1
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Al-Sousi AN, Whelan MC, Khalaf Z. Evaluating intraoperative ultrasound (IOUS) in focal cortical dysplasia (FCD) resection surgery: A systematic review. Surg Neurol Int 2024; 15:165. [PMID: 38840597 PMCID: PMC11152546 DOI: 10.25259/sni_109_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Background Surgery is the best approach to treating focal cortical dysplasia (FCD)-related epilepsy; yet, it has suboptimal outcomes because distinguishing the boundaries between the FCD region and normal brain tissue intraoperatively poses a challenge. The use of intraoperative ultrasound (IOUS) helps demarcate FCD lesion borders leading to more accurate intraoperative resection. In this review, the use of IOUS for the resection of FCD was evaluated. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Medline, Embase, Cochrane Library, Scopus Library, and Dynamed Library databases were searched, and two independent reviewers examined the articles. The search terms related to "drug-resistant epilepsy" and "intraoperative ultrasound." The results between January 2008 and April 2022 were abridged for FCD type, ultrasound resolution, extent of lesion resection, correction of brain shift, postoperative neurological deficits, and postoperative seizure freedom (Engel classification). Results Ten articles were included in the study. The parameters used to assess the efficacy of IOUS in FCD surgery were ultrasound resolution, demarcation of lesion boundaries, correction of brain shift, postoperative neurological deficits, and seizure freedom. Most studies have shown that IOUS produces high-resolution images. Surgery for Type 2 FCD patients had better outcomes than surgery for Type 1 FCD patients due to better visualization by IOUS. Patients were classified as Engel class 1 or class 2 postoperatively. Eight studies found that IOUS was superior to magnetic resonance imaging in brain shift correction. Conclusion The preliminary results look promising, especially for the international league against epilepsy class 2 FCD. However, there is a need for more high-quality research evaluating the use of IOUS in FCD and comparing it to other intraoperative imaging modalities.
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Affiliation(s)
| | - Maria C. Whelan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zahra Khalaf
- Department of Postgraduate Surgical Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
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2
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Khair AM, McIlvain G, McGarry MDJ, Kandula V, Yue X, Kaur G, Averill LW, Choudhary AK, Johnson CL, Nikam RM. Clinical application of magnetic resonance elastography in pediatric neurological disorders. Pediatr Radiol 2023; 53:2712-2722. [PMID: 37794174 PMCID: PMC11086054 DOI: 10.1007/s00247-023-05779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Magnetic resonance elastography is a relatively new, rapidly evolving quantitative magnetic resonance imaging technique which can be used for mapping the viscoelastic mechanical properties of soft tissues. MR elastography measurements are akin to manual palpation but with the advantages of both being quantitative and being useful for regions which are not available for palpation, such as the human brain. MR elastography is noninvasive, well tolerated, and complements standard radiological and histopathological studies by providing in vivo measurements that reflect tissue microstructural integrity. While brain MR elastography studies in adults are becoming frequent, published studies on the utility of MR elastography in children are sparse. In this review, we have summarized the major scientific principles and recent clinical applications of brain MR elastography in diagnostic neuroscience and discuss avenues for impact in assessing the pediatric brain.
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Affiliation(s)
| | - Grace McIlvain
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | | | - Vinay Kandula
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
| | - Xuyi Yue
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Gurcharanjeet Kaur
- Department of Neurology, New York-Presbyterian / Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren W Averill
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA
| | - Arabinda K Choudhary
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
- Department of Biomedical Research, Nemours Children's Hospital, Wilmington, DE, USA
| | - Rahul M Nikam
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE, USA.
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3
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Bin-Alamer O, Abou-Al-Shaar H, Gersey ZC, Huq S, Kallos JA, McCarthy DJ, Head JR, Andrews E, Zhang X, Hadjipanayis CG. Intraoperative Imaging and Optical Visualization Techniques for Brain Tumor Resection: A Narrative Review. Cancers (Basel) 2023; 15:4890. [PMID: 37835584 PMCID: PMC10571802 DOI: 10.3390/cancers15194890] [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: 08/29/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Advancements in intraoperative visualization and imaging techniques are increasingly central to the success and safety of brain tumor surgery, leading to transformative improvements in patient outcomes. This comprehensive review intricately describes the evolution of conventional and emerging technologies for intraoperative imaging, encompassing the surgical microscope, exoscope, Raman spectroscopy, confocal microscopy, fluorescence-guided surgery, intraoperative ultrasound, magnetic resonance imaging, and computed tomography. We detail how each of these imaging modalities contributes uniquely to the precision, safety, and efficacy of neurosurgical procedures. Despite their substantial benefits, these technologies share common challenges, including difficulties in image interpretation and steep learning curves. Looking forward, innovations in this field are poised to incorporate artificial intelligence, integrated multimodal imaging approaches, and augmented and virtual reality technologies. This rapidly evolving landscape represents fertile ground for future research and technological development, aiming to further elevate surgical precision, safety, and, most critically, patient outcomes in the management of brain tumors.
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Affiliation(s)
- Othman Bin-Alamer
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Hussam Abou-Al-Shaar
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Zachary C. Gersey
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Sakibul Huq
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Justiss A. Kallos
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - David J. McCarthy
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Jeffery R. Head
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Edward Andrews
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Xiaoran Zhang
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Constantinos G. Hadjipanayis
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (O.B.-A.); (H.A.-A.-S.); (Z.C.G.); (S.H.); (J.A.K.); (D.J.M.); (J.R.H.); (E.A.); (X.Z.)
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Walter U. Novel ultrasonic imaging of the brain and its vasculature: the long way to clinical guideline recommendation. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:460-466. [PMID: 37832533 DOI: 10.1055/a-2143-7233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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5
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Ko TS, Catennacio E, Shin SS, Stern J, Massey SL, Kilbaugh TJ, Hwang M. Advanced Neuromonitoring Modalities on the Horizon: Detection and Management of Acute Brain Injury in Children. Neurocrit Care 2023; 38:791-811. [PMID: 36949362 PMCID: PMC10241718 DOI: 10.1007/s12028-023-01690-9] [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: 06/02/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
Timely detection and monitoring of acute brain injury in children is essential to mitigate causes of injury and prevent secondary insults. Increasing survival in critically ill children has emphasized the importance of neuroprotective management strategies for long-term quality of life. In emergent and critical care settings, traditional neuroimaging modalities, such as computed tomography and magnetic resonance imaging (MRI), remain frontline diagnostic techniques to detect acute brain injury. Although detection of structural and anatomical abnormalities remains crucial, advanced MRI sequences assessing functional alterations in cerebral physiology provide unique diagnostic utility. Head ultrasound has emerged as a portable neuroimaging modality for point-of-care diagnosis via assessments of anatomical and perfusion abnormalities. Application of electroencephalography and near-infrared spectroscopy provides the opportunity for real-time detection and goal-directed management of neurological abnormalities at the bedside. In this review, we describe recent technological advancements in these neurodiagnostic modalities and elaborate on their current and potential utility in the detection and management of acute brain injury.
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Affiliation(s)
- Tiffany S Ko
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Eva Catennacio
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Samuel S Shin
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Stern
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | - Shavonne L Massey
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
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6
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Albakr A, Ben-Israel D, Yang R, Kruger A, Alhothali W, Al Towim A, Lama S, Ajlan A, Riva-Cambrin J, Prada F, Al-Habib A, Sutherland GR. Ultrasound Elastography in Neurosurgery: Current Applications and Future Perspectives. World Neurosurg 2023; 170:195-205.e1. [PMID: 36336268 DOI: 10.1016/j.wneu.2022.10.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Similar to clinical palpation, Ultrasound elastography (USE) helps distinguish between tissues by providing information on their elasticity. While it has been widely explored and has been applied to many body organs, USE has not been studied as extensively for application in neurosurgery. The current systematic review was performed to identify articles related to the use of interoperative USE in neurosurgery. METHODS Search included MEDLINE(R) database. Only original peer-reviewed full-text articles were included. No language or publication year restrictions were imposed. Two independent reviewers assessed the search results for relevance. The identified articles were screened by title, abstract, and full-text review. RESULTS Seventeen articles were included in the qualitative analysis and 13 articles were related to oncology, epilepsy (n = 3), and spine (n = 1). In oncology, USE was found useful in defining tumor stiffness, aiding surgical planning, detecting residual tumors, discriminating between tumor and brain tissue, and differentiating between different tumors. In epilepsy, USE could improve the detection of epileptogenic foci, thereby enhancing the prospect of complete and safe resection. The application in spinal surgery was limited to demonstrating that a compressed spinal cord is stiffer than the decompressed one. CONCLUSIONS USE was found to be a safe, quick, portable, and economic tool that was a useful intraoperative adjunct to provide information corresponding to a variety of neurosurgical diseases, at different stages of surgery. This review describes the current intraoperative neurosurgical applications of USE, the concept of elasticity, and different USE modalities as well as the technical challenges, limitations, and possible future implications.
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Affiliation(s)
- Abdulrahman Albakr
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - David Ben-Israel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Runze Yang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander Kruger
- Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wajda Alhothali
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Al Towim
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Sanju Lama
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Focused Ultrasound Foundation, Charlottesville, Virginia, USA
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Garnette R Sutherland
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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7
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Hersh AM, Weber-Levine C, Jiang K, Young L, Kerensky M, Routkevitch D, Tsehay Y, Perdomo-Pantoja A, Judy BF, Lubelski D, Theodore N, Manbachi A. Applications of elastography in operative neurosurgery: A systematic review. J Clin Neurosci 2022; 104:18-28. [PMID: 35933785 PMCID: PMC11023619 DOI: 10.1016/j.jocn.2022.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Elastography is an imaging technology capable of measuring tissue stiffness and consistency. The technology has achieved widespread use in the workup and management of diseases of the liver, breast, thyroid, and prostate. Although elastography is increasingly being applied in neurosurgery, it has not yet achieved widespread adoption and many clinicians remain unfamiliar with the technology. Therefore, we sought to summarize the range of applications and elastography modalities available for neurosurgery, report its effectiveness in comparison with conventional imaging methods, and offer recommendations. All full-text English-language manuscripts on the use of elastography for neurosurgical procedures were screened using the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases. Thirty-two studies were included with 990 patients, including 21 studies on intracranial tumors, 5 on hydrocephalus, 4 on epilepsy, 1 on spinal cord compression, and 1 on adolescent scoliosis. Twenty studies used ultrasound elastography (USE) whereas 12 used magnetic resonance elastography (MRE). MRE studies were mostly used in the preoperative setting for assessment of lesion stiffness, tumor-brain adherence, diagnostic workup, and operative planning. USE studies were performed intraoperatively to guide resection of lesions, determine residual microscopic abnormalities, assess the tumor-brain interface, and study mechanical properties of tumors. Elastography can assist with resection of brain tissue, detection of microscopic lesions, and workup of hydrocephalus, among other applications under investigation. Its sensitivity often exceeds that of conventional MRI and ultrasound for identifying abnormal tissue and lesion margins.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lisa Young
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Max Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Denis Routkevitch
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yohannes Tsehay
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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8
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Chan DTM, Zheng L, Minxin Y, Philip CWY, Chi-Ping Ng S, Poon WS. Measurement of aspiration pressure in cannula brain tumour biopsy and its correlation with ultrasonographic elastography. J Clin Neurosci 2022; 103:9-13. [PMID: 35792415 DOI: 10.1016/j.jocn.2022.06.014] [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: 04/21/2022] [Revised: 06/05/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stereotactic brain biopsy is to perform the manual aspiration tissue biopsy using a cannula on a syringe under stereotactic guidance to provide histological confirmation. Excessive vacuum aspiration increases the risk of haemorrhage. Manual aspiration relies on the surgeon's experience while the minimum vacuum pressure is unknown. OBJECTIVES 1. To assess the aspiration vacuum pressure range in cannula brain tumour biopsy; 2. To understand the correlation of ultrasound elastography data with the aspiration pressure. METHODS This prospective study has recruited 10 patients for stereotactic brain tumour biopsy. With the use of ultrasound elastography, strain ratio of the lesion was assessed in real time before biopsy. Vacuum aspiration pressures were recorded using a T-connector pressure sensor during the stereotactic biopsy. RESULTS A total of 11 biopsies were taken from 10 patients, including a bilateral biopsy for a patient with bifrontal lesions. The diagnostic yield was 100% in all the 10 patients with no symptomatic haemorrhage (but 2 subclinical haemorrhages in CT scan) nor infection. The vacuum pressures ranged from 40.34 to 65.61 kPa and the strain-ratio ranged from 0.405 to 2.74. Strain ratio of the lesion at the lower range required a lower range of aspiration pressure, whereas lesions of Strain ratio over 0.45 required a higher range of aspiration pressure. CONCLUSION A vacuum pressure of 40 to 66 kPas is safe and adequate for biopsy of various types of tumours with heterogenous elastographic characters. Ultrasonographic elastography may be a real-time guide for the minimum vacuum pressure required for biopsy.
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Affiliation(s)
- Danny Tat Ming Chan
- CUHK Otto Wong Brain Tumour Centre, Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Li Zheng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Ye Minxin
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong.
| | - Chiu Wai Yan Philip
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong; Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Stephanie Chi-Ping Ng
- CUHK Otto Wong Brain Tumour Centre, Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Wai Sang Poon
- CUHK Otto Wong Brain Tumour Centre, Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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9
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Dixon L, Lim A, Grech-Sollars M, Nandi D, Camp S. Intraoperative ultrasound in brain tumor surgery: A review and implementation guide. Neurosurg Rev 2022; 45:2503-2515. [PMID: 35353266 PMCID: PMC9349149 DOI: 10.1007/s10143-022-01778-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/07/2022]
Abstract
Accurate and reliable intraoperative neuronavigation is crucial for achieving maximal safe resection of brain tumors. Intraoperative MRI (iMRI) has received significant attention as the next step in improving navigation. However, the immense cost and logistical challenge of iMRI precludes implementation in most centers worldwide. In comparison, intraoperative ultrasound (ioUS) is an affordable tool, easily incorporated into existing theatre infrastructure, and operative workflow. Historically, ultrasound has been perceived as difficult to learn and standardize, with poor, artifact-prone image quality. However, ioUS has dramatically evolved over the last decade, with vast improvements in image quality and well-integrated navigation tools. Advanced techniques, such as contrast-enhanced ultrasound (CEUS), have also matured and moved from the research field into actual clinical use. In this review, we provide a comprehensive and pragmatic guide to ioUS. A suggested protocol to facilitate learning ioUS and improve standardization is provided, and an outline of common artifacts and methods to minimize them given. The review also includes an update of advanced techniques and how they can be incorporated into clinical practice.
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10
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Freeman CW, Hwang M. Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:170. [PMID: 35204891 PMCID: PMC8870205 DOI: 10.3390/children9020170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and changes in tissue stiffness in the brain. These techniques, which include contrast-enhanced ultrasound, microvascular imaging, and elastography, are providing new insights into and new methods of evaluating pathologies affecting children requiring critical care, including hypoxic-ischemic encephalopathy, stroke, and hydrocephalus. This review introduces advanced neurosonography techniques and their clinical applications in pediatric neurocritical care.
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Affiliation(s)
- Colbey W. Freeman
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
| | - Misun Hwang
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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11
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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12
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Al-Habib A, Alhothali W, Albakr A, Elwatidy S, Alawaji G, Alabdulsalam H, Albadr F, Alkubeyyer M, Abu Jamea A, Awwad W, Ullah A, Fakhouri F, Ajlan A. Effects of compressive lesions on intraoperative human spinal cord elasticity. J Neurosurg Spine 2021; 35:807-816. [PMID: 34416718 DOI: 10.3171/2021.1.spine201482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although evaluating tissue elasticity has various clinical applications, spinal cord elasticity (SCE) in humans has never been well documented. In this study, the authors aimed to evaluate the impact of compression on human SCE in vivo. METHODS The authors prospectively assessed SCE using intraoperative shear wave elastography (SWE). All consecutive patients undergoing spinal cord (SC) decompression (laminectomy or corpectomy) between June 2018 and June 2019 were included. After intraoperative exposure of the patient's dura mater, at least three SWE measurements of the SC and its coverings were performed. Intraoperative neurological monitoring in the form of motor and somatosensory evoked potentials was utilized. Cases were divided into two groups based on the state of SC compression following bone removal (laminectomy or corpectomy): patients with adequate decompression (the decompressed SC group [DCG]) following bone removal and patients with remining compression, e.g., compressing tumor or instability (the compressed SC group [COG]). RESULTS A total of 25 patients were included (8 females and 17 males) with a mean age of 48.28 ± 21.47 years. Most cases were degenerative diseases (10 cases) followed by tumors (6 cases), and the compression was observed at cervical (n = 14), thoracic (n = 9), and conus medullaris (n = 2) levels. The COG (6 cases) expressed significantly higher elasticity values, i.e., greater stiffness (median 93.84, IQR 75.27-121.75 kPa) than the decompressed SC in DCG (median 9.35, IQR 6.95-11.22 kPa, p < 0.001). Similarly, the compressed dura mater in the COG was significantly stiffer (mean ± SD 121.83 ± 70.63 kPa) than that in the DCG (29.78 ± 18.31 kPa, p = 0.042). Following SC decompression in COG, SCE values were significantly reduced (p = 0.006; adjusted for multiple comparisons). Intraoperative monitoring demonstrated no worsening from the baseline. CONCLUSIONS The current study is to the authors' knowledge the first to quantitatively demonstrate increased stiffness (i.e., elasticity value) of the human SC and dura mater in response to external compression in vivo. It appears that SCE is a dynamic phenomenon and is reduced following decompression. Moreover, the evaluation of human SCE using the SWE technique is feasible and safe. Information from future studies aiming to further define SCE could be valuable in the early and accurate diagnosis of the compressed SC.
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Affiliation(s)
- Amro Al-Habib
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | - Wajda Alhothali
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | - Sherif Elwatidy
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | - Ghaida Alawaji
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | - Fahad Albadr
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | | | | | - Anhar Ullah
- 4Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine; and
| | - Faisal Fakhouri
- 5Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
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Garcés Iñigo E, Llorens Salvador R, Escrig R, Hervás D, Vento M, Martí-Bonmatí L. Quantitative Evaluation of Neonatal Brain Elasticity Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:795-804. [PMID: 32876366 DOI: 10.1002/jum.15464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To demonstrate the feasibility of 2-dimensional brain ultrasound shear wave elastography (SWE) and to define the average elasticity values of the gray and white matter in term neonates. METHODS This work was a prospective observational single-center study including 55 healthy term neonates consecutively recruited in the maternity ward between the second and third postnatal days. All were successfully evaluated with a cerebral SWE examination performed with a multifrequency 4-9-MHz transducer. Bilateral sagittal planes of the thalamus and corona radiata were used to measure stiffness using a quantitative SWE method. Several elastograms with 5 to 15 nonoverlapping areas were obtained from the 2 different anatomic locations. The 5 most central measurements were averaged as representative values. RESULTS The 55 neonates ranged from 37 to 40 weeks' gestation. The estimated mean velocity values of the thalamus (1.17 m/s; 95% confidence interval, 1.13, 1.22 m/s) and corona radiata (1.60 m/s; 95% confidence interval, 1.57, 1.64 m/s) were statistically different (P < .001). There was no significant influence of laterality, gestational age, cephalic perimeter, sex, length, or type of delivery on the stiffness measurements. CONCLUSIONS Brain ultrasound SWE is feasible and allows measurements of neonatal brain elasticity. The elasticity of the thalamus and corona radiata at the frontal white matter in healthy term neonates is different. The knowledge of normal SWE ranges in term neonates allows comparative studies under pathologic conditions.
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Affiliation(s)
| | | | - Raquel Escrig
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Hervás
- Data Science, Biostatistics, and Bioinformatics Platform, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Máximo Vento
- Department of Pediatrics, Neonatal Research Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Mathon B, Clemenceau S, Carpentier A. Intraoperative Ultrasound Shear-Wave Elastography in Focal Cortical Dysplasia Surgery. J Clin Med 2021; 10:jcm10051049. [PMID: 33802551 PMCID: PMC7961510 DOI: 10.3390/jcm10051049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/31/2022] Open
Abstract
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound SWE techniques for the intraoperative detection of FCDs. We retrospectively analyzed data from 18 adult patients with drug-resistant epilepsy associated with FCD who had undergone SWE-guided surgery. Conventional B-mode images detected FCD in 2 patients (11.1%), while SWE detected FCD in 14 patients (77.8%). The stiffness ratios between MRI-positive and -negative cases were significantly different (3.6 ± 0.4 vs. 2.2 ± 0.6, respectively; p < 0.001). FCDs were significantly more frequently detected by interoperative SWE in women (OR 4.7, 95% CI (1.7–12.7); p = 0.004) and in patients in whom FCD was visible on magnetic resonance imaging (MRI; OR 2.3, 95% CI (1.3–4.3); p = 0.04). At 1 year after surgery and at last follow-up (mean = 21 months), seizure outcome was good (International League Against Epilepsy (ILAE) Class 1 or 2) in 72.2% and 55.6% of patients, respectively. Despite some limitations, our study highlighted the potential of SWE as an intraoperative tool to detect FCD. Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete FCD resection. Interobserver reliability of SWE measurements should also be assessed by further studies.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
- Correspondence: ; Tel.: +33-1-4216-3408
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
| | - Alexandre Carpentier
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (S.C.); (A.C.)
- Faculty of Medicine, Sorbonne University, 75005 Paris, France
- Paris Brain Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), 75013 Paris, France
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15
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Chan HW, Uff C, Chakraborty A, Dorward N, Bamber JC. Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection. Front Oncol 2021; 11:619286. [PMID: 33732645 PMCID: PMC7956956 DOI: 10.3389/fonc.2021.619286] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background The clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported. Aims To determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”. Methods Thirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan. Results The YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p < 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p < 0.001, respectively). Conclusions SWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.
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Affiliation(s)
- Huan Wee Chan
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom.,Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Christopher Uff
- Neurosurgery Department, Royal London Hospital, London, United Kingdom
| | - Aabir Chakraborty
- Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Neil Dorward
- Neurosurgery Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey Colin Bamber
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom
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16
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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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17
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Shear wave elastography for intracranial epidermoid tumors. Clin Neurol Neurosurg 2021; 207:106531. [PMID: 34182236 DOI: 10.1016/j.clineuro.2021.106531] [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: 10/17/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ultrasound elastography (USE) is a novel technique that assesses the mechanical properties of body tissues in real time. Based on elasticity measurements, USE enables the differentiation of tumor tissue from surrounding normal tissue. OBJECTIVES We aimed to evaluate an intraoperative SWE technique for differentiating tumor tissue (epidermoid cyst) from the surrounding normal brain tissue based on elastic properties. METHODS We prospectively report the intraoperative elasticity assessments of four patients diagnosed with epidermoid cysts. Along with standard ultrasonography, intraoperative shear wave elastography (SWE) was used to identify tumor tissue and assess the elasticity of each tumor and the surrounding normal brain. RESULTS USE enabled the differentiation between epidermoid cysts and the surrounding normal brain tissue in real time intraoperatively; visual data (SWE elasticity map) and quantitative data (elasticity measurements in kilopascals) were utilized to identify the epidermoid cyst based on its elastic properties. The area representing the epidermoid cyst had an increased elasticity on SWE view and high mean elasticity values (193.7 ± 70.9 kPa in case 1, 168 ± 24.5 kPa in case 2, 205.1 ± 6.7 kPa in case 3, and 101.3 ± 12.6 kPa in case 4). The area representing the adjacent normal brain tissue on SWE view had lower mean elasticity values (14.9 ± 1.9 kPa in case 1, 22.6 ± 8.3 kPa in case 2, and 23.8 ± 1.4 kPa in case 4). CONCLUSION This study demonstrates the feasibility and promising value of SWE as an intraoperative tool during epidermoid cyst resection. Epidermoid tissue remnants that are hidden from the microscopic view can be detected using SWE.
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18
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Prada F, Del Bene M, Rampini A, Mattei L, Casali C, Vetrano IG, Gennari AG, Sdao S, Saini M, Sconfienza LM, DiMeco F. Intraoperative Strain Elastosonography in Brain Tumor Surgery. Oper Neurosurg (Hagerstown) 2020; 17:227-236. [PMID: 30496587 DOI: 10.1093/ons/opy323] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited. OBJECTIVE To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization. METHODS We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization. RESULTS (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90% of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64% of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76% of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89%. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7% sensitivity and 94.7% specificity in differentiating LGG from HGG. CONCLUSION SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.
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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 Health Science Center, Charlottesville, Virginia
| | - 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
| | - Angela Rampini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Silvana Sdao
- IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, USA.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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19
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Prada F, Gennari AG, Quaia E, D'Incerti L, de Curtis M, DiMeco F, Tringali G. Advanced intraoperative ultrasound (ioUS) techniques in focal cortical dysplasia (FCD) surgery: A preliminary experience on a case series. Clin Neurol Neurosurg 2020; 198:106188. [PMID: 32956988 DOI: 10.1016/j.clineuro.2020.106188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Focal Cortical Dysplasia (FCD) represents a broad spectrum of histopathological entities that cause drug-resistant epilepsy. Surgery has been shown to be the treatment of choice, but incomplete resection represents the leading cause of seizure persistence. Preliminary experiences with intraoperative ultrasound (ioUS) have proven its potential in defining and characterizing the lesion. In this study we analyzed the feasibility of advanced ultrasound techniques such as sono-elastography (SE) and contrast enhancement ultrasound (CEUS) in a small cohort of patients with FCD. MATERIAL AND METHODS We retrospectively reviewed all clinical records and images of patients with drug resistant epilepsy who underwent at least one advanced sonographic technique (SE and/or CEUS) during ioUS guided surgery between November 2014 and October 2017. We excluded from our analysis all patients with lesions other than FCD or those who had FCD associated with other pathological entities. RESULTS Four patients with type IIb FCD in the right frontal lobe were evaluated. All of them underwent SE, which highlighted heterogeneous stiffness in the dysplastic foci, also multiple areas of higher consistency were detected in all patients. Three patients evaluated with CEUS had visible enhancement in the FCD. Neither SE nor CEUS were better than ioUS in the identification of lesion boundaries. In the three patients who underwent both SE and CEUS we found no correspondence between stiffer areas and enhancement in the dysplastic areas. CONCLUSION Ourpreliminary report confirms the feasibility of SE and CEUS in FCD surgery and describes the imaging findings in this category of patients. Studies on larger cohorts of patients are warranted to better clarify the role of these advanced intraoperative ultrasound techniques in patients with FCD.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Neurological Surgery, University of Virginia Virginia Health Science Center, Charlottesville, Virginia, USA.
| | - Antonio Giulio Gennari
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padova, Via Giustiniani, Padova, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Marco de Curtis
- Department of Neurology, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
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20
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Huesmann GR, Schwarb H, Smith DR, Pohlig RT, Anderson AT, McGarry MDJ, Paulsen KD, Wszalek TM, Sutton BP, Johnson CL. Hippocampal stiffness in mesial temporal lobe epilepsy measured with MR elastography: Preliminary comparison with healthy participants. NEUROIMAGE-CLINICAL 2020; 27:102313. [PMID: 32585569 PMCID: PMC7322100 DOI: 10.1016/j.nicl.2020.102313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023]
Abstract
Hippocampal stiffness in MTLE is measured with magnetic resonance elastography. The epileptogenic hippocampus is stiffer than non-epileptogenic hippocampus in MTLE. Hippocampal stiffness ratio is higher in MTLE patients than in healthy participants. Stiffness ratio provides additional diagnostic information to hippocampal volume.
Mesial temporal lobe epilepsy (MTLE) is the most common form of refractory epilepsy. Common imaging biomarkers are often not sensitive enough to identify MTLE sufficiently early to facilitate the greatest benefit from surgical or pharmacological intervention. The objective of this work is to establish hippocampal stiffness measured with magnetic resonance elastography (MRE) as a biomarker for MTLE; we hypothesized that the epileptogenic hippocampus in MTLE is stiffer than the non-epileptogenic hippocampus. MRE was used to measure hippocampal stiffness in a group of patients with unilateral MTLE (n = 12) and a group of healthy comparison participants (n = 13). We calculated the ratio of hippocampal stiffness ipsilateral to epileptogenesis to the contralateral side for both groups. We found a higher hippocampal stiffness ratio in patients with MTLE compared with healthy participants (1.14 v. 0.99; p = 0.004), and that stiffness ratio differentiated MTLE from control groups effectively (AUC = 0.85). Hippocampal stiffness ratio, when added to volume ratio, an established MTLE biomarker, significantly improved the ability to differentiate the two groups (p = 0.038). Stiffness measured with MRE is sensitive to hippocampal pathology in MTLE and the addition of MRE to neuroimaging assessments may improve detection and characterization of the disease.
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Affiliation(s)
- Graham R Huesmann
- Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States.
| | - Hillary Schwarb
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Interdisciplinary Health Sciences Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States.
| | - Daniel R Smith
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Ryan T Pohlig
- College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Aaron T Anderson
- Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | | | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Tracey Mencio Wszalek
- Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Bradley P Sutton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States.
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Abstract
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
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Mathon B, Amelot A, Carpentier A, Clemenceau S. Intraoperative real-time guidance using ShearWave Elastography for epilepsy surgery. Seizure 2019; 71:24-27. [PMID: 31176990 DOI: 10.1016/j.seizure.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/19/2019] [Accepted: 06/02/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In epilepsy surgery, seizure outcome is determined by the integrity of epileptogenic zone resection. ShearWave elastography (SWE) is a noninvasive imaging technique that generates a quantitative assessment of elasticity values permitting intraoperative real time tissue mapping by differentiating normal and pathological epileptogenic tissue. The aim of this study was to evaluate the contribution of SWE intraoperative guidance on the advancement of epileptogenic zone detection in epilepsy surgery. METHODS We prospectively analyzed epileptogenic zone resections using SWE guidance for 28 patients with severe and/or disabling drug-resistant focal epilepsy. RESULTS Conventional B-mode images visualized echogenicity differences between the epileptogenic lesion and normal brain tissue in 71.4% of cases, while SWE detected a significant difference in stiffness in 92.8% of cases (p = 0.02). Regarding cryptogenic epilepsy, none of the 4 MRI-negative focal cortical dysplasias was visualized by B-mode images, while 3 cases were detected by SWE. Postoperative brain MRI showed a complete resection of the epileptogenic zone in all MRI-positive cases. One year after the surgery, 85.7% of the patients were seizure free (ILAE class 1). CONCLUSION Despite some technical limitations, SWE improves the intraoperative detection of epileptogenic lesions and should be considered for all patients with cryptogenic and lesional epilepsy. Naturally this ought to be confirmed by larger case series additionally investigating long-term seizure outcome.
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Affiliation(s)
- Bertrand Mathon
- AP-HP, GHU La Pitié-Salpêtrière - Charles Foix, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, UPMC Univ., Paris 06, F-75005, Paris, France; Brain and Spine Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), Paris, France.
| | - Aymeric Amelot
- AP-HP, GHU La Pitié-Salpêtrière - Charles Foix, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, UPMC Univ., Paris 06, F-75005, Paris, France
| | - Alexandre Carpentier
- AP-HP, GHU La Pitié-Salpêtrière - Charles Foix, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, UPMC Univ., Paris 06, F-75005, Paris, France; Brain and Spine Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), Paris, France
| | - Stéphane Clemenceau
- AP-HP, GHU La Pitié-Salpêtrière - Charles Foix, Department of Neurosurgery, F-75013, Paris, France
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Prada F, Gennari AG, Del Bene M, Bono BC, Quaia E, D'Incerti L, Villani F, Didato G, Tringali G, DiMeco F. Intraoperative ultrasonography (ioUS) characteristics of focal cortical dysplasia (FCD) type II b. Seizure 2019; 69:80-86. [PMID: 30999253 DOI: 10.1016/j.seizure.2019.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Focal cortical dysplasia (FCD) is one of the major causes of drug-resistant epilepsy. Surgery has proved to be the treatment of choice, however up to a third of patients experience only partial resection. Ill-defined borders and lesions embedded in eloquent areas are two of the main drawbacks of FCD surgery. Preliminary experiences with intraoperative ultrasound (ioUS) have proved its feasibility and potential. We analyzed FCD' ioUS findings in our patients with FCD and compared them with magnetic resonance (MRI) ones. METHODS We retrospectively reviewed all records of patients with focal medically refractory epilepsy who underwent ioUS guided surgery between November 2014 and October 2017. Lesions other than FCD or FCD associated with other pathological entities were not considered. Patients' preoperative MRI and ioUS features were analyzed according to up-to-date literature and than compared. RESULTS A homogeneous population of five patients with type IIb FCD was evaluated. Focal cortical thickening and cortical ribbon hyper-intensity, blurring of the grey-white matter junction and hyper-intensity of the subcortical white matter on T2-weighted/FLAIR images were present in all patients. Cortical features had a complete concordance between ioUS and MRI. In particular ioUS thickening and hyper-echogenicity of cortical ribbon were identified in all cases (100%). Contrary, hyper-echoic subcortical white matter was detected in 60% of the patients. IoUS images resulted in clearer lesion borders than MRI images. CONCLUSION Our study confirms the potentials of ioUS as a valuable diagnostic tool to guide FCD surgeries.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, University of Virginia Virginia Health Science Center, Charlottesville, VA, USA.
| | - Antonio Giulio Gennari
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Beatrice Claudia Bono
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Medicine and Surgery, University of Milan, Via Festa del Perdono, Milan, Italy
| | - Emilio Quaia
- Department of Radiology, University of Padova, Via Giustiniani, Padova, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Flavio Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Giuseppe Didato
- Division of Clinical Epileptology and Experimental Neurophysiology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Giovanni Tringali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA
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Fovargue D, Nordsletten D, Sinkus R. Stiffness reconstruction methods for MR elastography. NMR IN BIOMEDICINE 2018; 31:e3935. [PMID: 29774974 PMCID: PMC6175248 DOI: 10.1002/nbm.3935] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 05/19/2023]
Abstract
Assessment of tissue stiffness is desirable for clinicians and researchers, as it is well established that pathophysiological mechanisms often alter the structural properties of tissue. Magnetic resonance elastography (MRE) provides an avenue for measuring tissue stiffness and has a long history of clinical application, including staging liver fibrosis and stratifying breast cancer malignancy. A vital component of MRE consists of the reconstruction algorithms used to derive stiffness from wave-motion images by solving inverse problems. A large range of reconstruction methods have been presented in the literature, with differing computational expense, required user input, underlying physical assumptions, and techniques for numerical evaluation. These differences, in turn, have led to varying accuracy, robustness, and ease of use. While most reconstruction techniques have been validated against in silico or in vitro phantoms, performance with real data is often more challenging, stressing the robustness and assumptions of these algorithms. This article reviews many current MRE reconstruction methods and discusses the aforementioned differences. The material assumptions underlying the methods are developed and various approaches for noise reduction, regularization, and numerical discretization are discussed. Reconstruction methods are categorized by inversion type, underlying assumptions, and their use in human and animal studies. Future directions, such as alternative material assumptions, are also discussed.
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Affiliation(s)
- Daniel Fovargue
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - David Nordsletten
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - Ralph Sinkus
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
- Inserm U1148, LVTSUniversity Paris Diderot, University Paris 13Paris75018France
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25
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Al-Habib A, Albakr A, Al Towim A, Alkubeyyer M, Abu Jamea A, Albadr F, Eldawlatly AA, Kashour T, Alkhalidi H, Alzahrani T. In vivo assessment of spinal cord elasticity using shear wave ultrasound in dogs. J Neurosurg Spine 2018; 29:461-469. [DOI: 10.3171/2018.2.spine171195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVEEvaluation of living tissue elasticity has wide applications in disease characterization and prognosis prediction. Few previous ex vivo attempts have been made to characterize spinal cord elasticity (SCE). Recently, tissue elasticity assessment has been clinically feasible using ultrasound shear wave elastography (SWE). The current study aims to characterize SCE in healthy dogs, in vivo, utilizing SWE, and to address SCE changes during compression.METHODSTen Greyhound dogs (mean age 14 months; mean weight 14.3 kg) were anesthetized and tracheally intubated, with hemodynamic and neurological monitoring. A 3-level, midcervical laminectomy was performed. SCE was assessed at baseline. Next, 8- and 13-mm balloon compressions were sequentially applied ventral to the spinal cord.RESULTSThe mean SCE was 18.5 ± 7 kPa. Elasticity of the central canal, pia mater, and dura mater were 21.7 ± 9.6 kPa, 26.1 ± 14.8 kPa, and 63.2 ± 11.5 kPa, respectively. As expected, the spinal cord demonstrated less elasticity than the dura mater (p < 0.0001) and pia mater (trend toward significance p = 0.08). Notably, the 13-mm balloon compression resulted in a stiffer spinal cord than at baseline (233 ± 73 kPa versus 18.5 ± 7 kPa, p < 0.0001) and 8-mm balloon compression (233 ± 73 kPa versus 185 ± 68 kPa, p < 0.048).CONCLUSIONSIn vivo SCE evaluation using SWE is feasible and comparable to earlier reports, as demonstrated by physical sectioning of the spinal cord. The compressed spinal cord is stiffer than a free spinal cord, with a linear increase in SCE with increasing mechanical compression. Knowledge of the biomechanical properties of the spinal cord including SCE has potential implications for disease management and prognosis.
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Affiliation(s)
- Amro Al-Habib
- 1Division of Neurosurgery, Department of Surgery, and
| | | | | | | | | | | | | | | | - Hisham Alkhalidi
- 5Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Nicolas E, Callé S, Nicolle S, Mitton D, Remenieras JP. Biomechanical characterization of ex vivo human brain using ultrasound shear wave spectroscopy. ULTRASONICS 2018; 84:119-125. [PMID: 29112910 DOI: 10.1016/j.ultras.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/04/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
The characterization of brain tissue is crucial to better understand neurological disorders. Mechanical characterization is an emerging tool in that field. The purpose of this work was to validate a transient ultrasound technique aimed at measuring dispersion of mechanical parameters of the brain tissue. The first part of this work was dedicated to the validation of that technique by comparing it with two proven rheology methods: a rotating plate rheometer, and a viscoelastic spectroscopy apparatus. Experiments were done on tissue mimicking gels. Results were compared on storage and loss modulus in the 20-100 Hz band. Our method was validated for the measurement of storage modulus dispersion, with some reserves on the measurement of loss modulus. The second part of this work was the measurement of the mechanical characteristics of ex vivo human white matter. We were able to measure the dispersion of the storage and loss modulus in the 20-100 Hz band, fitting the data with a custom power law model.
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Affiliation(s)
| | - Samuel Callé
- UMR Inserm U930, Université François-Rabelais, Tours, France
| | - Stéphane Nicolle
- Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR T9406, F69622 Lyon, France
| | - David Mitton
- Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR T9406, F69622 Lyon, France
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28
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Siedlecka M, Grajkowska W, Galus R, Dembowska-Bagińska B, Jóźwiak J. Focal cortical dysplasia: Molecular disturbances and clinicopathological classification (Review). Int J Mol Med 2016; 38:1327-1337. [DOI: 10.3892/ijmm.2016.2760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/23/2016] [Indexed: 11/05/2022] Open
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The use of ultrasound in intracranial tumor surgery. Acta Neurochir (Wien) 2016; 158:1179-85. [PMID: 27106844 DOI: 10.1007/s00701-016-2803-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/04/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND As an intraoperative imaging modality, ultrasound is a user-friendly and cost-effective real-time imaging technique. Despite this, it is still not routinely employed for brain tumor surgery. This may be due to the poor image quality in inexperienced hands, and the well-documented learning curve. However, with regular use, the operator issues are addressed, and intraoperative ultrasound can provide valuable real-time information. The aim of this review is to provide an understanding for neurosurgeons of the development and use of ultrasound in intracranial tumor surgery, and possible future advances. METHODS A systematic search of the electronic databases Embase, Medline OvidSP, PubMed, Cochrane, and Google Scholar regarding the use of ultrasound in intracranial tumor surgery was undertaken. RESULTS AND DISCUSSION Intraoperative ultrasound has been shown to be able to accurately account for brain shift and has potential for regular use in brain tumor surgery. Further developments in probe size, resolution, and image reconstruction techniques will ensure that intraoperative ultrasound is more accessible and attractive to the neuro-oncological surgeon. CONCLUSIONS This review has summarized the development of ultrasound and its uses with particular reference to brain tumor surgery, detailing the ongoing challenges in this area.
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Daldrup-Link HE, Sammet C, Hernanz-Schulman M, Barsness KA, Cahill AM, Chung E, Doria AS, Darge K, Krishnamurthy R, Lungren MP, Moore S, Olivieri L, Panigrahy A, Towbin AJ, Trout A, Voss S. White Paper on P4 Concepts for Pediatric Imaging. J Am Coll Radiol 2016; 13:590-597.e2. [PMID: 26850380 PMCID: PMC4860067 DOI: 10.1016/j.jacr.2015.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/21/2022]
Abstract
Over the past decade, innovations in the field of pediatric imaging have been based largely on single-center and retrospective studies, which provided limited advances for the benefit of pediatric patients. To identify opportunities for potential "quantum-leap" progress in the field of pediatric imaging, the ACR-Pediatric Imaging Research (PIR) Committee has identified high-impact research directions related to the P4 concept of predictive, preventive, personalized, and participatory diagnosis and intervention. Input from 237 members of the Society for Pediatric Radiology was clustered around 10 priority areas, which are discussed in this article. Needs within each priority area have been analyzed in detail by ACR-PIR experts on these topics. By facilitating work in these priority areas, we hope to revolutionize the care of children by shifting our efforts from unilateral reaction to clinical symptoms, to interactive maintenance of child health.
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Affiliation(s)
- Heike E Daldrup-Link
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California.
| | - Christina Sammet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Ellen Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew P Lungren
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Sheila Moore
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Andrew Trout
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Stephan Voss
- Children's Hospital of Boston, Boston, Massachusetts
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31
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Sacino MF, Ho CY, Murnick J, Keating RF, Gaillard WD, Oluigbo CO. The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients. Neurosurg Focus 2016; 40:E16. [DOI: 10.3171/2016.1.focus15538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions.
METHODS
The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale.
RESULTS
At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02).
CONCLUSIONS
These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.
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32
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Miller D, Sure U. Current Standards and Future Perspectives in Intraoperative Ultrasound. Neurooncol Pract 2015. [DOI: 10.1093/nop/npv047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bagić A. Look back to leap forward: The emerging new role of magnetoencephalography (MEG) in nonlesional epilepsy. Clin Neurophysiol 2015; 127:60-66. [PMID: 26055337 DOI: 10.1016/j.clinph.2015.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 05/02/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
This review considers accumulating evidence for a new role of MEG/MSI in increasing the diagnostic yield of supposedly negative MRIs, and suggests changes in the use of MEG/MSI in presurgical epilepsy evaluations. Specific alterations in practice protocols for both the MEG practitioner (i.e. physician magnetoencephalographer) and MEG user (i.e. referring physician) are proposed that should further enhance the overall value of MEG/MSI. Although advances in MEG analysis methods will likely become increasingly assisted by computers, interpretive competency and prudent clinical judgment remain irreplaceable.
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Affiliation(s)
- Anto Bagić
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), UPMC MEG Epilepsy Program, Department of Neurology, University of Pittsburgh Medical School, Suite 811, Kaufmann Medical Building, 3471 Fifth Ave, Pittsburgh, PA 15213, USA.
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Cheon JE. Intraoperative neurosonography revisited: effective neuronavigation in pediatric neurosurgery. Ultrasonography 2015; 34:79-87. [PMID: 25672771 PMCID: PMC4372713 DOI: 10.14366/usg.14054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 11/17/2022] Open
Abstract
Intraoperative ultrasonography (IOUS) is a widely used noninvasive method to evaluate the morphology, vasculature, and pathologies of the brain. The advantages of IOUS include realtime depiction of neuroanatomy, accurate localization and characterization of a lesion, reduced surgical exploration and surgical time, and presumably decreased patient morbidity. IOUS is useful in the intraoperative monitoring of lesion resection as well as intraoperative localization and characterization of focal parenchymal lesions. This review aims to provide an overview of the clinical application of IOUS in pediatric intracranial neurosurgery.
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Affiliation(s)
- Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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