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Yeole U, Shetty P, Singh V, Moiyadi A. Pattern of use of intraoperative ultrasound in surgery for brain tumors influences outcomes in glial tumors. Br J Neurosurg 2024; 38:1052-1061. [PMID: 34927516 DOI: 10.1080/02688697.2021.2016619] [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: 05/09/2021] [Revised: 06/29/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intraoperative ultrasound (iUS) imaging has emerged as a promising adjunct in glioma surgery with both, 2-dimensional (2D) as well as navigated 3-dimensional (n3D), modes increasingly being used. METHODS We analyzed our decade-long experience of 1075 brain tumor (807, 75% gliomas) cases operated using iUS. A retrospective chart and electronic records review was performed. The primary aim was to understand the patterns of use of iUS mode and its purpose of application (as a localizing tool or as a resection control modality) as well as to evaluate its impact on the extent of resection. RESULTS The use of iUS increased over time, especially with the introduction of n3DUS though 2DUS remained the more commonly used mode (63%) overall during this period. For biopsies (156 cases), both 2D, as well as n3D iUS, were used as a localizing tool only. Lesion localization was the major purpose for use of iUS even for tumor resections (61%). Resection control was performed more often for gliomas (46.5% compared to 16.5% in non-glial tumors). n3DUS was the preferred modality as a resection control tool irrespective of histological class. GTR (gross total resection) was achieved in 53.1% cases overall, while in glial and non-glial tumors it was 44.7% and 80.7%, respectively. GTR was higher when iUS was used as a resection control modality. The US and MR defined EOR (extent of resection) showed substantial agreement (κ = 0.678) with high diagnostic accuracy of 84% for glial tumors. In glial tumors, iUS was used more often in eloquent tumors and GTR rates were slightly higher than when iUS was not used. CONCLUSION iUS is a versatile tool and is a useful surgical adjunct for glioma surgeons. Besides its proven benefit as a localizing tool, when used as a tool for resection control it improves the resection rates. n3DUS may offer benefits over 2DUS as a resection control modality, though the evidence is still evolving.
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Affiliation(s)
- Ujwal Yeole
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Patel V, Chavda V. Intraoperative glioblastoma surgery-current challenges and clinical trials: An update. CANCER PATHOGENESIS AND THERAPY 2024; 2:256-267. [PMID: 39371095 PMCID: PMC11447313 DOI: 10.1016/j.cpt.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 10/08/2024]
Abstract
Surgical excision is an important part of the multimodal therapy strategy for patients with glioblastoma, a very aggressive and invasive brain tumor. While major advances in surgical methods and technology have been accomplished, numerous hurdles remain in the field of glioblastoma surgery. The purpose of this literature review is to offer a thorough overview of the current challenges in glioblastoma surgery. We reviewed the difficulties associated with tumor identification and visualization, resection extent, neurological function preservation, tumor margin evaluation, and inclusion of sophisticated imaging and navigation technology. Understanding and resolving these challenges is critical in order to improve surgical results and, ultimately, patient survival.
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Affiliation(s)
- Vimal Patel
- Department of Pharmaceutics, Anand Pharmacy College, Anand, Gujarat 388001, India
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Department of Medicine, Multispecialty, Trauma and ICCU Center, Sardar Hospital, Ahmedabad, Gujarat 382350, India
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Dietvorst S, Narayan A, Agbor C, Hennigan D, Gorodezki D, Bianchi F, Mallucci C, Frassanito P, Padayachy L, Schuhmann MU. Role of intraoperative ultrasound and MRI to aid grade of resection of pediatric low-grade gliomas: accumulated experience from 4 centers. Childs Nerv Syst 2024:10.1007/s00381-024-06532-3. [PMID: 39012356 DOI: 10.1007/s00381-024-06532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Pediatric low-grade gliomas (pLGG) are the most common brain tumors in children and achieving complete resection (CR) in pLGG is the most important prognostic factor. There are multiple intraoperative tools to optimize the extent of resection (EOR). This article investigates and discusses the role of intraoperative ultrasound (iUS) and intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of pLGG. METHODS The tumor registries at Tuebingen, Rome and Pretoria were searched for pLGG with the use of iUS and data on EOR. The tumor registries at Liverpool and Tuebingen were searched for pLGG with the use of iMRI where preoperative CR was the surgical intent. Different iUS and iMRI machines were used in the 4 centers. RESULTS We included 111 operations which used iUS and 182 operations using iMRI. Both modalities facilitated intended CR in hemispheric supra- and infratentorial location in almost all cases. In more deep-seated tumor location like supratentorial midline tumors, iMRI has advantages over iUS to visualize residual tumor. Functional limitations limiting CR arising from eloquent involved or neighboring brain tissue apply to both modalities in the same way. In the long-term follow-up, both iUS and iMRI show that achieving a complete resection on intraoperative imaging significantly lowers recurrence of disease (chi-square test, p < 0.01). CONCLUSION iUS and iMRI have specific pros and cons, but both have been proven to improve achieving CR in pLGG. Due to advances in image quality, cost- and time-efficiency, and efforts to improve the user interface, iUS has emerged as the most accessible surgical adjunct to date to aid and guide tumor resection. Since the EOR has the most important effect on long-term outcome and disease control of pLGG in most locations, we strongly recommend taking all possible efforts to use iUS in any surgery, independent of intended resection extent and iMRI if locally available.
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Affiliation(s)
- Sofie Dietvorst
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Armen Narayan
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Cyril Agbor
- Brain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, University of Pretoria, Pretoria, South Africa
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - David Gorodezki
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Tuebingen, Germany
| | - Federico Bianchi
- Pediatric Neurosurgery, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Paolo Frassanito
- Pediatric Neurosurgery, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Llewellyn Padayachy
- Brain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, University of Pretoria, Pretoria, South Africa
- Pediatric Neurosurgery Unit, Department of Neurosurgery, Steve Biko Academic Hospital Pretoria, Pretoria, South Africa
| | - Martin Ulrich Schuhmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
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Reyes Soto G, Murillo Ponce C, Catillo-Rangel C, Cacho Diaz B, Nurmukhametov R, Chmutin G, Natalaja Mukengeshay J, Mpoyi Tshiunza C, Ramirez MDJE, Montemurro N. Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery. Cureus 2024; 16:e62278. [PMID: 39006708 PMCID: PMC11246190 DOI: 10.7759/cureus.62278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Although the use of transcranial ultrasound dates to the mid-20th century, the main purpose of this research work is to standardize its use in the resection of brain tumors. This is due to its wide availability, low cost, lack of contraindications, and absence of harmful effects for the patient and medical staff, along with the possibility of real-time verification of the complete resection of tumor lesions and minimization of vascular injuries or damage to adjacent structures. METHODS A retrospective study was conducted from June to December 2022. The study included eight patients (three men and five women) aged between 32 and 76 years. Histological examination revealed two high-grade gliomas, one low-grade glioma, and five metastatic lesions. RESULTS The low-grade glioma appeared as a homogeneously echogenic structure and easily distinguishable from brain parenchyma, whereas metastases and high-grade gliomas showed higher echogenicity, being identified as malignant lesions due to areas of low echogenicity necrosis and peritumoral edema identified as a hyperechogenic structure. CONCLUSIONS The use of intraoperative transcranial ultrasound constitutes an important tool for neurosurgeons during tumor resection. Although it is easy to use, intraoperative ultrasound requires a relatively short learning curve and a good understanding of the fundamentals of ultrasound. Its main advantage over neuronavigation is that it is not affected by the "brain shift" phenomenon that commonly occurs during tumor resection, since the ultrasound images are updated during surgery.
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Affiliation(s)
- Gervith Reyes Soto
- Neurosurgical Oncology, Instituto Nacional de Cancerología, Mexico City, MEX
| | | | - Carlos Catillo-Rangel
- Neurosurgery, Hospital Regional 1ro de Octubre (ISSSTE or Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado), Mexico City, MEX
| | | | - Renat Nurmukhametov
- Neurosurgery, 2nd National Clinical Centre of Federal State Budgetary Research Institution (Russian Research Center of Surgery named after Academician B.V. Petrovsky), Moscow, RUS
| | - Gennady Chmutin
- Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | | | | | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP) University of Pisa, Pisa, ITA
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Cepeda S, García-García S, Arrese I, Sarabia R. Non-navigated 2D intraoperative ultrasound: An unsophisticated surgical tool to achieve high standards of care in glioma surgery. J Neurooncol 2024; 167:387-396. [PMID: 38413458 DOI: 10.1007/s11060-024-04614-5] [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: 10/17/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE In an era characterized by rapid progression in neurosurgical technologies, traditional tools such as the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) risk being overshadowed. Against this backdrop, this study endeavors to provide a comprehensive assessment of the clinical efficacy and surgical relevance of nn-2D-IOUS, specifically in the context of glioma resections. METHODS This retrospective study undertaken at a single center evaluated 99 consecutive, non-selected patients diagnosed with both high-grade and low-grade gliomas. The primary objective was to assess the proficiency of nn-2D-IOUS in generating satisfactory image quality, identifying residual tumor tissue, and its influence on the extent of resection. To validate these results, early postoperative MRI data served as the reference standard. RESULTS The nn-2D-IOUS exhibited a high level of effectiveness, successfully generating good quality images in 79% of the patients evaluated. With a sensitivity rate of 68% and a perfect specificity of 100%, nn-2D-IOUS unequivocally demonstrated its utility in intraoperative residual tumor detection. Notably, when total tumor removal was the surgical objective, a resection exceeding 95% of the initial tumor volume was achieved in 86% of patients. Additionally, patients in whom residual tumor was not detected by nn-2D-IOUS, the mean volume of undetected tumor tissue was remarkably minimal, averaging at 0.29 cm3. CONCLUSION Our study supports nn-2D-IOUS's invaluable role in glioma surgery. The results highlight the utility of traditional technologies for enhanced surgical outcomes, even when compared to advanced alternatives. This is particularly relevant for resource-constrained settings and emphasizes optimizing existing tools for efficient patient care. NCT05873946 - 24/05/2023 - Retrospectively registered.
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Affiliation(s)
- Santiago Cepeda
- Department of Neurosurgery, University Hospital Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain.
| | - Sergio García-García
- Department of Neurosurgery, University Hospital Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Ignacio Arrese
- Department of Neurosurgery, University Hospital Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Rosario Sarabia
- Department of Neurosurgery, University Hospital Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain
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Toma D, Buvala J, Šteňo A. Hyperechoic Area Under Insular Gliomas: A Potentially Hazardous Intraoperative Ultrasound Artifact. World Neurosurg 2024; 182:e899-e904. [PMID: 38141756 DOI: 10.1016/j.wneu.2023.12.086] [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: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Intraoperative ultrasound (IOUS) images can be distorted by various artifacts. During surgeries for insular low-grade gliomas (LGGs), we repeatedly observed a distinct hyperechoic artifact adjacent to medial tumor borders, localized in brain regions with normal appearance on magnetic resonance imaging (MRI) that has not been reported before. METHODS We retrospectively evaluated saved 3-dimensional (3D) IOUS images of 20 patients harboring insular LGGs. Twelve patients were operated on between 2010 and 2015 using an older navigated 3D IOUS system. Additionally, 3D-IOUS images of 8 patients operated on between 2021 and 2023 using a new high-end 3D-IOUS system were evaluated. The investigated region was the area under medial tumor borders, which were defined using preoperative MRI. RESULTS In 17 out of 20 cases (85%), a distinct hyperechoic area adjacent to medial tumor borders localized in brain regions with normal appearance on preoperative MRI was found; in the remaining 3 cases the saved images were suboptimal and did not allow evaluation of the area under the medial tumor borders. CONCLUSIONS Although the causes of this bright artifact are unclear, we can hypothesize that the reverberation in between different parallel layers of white and gray matter localized under the insula could play a role in its appearance. Importantly, as this hyperechoic area was depicted already before any tumor resection, it may lead to erroneous conclusion that the tumor spreads more medially. Potential resection in this region may cause significant neurologic sequelae.
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Affiliation(s)
- Dávid Toma
- Department of Neurosurgery, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Ján Buvala
- Department of Neurosurgery, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Andrej Šteňo
- Department of Neurosurgery, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
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Sabeghi P, Zarand P, Zargham S, Golestany B, Shariat A, Chang M, Yang E, Rajagopalan P, Phung DC, Gholamrezanezhad A. Advances in Neuro-Oncological Imaging: An Update on Diagnostic Approach to Brain Tumors. Cancers (Basel) 2024; 16:576. [PMID: 38339327 PMCID: PMC10854543 DOI: 10.3390/cancers16030576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
This study delineates the pivotal role of imaging within the field of neurology, emphasizing its significance in the diagnosis, prognostication, and evaluation of treatment responses for central nervous system (CNS) tumors. A comprehensive understanding of both the capabilities and limitations inherent in emerging imaging technologies is imperative for delivering a heightened level of personalized care to individuals with neuro-oncological conditions. Ongoing research in neuro-oncological imaging endeavors to rectify some limitations of radiological modalities, aiming to augment accuracy and efficacy in the management of brain tumors. This review is dedicated to the comparison and critical examination of the latest advancements in diverse imaging modalities employed in neuro-oncology. The objective is to investigate their respective impacts on diagnosis, cancer staging, prognosis, and post-treatment monitoring. By providing a comprehensive analysis of these modalities, this review aims to contribute to the collective knowledge in the field, fostering an informed approach to neuro-oncological care. In conclusion, the outlook for neuro-oncological imaging appears promising, and sustained exploration in this domain is anticipated to yield further breakthroughs, ultimately enhancing outcomes for individuals grappling with CNS tumors.
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Affiliation(s)
- Paniz Sabeghi
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA; (P.S.); (E.Y.); (P.R.); (D.C.P.)
| | - Paniz Zarand
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717411, Iran;
| | - Sina Zargham
- Department of Basic Science, California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA 95757, USA;
| | - Batis Golestany
- Division of Biomedical Sciences, Riverside School of Medicine, University of California, 900 University Ave., Riverside, CA 92521, USA;
| | - Arya Shariat
- Kaiser Permanente Los Angeles Medical Center, 4867 W Sunset Blvd, Los Angeles, CA 90027, USA;
| | - Myles Chang
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90089, USA;
| | - Evan Yang
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA; (P.S.); (E.Y.); (P.R.); (D.C.P.)
| | - Priya Rajagopalan
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA; (P.S.); (E.Y.); (P.R.); (D.C.P.)
| | - Daniel Chang Phung
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA; (P.S.); (E.Y.); (P.R.); (D.C.P.)
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St., Los Angeles, CA 90033, USA; (P.S.); (E.Y.); (P.R.); (D.C.P.)
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Moiyadi A, Shetty P, Singh VK, Yeole U. Intraoperative Navigated Three-Dimensional Ultrasound Guidance Improves Resection in Gliomas Compared with Standard Two-Dimensional Ultrasound-Results from a Comparative Cohort Study. World Neurosurg 2023; 180:e233-e242. [PMID: 37739176 DOI: 10.1016/j.wneu.2023.09.041] [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: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Intraoperative ultrasound is a promising tool for intraoperative tumor resection control. Navigated three-dimensional US (n3DUS) has many benefits over standard two-dimensional US (2DUS). METHODS Two cohorts (2DUS and n3DUS) of patients with histologically confirmed adult diffuse gliomas undergoing US-guided resection control were compared. The primary outcomes assessed were extent of resection and morbidity. Multivariate analysis was performed to account for tumor characteristics (delineation and eloquence) and surgeon experience, which could confound the results. RESULTS n3DUS was used more often (n = 252) than 2DUS (n = 86). Tumor delineation was similar in 2DUS and n3DUS cohorts, although the n3DUS cohort included more nonenhancing, histologically lower grade (2-3) gliomas and had more gliomas located in eloquent regions; also, n3DUS was more often used by senior surgeons. Gross total resection (GTR) rates were 47%, and major morbidity was 9.5%. On multivariate analysis, after controlling for all other variables between the 2 groups, patients with well-delineated tumors, patients with prior treatment, and patients who underwent n3DUS were more likely to have GTR (adjusted odds ratios 3.0, 1.8, and 2.2, respectively), whereas patients with tumors in eloquent locations were half as likely (adjusted odds ratio 0.5) to have GTR. Eloquent located tumors were likely to be associated with higher neurological morbidity, although major morbidity was not significantly different. CONCLUSIONS Good delineation, noneloquent location, and use of n3DUS was associated with a higher probability of GTR in glioma surgery. Surgeons' experience did not influence the extent of resection. Morbidity was predominantly associated with eloquent location, independent of all other factors.
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Affiliation(s)
- Aliasgar Moiyadi
- Department of Surgical Oncology, Neurosurgical Services, Tata Memorial Centre, Mumbai, India; Department of Health Sciences, Homi Bhabha National Institute, Mumbai, India.
| | - Prakash Shetty
- Department of Surgical Oncology, Neurosurgical Services, Tata Memorial Centre, Mumbai, India; Department of Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Kumar Singh
- Department of Surgical Oncology, Neurosurgical Services, Tata Memorial Centre, Mumbai, India; Department of Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Ujwal Yeole
- Department of Surgical Oncology, Neurosurgical Services, Tata Memorial Centre, Mumbai, India; Department of Health Sciences, Homi Bhabha National Institute, Mumbai, India
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Kumar M, Moiyadi A, Rangaraj N, Noronha S, Shetty P, Singh VK, Choudhari AK. Implications of use of different intraoperative ultrasound modalities during glioma surgery - A comparative study of factors affecting outcomes. Int J Med Inform 2023; 177:105154. [PMID: 37506442 DOI: 10.1016/j.ijmedinf.2023.105154] [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: 04/26/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The main goal of glioma surgery is to remove the maximum amount of tumor without worsening the patient's neurological condition. Intraoperative ultrasound (US) imaging technologies (2D and 3D) are available to assist surgeons, providing real-time updates. Considering additional time, personnel, and cost, we investigate if comparable outcomes can be achieved using basic (2D) and advanced (3D) technology. OBJECTIVE We propose predictive models for (i) glioma tumor resectability (ii) surgical outcome, and (iii) a model to predict the outcome of surgery aided with a particular ultrasound and compare outcomes between 2D and 3D US. METHODOLOGY We used real-world surgery data from a tertiary cancer centre. Three groups of cases were analyzed (2D US used, 3D US used, and no US used during resection). The data analysis uses hypothesis testing, bootstrap sampling, and logistic regression. RESULTS The preoperatively anticipated extent of tumor removal correlated with the postoperative MRI measurement of tumor removal for US-supported surgery (p=0.01) but not for no US-supported surgeries (p = 0.13). A combination of delineation, eloquence, and the multifocal/multicentric nature of the tumor effectively predicted resectability. The eventual outcome of surgery (actual extent of resection achieved) can be predicted by prior treatment status, delineation, eloquence, and satellite nodules. Based on our prediction model (training set of 350 cases and test of 40 cases of US-guided surgeries), we identify some cases where 3D US seems to offer superior EORs. CONCLUSION The resectability of glioma tumors is crucial in determining surgical objectives, and the type of ultrasound used as support impacts tumor removal. The findings in this study aid informed decision-making and optimize imaging technology usage, providing a decision flow for selecting ultrasound based on tumor characteristics.
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Affiliation(s)
- Manoj Kumar
- Industrial Engineering & Operations Research, IIT Bombay, India.
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Centre Mumbai, India; Dept. of Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Centre Mumbai, India; Dept. of Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Kumar Singh
- Department of Neurosurgery, Tata Memorial Centre Mumbai, India; Dept. of Health Sciences, Homi Bhabha National Institute, Mumbai, India
| | - Amit Kumar Choudhari
- Department of Neurosurgery, Tata Memorial Centre Mumbai, India; Department of Radiology, Tata Memorial Centre Mumbai, India
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Guil-Ibáñez JJ, Gomar-Alba M, Castelló-Ruiz MJ, García-Pérez F, Narro-Donate JM, Vargas-López AJ, Masegosa-González J. Intraoperative ultrasound-assisted surgery in orbital apex tumours: technical note. J Ultrasound 2023; 26:733-741. [PMID: 36642754 PMCID: PMC10469155 DOI: 10.1007/s40477-022-00762-4] [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: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Since the introduction of ultrasonography (US) in the operating theatre in the early 1970s, intraoperative ultrasound (IOUS) has become a very useful tool for real-time neurosurgical procedures. The main limitation of US is its innately reduced capacity to penetrate the intact skull. This is the reason why most IOUS-assisted procedures are usually performed via transfontanellar or after a craniotomy or laminotomy is done. OBJECTIVE We present a 54-year-old woman with a right optic nerve sheath meningioma, who was operated on by a right cranio-orbital approach and IOUS-assisted tumour removal. METHODS Data concerning the anamnesis and complementary studies were obtained from the clinical history. Surgical images were obtained in the operating room during surgery. Images obtained by US were compared with the preoperative and postoperative imaging scans. IOUS imaging was also compared with the intraoperative findings. RESULTS The correlation between US and both preoperative and postoperative studies was very high. During surgery, both transpalpebral and transperiorbital IOUS facilitated the resection with no specific technical difficulties or significant time consumption. CONCLUSION Recent improvements in the image quality of IOUS devices offer several attractive options for real-time neuronavigation. We describe our initial experience with the IOUS-assisted technique for orbital apex tumours. In our patient transpalpebral and transperiorbital IOUS provided an excellent source of control over location and over the extent of tumour resection. We hope that this description of how we usually perform this procedure may be useful for some selected cases and contribute to the further enhancement and improvement of the technique.
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Affiliation(s)
- José Javier Guil-Ibáñez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain.
| | - Mario Gomar-Alba
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - María José Castelló-Ruiz
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - Fernando García-Pérez
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - José María Narro-Donate
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - Antonio José Vargas-López
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
| | - José Masegosa-González
- Department of Neurosurgery, Hospital Universitario Torrecárdenas, Calle Hermandad Donantes de Sangre s/n, 04009, Almería, Spain
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De Rosa A, Guizzardi G, Moncada M, Roldán P, Ferrés A, Topczewski TE, Somma T, Cavallo LM, González J, Enseñat J, Di Somma A. Ultrasound-Oriented Surgical Planning ("UOSP") for Intracranial Lesions: A Systematic Integration to the Standard Preoperative Planning. World Neurosurg 2023; 170:e766-e776. [PMID: 36455842 DOI: 10.1016/j.wneu.2022.11.122] [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: 09/11/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intraoperative ultrasound (iUS) is a well-established technique whose aim is to provide real-time visualization of deep lesions during brain surgery. The lack of definition of anatomic semeiotics and the unusual direction of the insonation plane make interpretation and orientation challenging for the surgeon who newly approaches to such a tool. We propose a novel protocol to be applied during the surgical planning for intracranial lesions surgery, a so-called ultrasound-oriented surgical planning ("UOSP") protocol, and we provide a retrospective analysis of 21 patients who underwent surgery for an intracranial lesion in which UOSP was applied. To further enlighten different surgical orientation strategies and possible limitations given by the technique, we discuss 3 illustrative cases assigned to 3 categories ("basic," "intermediate," and "challenging" lesions) with progressively growing difficulty in anatomic orientation during a surgical procedure. METHODS A total of 21 patients operated between March 2021 and July 2021 and where the UOSP protocol was applied during surgical planning were evaluated retrospectively. The UOSP protocol was performed the days before the surgical intervention by the same surgical team. RESULTS The UOSP protocol was successfully applied in all 21 patients. In all cases, the preoperative imaging obtained during surgical planning corresponded to the images observed during the application of iUS. CONCLUSIONS The introduction of the UOSP protocol during the planification of the surgical intervention for an intracerebral lesion may serve as a key factor to overcome the actual limitations inherent to the iUS technique. Utilization of this protocol may facilitate wider use of iUS in neurosurgery.
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Affiliation(s)
- Andrea De Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy
| | | | - Marina Moncada
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Pedro Roldán
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Abel Ferrés
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | | | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Josep González
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain.
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12
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Broggi M, Zattra CM, Restelli F, Acerbi F, Seveso M, Devigili G, Schiariti M, Vetrano IG, Ferroli P, Broggi G. A Brief Explanation on Surgical Approaches for Treatment of Different Brain Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:689-714. [PMID: 37452959 DOI: 10.1007/978-3-031-23705-8_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The main goal of brain tumor surgery is to achieve gross total tumor resection without postoperative complications and permanent new deficits. However, when the lesion is located close or within eloquent brain areas, cranial nerves, and/or major brain vessels, it is imperative to balance the extent of resection with the risk of harming the patient, by following a so-called maximal safe resection philosophy. This view implies a shift from an approach-guided attitude, in which few standard surgical approaches are used to treat almost all intracranial tumors, to a pathology-guided one, with surgical approaches actually tailored to the specific tumor that has to be treated with specific dedicated pre- and intraoperative tools and techniques. In this chapter, the basic principles of the most commonly used neurosurgical approaches in brain tumors surgery are presented and discussed along with an overview on all available modern tools able to improve intraoperative visualization, extent of resection, and postoperative clinical outcome.
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Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Mirella Seveso
- Neuroanesthesia and Neurointensive Care Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
- Scientific Director, Fondazione I.E.N. Milano, Italy.
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13
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Kumar M, Noronha S, Rangaraj N, Moiyadi A, Shetty P, Singh VK. Choice of intraoperative ultrasound adjuncts for brain tumor surgery. BMC Med Inform Decis Mak 2022; 22:307. [DOI: 10.1186/s12911-022-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Gliomas are among the most typical brain tumors tackled by neurosurgeons. During navigation for surgery of glioma brain tumors, preoperatively acquired static images may not be accurate due to shifts. Surgeons use intraoperative imaging technologies (2-Dimensional and navigated 3-Dimensional ultrasound) to assess and guide resections. This paper aims to precisely capture the importance of preoperative parameters to decide which type of ultrasound to be used for a particular surgery.
Methods
This paper proposes two bagging algorithms considering base classifier logistic regression and random forest. These algorithms are trained on different subsets of the original data set. The goodness of fit of Logistic regression-based bagging algorithms is established using hypothesis testing. Furthermore, the performance measures for random-forest-based bagging algorithms used are AUC under ROC and AUC under the precision-recall curve. We also present a composite model without compromising the explainability of the models.
Results
These models were trained on the data of 350 patients who have undergone brain surgery from 2015 to 2020. The hypothesis test shows that a single parameter is sufficient instead of all three dimensions related to the tumor ($$p < 0.05$$
p
<
0.05
). We observed that the choice of intraoperative ultrasound depends on the surgeon making a choice, and years of experience of the surgeon could be a surrogate for this dependence.
Conclusion
This study suggests that neurosurgeons may not need to focus on a large set of preoperative parameters in order to decide on ultrasound. Moreover, it personalizes the use of a particular ultrasound option in surgery. This approach could potentially lead to better resource management and help healthcare institutions improve their decisions to make the surgery more effective.
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14
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Prada F, Ciocca R, Corradino N, Gionso M, Raspagliesi L, Vetrano IG, Doniselli F, Del Bene M, DiMeco F. Multiparametric Intraoperative Ultrasound in Oncological Neurosurgery: A Pictorial Essay. Front Neurosci 2022; 16:881661. [PMID: 35516800 PMCID: PMC9063404 DOI: 10.3389/fnins.2022.881661] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 12/20/2022] Open
Abstract
Intraoperative ultrasound (ioUS) is increasingly used in current neurosurgical practice. This is mainly explained by its affordability, handiness, multimodal real-time nature, and overall by its image spatial and temporal resolution. Identification of lesion and potential residue, analysis of the vascularization pattern, and characterization of the nature of the mass are only some of the advantages that ioUS offers to guide safe and efficient tumor resection. Technological advances in ioUS allow to achieve both structural and functional imaging. B-mode provides high-resolution visualization of the lesion and of its boundaries and relationships. Pioneering modes, such as contrast-enhanced ultrasound (CEUS), ultrasensitive Doppler, and elastosonography, are tools with great potential in characterizing different functional aspects of the lesion in a qualitative and quantitative manner. As already happening for many organs and pathologies, the combined use of different US modalities offers new insights in a multiparametric fashion. In this study, we present the potential of our multiparametric approach for ioUS during neuro-oncological surgery. In this effort, we provide a pictorial essay focusing on the most frequent pathologies: low- and high-grade gliomas, meningiomas, and brain metastases.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
- Focused Ultrasound Foundation, Charlottesville, VA, United States
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- *Correspondence: Francesco Prada,
| | - Riccardo Ciocca
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Faculty of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
| | - Nicoletta Corradino
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Faculty of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
| | - Matteo Gionso
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Faculty of Medicine and Surgery, Humanitas University, Pieve Emanuele, Italy
| | - Luca Raspagliesi
- Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Neurosurgery, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Fabio Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Johns Hopkins Medical School, Baltimore, MD, United States
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Cepeda S, García-García S, Arrese I, Velasco-Casares M, Sarabia R. Advantages and Limitations of Intraoperative Ultrasound Strain Elastography Applied in Brain Tumor Surgery: A Single-Center Experience. Oper Neurosurg (Hagerstown) 2022; 22:305-314. [DOI: 10.1227/ons.0000000000000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
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Does the use of surgical adjuncts affect post-operative infection rates in Neuro-oncology surgery? World Neurosurg 2022; 162:e246-e250. [PMID: 35259507 DOI: 10.1016/j.wneu.2022.02.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a significant cause of post-operative morbidity and mortality. As oncological care advances, the use of surgical adjuncts such as intraoperative US (Ultrasound), 5-ALA (5-Aminolevulinic acid) and neurophysiological monitoring has increased. This study set out to identify whether the use of surgical adjuncts in supratentorial tumour surgery lead to increased operative time or increased rates of SSI. METHODS This is a retrospective study at a large tertiary clinical neurosciences centre in the UK. We included all patients who underwent an elective supratentorial craniotomy for a tumour over a 12 month period. We retrospectively assessed whether patients had had a post-operative infection at 30 days or 4 months using our electronic patient record system. RESULTS 267 patients were included. The median age was 58 years (range 17-87 years) with roughly equal numbers of males and females (males = 138/267, 52%). Most operations were carried out for gliomas (149/267, 56%) or metastases (61/267, 23%). The median length of surgery was 3 hours 6 minutes with 24% lasting >4 hours. The overall infection rate was 4.5%. Intraoperative monitoring and 5-ALA was associated with longer operative times although not necessarily larger craniotomy sizes whilst intraoperative US was associated with a shorter operative time and smaller craniotomy size. These adjuncts were not associated with an increased risk of infection. CONCLUSION This study adds reassurance that whilst some surgical adjuncts lead to increased operative times in our study there was no apparent increased risk of infection as a result of this.
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17
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Postoperative CT scans after resection of brain metastases: neurosurgical routine or added value? J Neurooncol 2022; 157:157-163. [DOI: 10.1007/s11060-022-03957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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18
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Chryssikos T, Wessell A, Pratt N, Cannarsa G, Sharma A, Olexa J, Han N, Schwartzbauer G, Sansur C, Crandall K. Enhanced Safety of Pedicle Subtraction Osteotomy Using Intraoperative Ultrasound. World Neurosurg 2021; 152:e523-e531. [PMID: 34098140 DOI: 10.1016/j.wneu.2021.05.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pedicle subtraction osteotomy (PSO) can improve sagittal alignment but carries risks, including iatrogenic spinal cord and nerve root injury. Critically, during the reduction phase of the technique, medullary kinking or neural element compression can lead to neurologic deficits. METHODS We describe 3 cases of thoracic PSO and evaluate the feasibility, findings, and utility of intraoperative ultrasound in this setting. RESULTS Intraoperative ultrasound can provide a visual assessment of spinal cord morphology before and after PSO reduction and influences surgical decision making with regard to the final amount of sagittal plane correction. This modality is particularly useful for confirming ventral decompression of disc-osteophyte complex before reduction and also after reduction maneuvers when there is kinking of the thecal sac but uncertainty about the underlying status of the spinal cord. Intraoperative ultrasound is a reliable modality that fits well into the technical sequence of PSO, adds a minimal amount of operative time, and has few limitations. CONCLUSIONS We propose that intraoperative ultrasound is a useful supplement to standard neuromonitoring modalities for ensuring safe PSO reduction and decompression of neural elements.
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Affiliation(s)
- Timothy Chryssikos
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.
| | - Aaron Wessell
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Gregory Cannarsa
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Nathan Han
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Gary Schwartzbauer
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Kenneth Crandall
- Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA
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19
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Šteňo A, Buvala J, Šteňo J. Large Residual Pilocytic Astrocytoma After Failed Ultrasound-Guided Resection: Intraoperative Ultrasound Limitations Require Special Attention. World Neurosurg 2021; 150:140-143. [PMID: 33819702 DOI: 10.1016/j.wneu.2021.03.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
While benefits of neurosurgical intraoperative ultrasound (IOUS) are reported frequently, this method still has some significant pitfalls, which are described less often. However, sufficient knowledge on dealing with IOUS drawbacks, particularly various image artifacts, is important for successful surgery. We report a case of failed IOUS-guided pediatric cerebellar pilocytic astrocytoma resection, incorrectly evaluated as gross total resection according to IOUS. A large tumor residuum was left in place. Successful IOUS-guided reoperation using new IOUS technology and appropriate ultrasound imaging technique are described. The most probable reasons for initial resection failure and crucial points of reoperation, predominantly dealing with IOUS artifacts, are discussed. Neurosurgeons should be aware of IOUS limitations and have sufficient knowledge about how to overcome them before adopting routine use of this intraoperative imaging modality.
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Affiliation(s)
- Andrej Šteňo
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
| | - Ján Buvala
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Juraj Šteňo
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
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20
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Nagaraja TN, Lee IY. Cerebral microcirculation in glioblastoma: A major determinant of diagnosis, resection, and drug delivery. Microcirculation 2021; 28:e12679. [PMID: 33474805 DOI: 10.1111/micc.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood-tumor barrier (BTB) permeability in tumor periphery due to glioma-induced vascular dysregulation allow T1 contrast-enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)-based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood-brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri-ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy.
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Affiliation(s)
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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21
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Kaale AJ, Rutabasibwa N, Mchome LL, Lillehei KO, Honce JM, Kahamba J, Ormond DR. The use of intraoperative neurosurgical ultrasound for surgical navigation in low- and middle-income countries: the initial experience in Tanzania. J Neurosurg 2021; 134:630-637. [PMID: 32109864 DOI: 10.3171/2019.12.jns192851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuronavigation has become a crucial tool in the surgical management of CNS pathology in higher-income countries, but has yet to be implemented in most low- and middle-income countries (LMICs) due to cost constraints. In these resource-limited settings, neurosurgeons typically rely on their understanding of neuroanatomy and preoperative imaging to help guide them through a particular operation, making surgery more challenging for the surgeon and a higher risk for the patient. Alternatives to assist the surgeon improve the safety and efficacy of neurosurgery are important for the expansion of subspecialty neurosurgery in LMICs. A low-cost and efficacious alternative may be the use of intraoperative neurosurgical ultrasound. The authors analyze the preliminary results of the introduction of intraoperative ultrasound in an LMIC setting. METHODS After a training program in intraoperative ultrasound including courses conducted in Dar es Salaam, Tanzania, and Aurora, Colorado, neurosurgeons at the Muhimbili Orthopaedic and Neurosurgical Institute began its independent use. The initial experience is reported from the first 24 prospective cases in which intraoperative ultrasound was used. When possible, ultrasound findings were recorded and compared with postoperative imaging findings in order to establish accuracy of intraoperative interpretation. RESULTS Of 24 cases of intraoperative ultrasound that were reported, 29.2% were spine surgeries and 70.8% were cranial. The majority were tumor cases (95.8%). Lesions were identified through the dura mater in all 24 cases, with 20.8% requiring extension of craniotomy or laminectomy due to inadequate exposure. Postoperative imaging (typically CT) was only performed in 11 cases, but all 11 matched the findings on post-dural closure ultrasound. CONCLUSIONS The use of intraoperative ultrasound, which is affordable and available locally, is changing neurosurgical care in Tanzania. Ultimately, expanding the use of intraoperative B-mode ultrasound in Tanzania and other LMICs may help improve neurosurgical care in these countries in an affordable manner.
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Affiliation(s)
- Aingaya J Kaale
- 1Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Nicephorus Rutabasibwa
- 1Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Laurent Lemeri Mchome
- 1Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | | | - Justin M Honce
- 3Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Joseph Kahamba
- 1Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
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22
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Tandon PN. Expert Commentary on "Some Observations on Intracranial Glioma" by Ramesh Chandra, Sanatan Rath, K V. Mathai and Jacob Chandy. Neurol India 2020; 68:728-731. [PMID: 32859808 DOI: 10.4103/0028-3886.293451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Prakash N Tandon
- National Brain Research Centre, Manesar, Gurugram, Haryana, India
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23
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Yeole U, Singh V, Mishra A, Shaikh S, Shetty P, Moiyadi A. Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology. Ultrasonography 2020; 39:394-406. [PMID: 32660206 PMCID: PMC7515658 DOI: 10.14366/usg.20044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Intraoperative imaging has become one of the most important adjuncts in neurosurgery, especially in the surgical treatment of intra-axial tumors. Navigation and intraoperative magnetic resonance imaging have limitations, and intraoperative ultrasonography (IOUS) has emerged as a versatile and multifaceted alternative. With technological advances in ultrasound scanners and newer multifunctional probes, the potential of IOUS is increasingly being utilized in the resection of tumors. The addition of image guidance to IOUS has exponentially increased the power of this technique. Navigated ultrasonography (nUS) can now overcome many of the limitations of conventional standalone two-dimensional ultrasonography. In this pictorial essay, we outline our nUS technique (both two- and three-dimensional) for the resection of intra-axial tumors with illustrated examples highlighting the various steps and corresponding benefits of the technique.
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Affiliation(s)
- Ujwal Yeole
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Ajit Mishra
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Salman Shaikh
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
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Li Y, Polyak D, Johnson E, Yecies D, Shevidi S, de la Zerda A, Gephart MH, Chu S. Difference-Frequency Ultrasound Imaging With Non-Linear Contrast. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1759-1766. [PMID: 31804930 PMCID: PMC8189081 DOI: 10.1109/tmi.2019.2957280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Conventional ultrasound imaging is based on the scattering of sound from inhomogeneities in the density and the speed of sound and is often used in medicine to resolve pathologic compared to normal tissue. Here we demonstrate a difference-frequency ultrasound (dfUS) imaging method that is based on the interaction of two sound pulses that propagate non-collinearly and intersect in space and time. The dfUS signal arises primarily from the second-order non-linear coefficient, a contrast mechanism that differs from linear and harmonic US imaging. The distinct contrast mechanism allows dfUS to image anatomic features that are not identifiable in conventional US images of salmon and pig kidney tissue. Further, dfUS produces enhanced contrast of glioblastoma tumor implanted in the mouse brain, revealing its potential for improving medical diagnosis. Progress towards a real-time system is discussed.
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25
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Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:1221-1233. [PMID: 31410683 DOI: 10.1007/s10143-019-01160-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Intraoperative ultrasonography (iUS) is considered an accurate, safe, and cost-effective tool to estimate the extent of resection of both high-grade (HGG) and low-grade (DLGG) diffuse gliomas (DGs). However, it is currently missing an evidence-based assessment of iUS diagnostic accuracy in DGs surgery. The objective of review is to perform a systematic review and meta-analysis of the diagnostic performance of iUS in detecting tumor residue after DGs resection. A comprehensive literature search for studies published through October 2018 was performed according to PRISMA-DTA and STARD 2015 guidelines, using the following algorithm: ("ultrasound" OR "ultrasonography" OR "ultra-so*" OR "echo*" OR "eco*") AND ("brain" OR "nervous") AND ("tumor" OR "tumour" OR "lesion" OR "mass" OR "glio*" OR "GBM") AND ("surgery" OR "surgical" OR "microsurg*" OR "neurosurg*"). Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) of iUS in DGs were calculated. A subgroup analysis for HGGs and DLGGs was also conducted. Thirteen studies were included in the systematic review (665 DGs). Ten articles (409 DGs) were selected for the meta-analysis with the following results: sensitivity 72.2%, specificity 93.5%, LR- 0.29, LR+ 3, and DOR 9.67. Heterogeneity among studies was non-significant. Subgroup analysis demonstrates a better diagnostic performance of iUS for DLGGs compared with HGGs. iUS is an effective technique in assessing DGs resection. No significant differences are seen regarding iUS modality and transducer characteristics. Its diagnostic performance is higher in DLGGs than HGGs and could be worsened by previous treatments, surgical artifacts, and small tumor residue volumes.
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Patel NV, Schneider J, Chiluwal A, Boockvar JA. Commentary: Intraoperative Strain Elastosonography in Brain Tumors Surgery. Oper Neurosurg (Hagerstown) 2019; 17:E50-E51. [PMID: 30535389 DOI: 10.1093/ons/opy366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nitesh V Patel
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Julia Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Amrit Chiluwal
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Wu DF, He W, Lin S, Han B, Zee CS. Using Real-Time Fusion Imaging Constructed from Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging for High-Grade Glioma in Neurosurgery. World Neurosurg 2019; 125:e98-e109. [DOI: 10.1016/j.wneu.2018.12.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/20/2023]
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Automatic and efficient MRI-US segmentations for improving intraoperative image fusion in image-guided neurosurgery. NEUROIMAGE-CLINICAL 2019; 22:101766. [PMID: 30901714 PMCID: PMC6425116 DOI: 10.1016/j.nicl.2019.101766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 01/20/2019] [Accepted: 03/10/2019] [Indexed: 11/24/2022]
Abstract
Knowledge of the exact tumor location and structures at risk in its vicinity are crucial for neurosurgical interventions. Neuronavigation systems support navigation within the patient's brain, based on preoperative MRI (preMRI). However, increasing tissue deformation during the course of tumor resection reduces navigation accuracy based on preMRI. Intraoperative ultrasound (iUS) is therefore used as real-time intraoperative imaging. Registration of preMRI and iUS remains a challenge due to different or varying contrasts in iUS and preMRI. Here, we present an automatic and efficient segmentation of B-mode US images to support the registration process. The falx cerebri and the tentorium cerebelli were identified as examples for central cerebral structures and their segmentations can serve as guiding frame for multi-modal image registration. Segmentations of the falx and tentorium were performed with an average Dice coefficient of 0.74 and an average Hausdorff distance of 12.2 mm. The subsequent registration incorporates these segmentations and increases accuracy, robustness and speed of the overall registration process compared to purely intensity-based registration. For validation an expert manually located corresponding landmarks. Our approach reduces the initial mean Target Registration Error from 16.9 mm to 3.8 mm using our intensity-based registration and to 2.2 mm with our combined segmentation and registration approach. The intensity-based registration reduced the maximum initial TRE from 19.4 mm to 5.6 mm, with the approach incorporating segmentations this is reduced to 3.0 mm. Mean volumetric intensity-based registration of preMRI and iUS took 40.5 s, including segmentations 12.0 s. We demonstrate that our segmentation-based registration increases accuracy, robustness, and speed of multi-modal image registration of preoperative MRI and intraoperative ultrasound images for improving intraoperative image guided neurosurgery. For this we provide a fast and efficient segmentation of central anatomical structures of the perifalcine region on ultrasound images. We demonstrate the advantages of our method by comparing the results of our segmentation-based registration with the initial registration provided by the navigation system and with an intensity-based registration approach.
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Pichierri A, Bradley M, Iyer V. Intraoperative Magnetic Resonance Imaging-Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System. World Neurosurg X 2019; 3:100022. [PMID: 31225516 PMCID: PMC6584609 DOI: 10.1016/j.wnsx.2019.100022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Despite the most recent surgical aids and tools, surgical removal of infiltrating brain tumors remains a challenge. Unclear margins, edematous areas, and infiltrative behavior are the main causes for failing gross total removals. Also, excessive resection of peri-tumoral tissue often carries risks of damaging the nearby functioning cortical and subcortical structures with an unacceptable decrease in patient's quality of life and postoperative functional status, and the risk of making patients not eligible to adjuvant treatments. Awake surgery and intraoperative magnetic resonance imaging (ioMRI) are among the most effective aids in preventing damage to functional brain while maximizing the extent of resection. Methods We present our series of 46 patients operated on at Southmead Hospital (North Bristol NHS Trust) in between July 2014 and February 2017 using ioMRI plus or minus awake surgery. Setting, patient features, indications, type and size of tumors, surgical times, extent of resection, morbidity, and survival are analyzed and discussed. Results Overall, ioMRI check led to a +43% resections in Group 1 and +58% in Group 2. In grade 2 tumors, GTR was 46% in Group 1 and 55% in Group 2 (41% in control group). In grade 3 tumors, GTR was 57% in Group 1 and 66% in Group 2 (30% in control group). In Grade 4 tumors, GTR was 63% in Group 1, 66% in Group 2 (36% in control group). In terms of theatre occupation, the use of ioMRI added 1/2 operative session; the addition of awake surgery implied the use of another 1/2 operative session. Morbidity did not differ among the groups, with low incidence of permanent post-operative deficits (<5%). Group 2 OS was statistically longer when compared to the control group. Conclusions Using ioMRI together with awake surgery is demanding for the anesthetic team, staff nurses, and for the patient. Nevertheless, low morbidity, greater total resections rates, and longer survival suggest its use is effective in making more approachable gliomas of all grades that we would consider “complex” due to their intrinsic features or locations.
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Key Words
- 5-ALA, 5-Aminolevulinic acid
- Awake surgery
- EOR, Extent of resection
- FLAIR, Fluid-attenuated inversion recovery
- GBM, Glioblastoma multiforme
- GTR, Gross total resection
- Glioma
- HGG, High-grade glioma
- LGG, Low-grade glioma
- MAC, Monitored anesthesia care
- Neuro-oncology
- OS, Overall survival
- PFS, Progression-free survival
- PR, Partial resection
- PS, Performance Status
- Survival
- Volumetric analysis
- WHO, World Health Organization
- ioMRI
- ioMRI, Intraoperative magnetic resonance imaging
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Affiliation(s)
- Angelo Pichierri
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Marcus Bradley
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Venkat Iyer
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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Patil AD, Singh V, Sukumar V, Shetty PM, Moiyadi AV. Comparison of outcomes of free-hand 2-dimensional ultrasound-guided versus navigated 3-dimensional ultrasound-guided biopsy for supratentorial tumours: a single-institution experience with 125 cases. Ultrasonography 2018; 38:255-263. [PMID: 30779873 PMCID: PMC6595123 DOI: 10.14366/usg.18036] [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: 06/20/2018] [Accepted: 12/08/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the relative utility and benefits of free-hand 2-dimensional intraoperative ultrasound (FUS) and navigated 3-dimensional intraoperative ultrasound (NUS) as ultrasound-guided biopsy (USGB) techniques for supratentorial lesions. Methods All patients who underwent USGB for suspected supratentorial tumours from January 2008 to December 2017 were retrospectively analyzed. The charts and electronic medical records of these patients were studied. Demographic, surgical, and pathological variables were collected and analyzed. The study group consisted of patients who underwent either FUS or NUS for biopsy. Results A total of 125 patients (112 adults and 13 children) underwent USGB during the study period (89 FUS and 36 NUS). NUS was used more often for deep-seated lesions (58% vs. 18% for FUS, P<0.001). The mean operating time for NUS was longer than for FUS (156 minutes vs. 124 minutes, P=0.001). Representative yield was found in 97.7% of biopsies using FUS and in 100% of biopsies using NUS (diagnostic yield, 93.6% and 91.3%, respectively). The majority of lesions (89%) were high-grade gliomas or lymphomas. Postoperative complications were more common in the NUS group (8.3% vs. 1.2%), but were related to the tumour location (deep). Conclusion Despite the longer operating time and higher rate of postoperative complications, NUS has the benefit of being suitable for biopsies of deep-seated supratentorial lesions, while FUS remains valuable for superficial lesions.
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Affiliation(s)
- Aditya D Patil
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vivek Sukumar
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prakash M Shetty
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar V Moiyadi
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Advances in Glioblastoma Operative Techniques. World Neurosurg 2018; 116:529-538. [DOI: 10.1016/j.wneu.2018.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/13/2018] [Indexed: 11/24/2022]
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Sweeney JF, Smith H, Taplin A, Perloff E, Adamo MA. Efficacy of intraoperative ultrasonography in neurosurgical tumor resection. J Neurosurg Pediatr 2018; 21:504-510. [PMID: 29451454 DOI: 10.3171/2017.11.peds17473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative ultrasonography (IOUS) is a widely accessible imaging modality that provides real-time surgical guidance with minimal identified risk or additional operative time. A recent study by the authors found a strong correlation between IOUS and postoperative MRI findings when evaluating the extent of tumor resection, suggesting that IOUS might have significant clinical implications. The objective of this study was to expand on results from the previous study in order to provide more evidence on the usage of IOUS in the determination of gross-total resection (GTR) in both adult and pediatric patients with brain tumors. METHODS This study consisted of a retrospective review of adult and pediatric neurosurgical patients who were treated at Albany Medical Center between August 2009 and March 2016 for a tumor of the brain. All patients were treated with IOUS and then underwent postoperative MRI (with and without contrast) within 1 week of surgery. RESULTS A total of 260 patients (55% of whom were males) met inclusion criteria for the study (age range 3 months to 84 years). IOUS results showed a strong association with postoperative MRI results (φ = 0.693, p < 0.001) and an 81% intended GTR rate. In cases in which GTR was pursued, 19% had false-negative results. IOUS was able to accurately identify residual tumor in 100% of subtotal resection cases where resection was stopped due to invasion of tumor into eloquent locations. Cases involving gliomas had a 75% intended GTR rate and a 25% false-negative rate. Cases involving metastatic tumors had an 87% intended GTR rate and a 13% false-negative rate. The sensitivity, specificity, negative predictive value, and positive predictive value are reported for IOUS in all included tumor pathologies, glioma cases, and metastatic tumor cases, respectively. CONCLUSIONS The use of IOUS may allow for a reliable imaging modality to achieve a more successful GTR of brain tumors in both adult and pediatric neurosurgical patients. When attempting GTR, the authors demonstrated an 81% GTR rate. The authors also report false-negative IOUS results in 19% of attempted GTR cases. The authors support the use of IOUS in both adult and pediatric CNS tumor surgery to improve surgical outcomes. However, further studies are warranted to address existing limitations with its use to further improve its efficacy and better define its role as an intraoperative imaging tool.
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Affiliation(s)
- Jared F Sweeney
- 2Upstate Medical University College of Medicine, Syracuse, New York
| | - Heather Smith
- 1Department of Neurosurgery, Albany Medical Center, Albany; and
| | - AmiLyn Taplin
- 1Department of Neurosurgery, Albany Medical Center, Albany; and
| | - Eric Perloff
- 1Department of Neurosurgery, Albany Medical Center, Albany; and
| | - Matthew A Adamo
- 1Department of Neurosurgery, Albany Medical Center, Albany; and
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Garzon-Muvdi T, Kut C, Li X, Chaichana KL. Intraoperative imaging techniques for glioma surgery. Future Oncol 2017; 13:1731-1745. [PMID: 28795843 DOI: 10.2217/fon-2017-0092] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Gliomas are CNS neoplasms that infiltrate the surrounding brain parenchyma, complicating their treatment. Tools that increase extent of resection while preventing neurological deficit are essential to improve prognosis of patients diagnosed with gliomas. Tools such as intraoperative MRI, ultrasound and fluorescence-guided microsurgery have been used in the surgical resection of CNS gliomas with the goal of maximizing extent of resection to improve patient outcomes. In addition, emerging experimental techniques, for example, optical coherence tomography and Raman spectroscopy are promising techniques which could 1 day add to the increasing armamentarium used in the surgical resection of CNS gliomas. Here, we present the potential advantages and limitations of these imaging techniques for the purposes of identifying gliomas in the operating room.
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Affiliation(s)
| | - Carmen Kut
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA
| | - Xingde Li
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA
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Mena F. ECOGRAFÍA INTRAOPERATORIA EN CIRUGÍA ONCOLÓGICA CEREBRAL Y ESPINAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Moiyadi AV, Shetty P, Degaonkar A. Resection of Pediatric Brain Tumors: Intraoperative Ultrasound Revisited. J Pediatr Neurosci 2017; 12:19-23. [PMID: 28553373 PMCID: PMC5437781 DOI: 10.4103/jpn.jpn_141_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Extent of resection is a very important prognostic marker in most pediatric brain tumors. Intraoperative imaging facilitates resection control. Intraoperative ultrasound (IOUS) is a cost-effective alternative to intraoperative magnetic resonance, but scant literature addresses its utility in this context. Methods: We retrospectively reviewed all pediatric brain tumors operated at our center using navigated three-dimensional ultrasound (US). The utility of the US in resection control was recorded and extent of resection evaluated. Results: IOUS was used in 20 cases (3 for frameless biopsy and 17 for tumor resection control). It was 100% accurate in localizing all tumors and yielded 100% diagnosis in the biopsy cases. Technical limitations precluded its use in 2 of the 17 cases of tumor resection. In the remaining 15, it correctly predicted the residual tumor status in 13 cases (87%). A gross total resection was achieved overall in 12 cases (80%) with postoperative morbidity in only one case. Conclusions: IOUS is a useful tool to localize intracranial tumors and guide the resection reliably. Widespread use can improve its applicability and make it an effective intraoperative imaging tool in pediatric brain tumors.
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Affiliation(s)
- Aliasgar V Moiyadi
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prakash Shetty
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amol Degaonkar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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