article was reviewed and the reference lists from select articles were further evaluated for relevance. A total of 64 articles included information about the role of fluorescence in resection of high-grade gliomas and therefore were selectively included for our analysis. RESULTS 5-ALA and fluorescein sodium have shown promise as fluorescent markers in detecting residual tumor intraoperatively. These techniques have demonstrated a significant increase in the extent of tumor resection. Regulatory barriers have limited the use of 5-ALA and technological challenges have restricted the use of fluorescein and its derivatives in the United States. Limitations to this technology currently exist, such as the fact that fluorescence at tumor margins is not always reliable for identification of tumor-brain interface. CONCLUSIONS These techniques are safe and effective for increasing gross total resection. The development of more tumor-specific fluorophores is needed to resolve problems with subjective interpretation of fluorescent signal at tumor margins. Techniques such as quantum dots and polymer or iron oxide-based nanoparticles have shown promise as potential future tools.
Collapse
Affiliation(s)
- Yiping Li
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David W Roberts
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Pablo A Valdés
- Section of Neurosurgery, Department of Surgery, Dartmouth Medical School, Lebanon, New Hampshire, USA; Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| |
Collapse
|
6
|
Hingtgen S, Figueiredo JL, Farrar C, Duebgen M, Martinez-Quintanilla J, Bhere D, Shah K. Real-time multi-modality imaging of glioblastoma tumor resection and recurrence. J Neurooncol 2012; 111:153-61. [PMID: 23242736 DOI: 10.1007/s11060-012-1008-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 11/21/2012] [Indexed: 12/25/2022]
Abstract
The lack of relevant pre-clinical animal models incorporating the clinical scenario of Glioblastoma multiforme (GBM) resection and recurrence has contributed significantly to the inability to successfully treat GBM. A multi-modality imaging approach that allows real-time assessment of tumor resection during surgery and non-invasive detection of post-operative tumor volumes is urgently needed. In this study, we report the development and implementation of an optical imaging and magnetic resonance imaging (MRI) approach to guide GBM resection during surgery and track tumor recurrence at multiple resolutions in mice. Intra-operative fluorescence-guided surgery allowed real-time monitoring of intracranial tumor removal and led to greater than 90 % removal of established intracranial human GBM. The fluorescent signal clearly delineated tumor margins, residual tumor, and correlated closely with the clinically utilized fluorescence surgical marker 5-aminolevulinic acid/porphyrin. Post-operative non-invasive optical imaging and MRI confirmed near-complete tumor removal, which was further validated by immunohistochemistry (IHC). Longitudinal non-invasive imaging and IHC showed rapid recurrence of multi-focal tumors that exhibited a faster growth rate and altered blood-vessel density compared to non-resected tumors. Surgical tumor resection significantly extended long-term survival, however mice ultimately succumbed to the recurrent GBM. This multi-modality imaging approach to GBM resection and recurrence in mice should provide an important platform for investigating multiple aspects of GBM and ultimately evaluating novel therapeutics.
Collapse
Affiliation(s)
- Shawn Hingtgen
- Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | | | | | |
Collapse
|
7
|
Apuzzo MLJ, Pagán VM, Faccio R, Liu CY. A Bosphorus submarine passage and the reinvention of neurosurgery. World Neurosurg 2012. [PMID: 23177761 DOI: 10.1016/j.wneu.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.
Collapse
Affiliation(s)
- Michael L J Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | | | | | | |
Collapse
|
8
|
Kobayashi H, Longmire MR, Ogawa M, Choyke PL. Rational chemical design of the next generation of molecular imaging probes based on physics and biology: mixing modalities, colors and signals. Chem Soc Rev 2011; 40:4626-48. [PMID: 21607237 PMCID: PMC3417232 DOI: 10.1039/c1cs15077d] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In recent years, numerous in vivo molecular imaging probes have been developed. As a consequence, much has been published on the design and synthesis of molecular imaging probes focusing on each modality, each type of material, or each target disease. More recently, second generation molecular imaging probes with unique, multi-functional, or multiplexed characteristics have been designed. This critical review focuses on (i) molecular imaging using combinations of modalities and signals that employ the full range of the electromagnetic spectra, (ii) optimized chemical design of molecular imaging probes for in vivo kinetics based on biology and physiology across a range of physical sizes, (iii) practical examples of second generation molecular imaging probes designed to extract complementary data from targets using multiple modalities, color, and comprehensive signals (277 references).
Collapse
Affiliation(s)
- Hisataka Kobayashi
- Molecular Imaging Program, National Cancer Institute/NIH, Bldg. 10, Room B3B69, MSC 1088, 10 Center Dr Bethesda, Maryland 20892-1088, USA.
| | | | | | | |
Collapse
|
9
|
Winer JL, Kim PE, Law M, Liu CY, Apuzzo ML. Visualizing the Future: Enhancing Neuroimaging with Nanotechnology. World Neurosurg 2011; 75:626-37; discussion 618-9. [DOI: 10.1016/j.wneu.2011.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/04/2011] [Indexed: 11/30/2022]
|