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Chirizzi C, Pellegatta S, Gori A, Falco J, Rubiu E, Acerbi F, Bombelli FB. Next-generation agents for fluorescence-guided glioblastoma surgery. Bioeng Transl Med 2024; 9:e10608. [PMID: 38818124 PMCID: PMC11135154 DOI: 10.1002/btm2.10608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 06/01/2024] Open
Abstract
Glioblastoma is a fast-growing and aggressive form of brain cancer. Even with maximal treatment, patients show a low median survival and are often subjected to a high recurrence incidence. The currently available treatments require multimodal management, including maximal safe surgical resection, followed by radiation and chemotherapy. Because of the infiltrative glioblastoma nature, intraoperative differentiation of cancer tissue from normal brain parenchyma is very challenging, and this accounts for the low rate of complete tumor resection. For these reasons, clinicians have increasingly used various intraoperative adjuncts to improve surgical results, such as fluorescent agents. However, most of the existing fluorophores show several limitations such as poor selectivity, photostability, photosensitization and high costs. This could limit their application to successfully improve glioblastoma resection. In the present perspective, we highlight the possibility to develop next-generation fluorescent tools able to more selectively label cancer cells during surgical resection.
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Affiliation(s)
- Cristina Chirizzi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilanoItaly
| | - Serena Pellegatta
- Unit of Immunotherapy of Brain TumorsFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
- Unit of NeuroncologyFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Alessandro Gori
- National Research Council of Italy, Istituto di Scienze e Tecnologie Chimiche (SCITEC‐CNR)MilanItaly
| | - Jacopo Falco
- Neurosurgical Unit 2, Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Emanuele Rubiu
- Neurosurgical Unit 2, Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
| | - Francesco Acerbi
- Neurosurgical Unit 2, Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
- Experimental Microsurgical Laboratory, Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanoItaly
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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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Hou Y, Li Y, Li Q, Yu Y, Tang J. Full-course resection control strategy in glioma surgery using both intraoperative ultrasound and intraoperative MRI. Front Oncol 2022; 12:955807. [PMID: 36091111 PMCID: PMC9453394 DOI: 10.3389/fonc.2022.955807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntraoperative ultrasound(iUS) and intraoperative MRI (iMRI) are effective ways to perform resection control during glioma surgery. However, most published studies employed only one modality. Few studies have used both during surgery. How to combine these two techniques reasonably, and what advantages they could have for glioma surgery are still open questions.MethodsWe retrospectively reviewed a series of consecutive patients who underwent initial surgical treatment of supratentorial gliomas in our center. We utilized a full-course resection control strategy to combine iUS and iMRI: IUS for pre-resection assessment and intermediate resection control; iMRI for final resection control. The basic patient characteristics, surgical results, iMRI/iUS findings, and their impacts on surgical procedures were evaluated and reported.ResultsA total of 40 patients were included. The extent of resection was 95.43 ± 10.37%, and the gross total resection rate was 72.5%. The median residual tumor size was 6.39 cm3 (range 1.06–16.23 cm3). 5% (2/40) of patients had permanent neurological deficits after surgery. 17.5% (7/40) of patients received further resection after the first iMRI scan, resulting in four (10%) more patients achieving gross total resection. The number of iMRI scans per patient was 1.18 ± 0.38. The surgical time was 4.5 ± 3.6 hours. The pre-resection iUS scan revealed that an average of 3.8 borders of the tumor were beside sulci in 75% (30/40) patients. Intermediate resection control was utilized in 67.5% (27/40) of patients. In 37.5% (15/40) of patients, the surgical procedures were changed intraoperatively based on the iUS findings. Compared with iMRI, the sensitivity and specificity of iUS for residual tumors were 46% and 96%, respectively.ConclusionThe full-course resection control strategy by combining iUS and iMRI could be successfully implemented with good surgical results in initial glioma surgeries. This strategy might stabilize resection control quality and provide the surgeon with more intraoperative information to tailor the surgical strategy. Compared with iMRI-assisted glioma surgery, this strategy might improve efficiency by reducing the number of iMRI scans and shortening surgery time.
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Affiliation(s)
- Yuanzheng Hou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiongge Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Yu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jie Tang,
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Hou Y, Tang J. Advantages of Using 3D Intraoperative Ultrasound and Intraoperative MRI in Glioma Surgery. Front Oncol 2022; 12:925371. [PMID: 35719958 PMCID: PMC9203997 DOI: 10.3389/fonc.2022.925371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuanzheng Hou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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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 2021:1-10. [PMID: 34927516 DOI: 10.1080/02688697.2021.2016619] [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: 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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de Quintana-Schmidt C, Salgado-Lopez L, Aibar-Duran JA, Alvarez Holzapfel MJ, Cortes CA, Alvarado JDP, Rodriguez RR, Teixidó JM. Neuronavigated Ultrasound in Neuro-Oncology: A True Real-Time Intraoperative Image. World Neurosurg 2021; 157:e316-e326. [PMID: 34655818 DOI: 10.1016/j.wneu.2021.10.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ultrasound is considered a real-time imaging method in neuro-oncology because of its highly rapid image acquisition time. However, to our knowledge, there are no studies that analyze the additional surgical time that it requires. METHODS A prospective study of 100 patients who underwent intra-axial brain tumor resection with navigated intraoperative ultrasound. The primary outcomes were lesion visibility grade on ultrasound and concordance with preoperative magnetic resonance imaging (MRI) scan, intraoperative ultrasound usage time, and percentage of tumor resection on ultrasound and comparison with postoperative MRI scan. RESULTS The breakdown of patients included the following: 53 high-grade gliomas, 26 metastases, 14 low-grade gliomas, and 7 others. Ninety-six percent of lesions were clearly visualized. The tumor border was clearly delimited in 71%. Concordance with preoperative MRI scan was 78% (P < 0.001). The mean time ± SD for sterile covering of the probe was 2.16 ± 0.5 minutes, and the mean image acquisition time was 2.49 ± 1.26 minutes. Insular tumor location, low-grade glioma, awake surgery, and recurrent tumor were statistically associated with an increased ultrasound usage time. Ultrasound had a sensitivity of 94.4% and a specificity of 100% for residual tumor detection. CONCLUSIONS Neuronavigated ultrasound can be considered a truly real-time intraoperative imaging method because it does not increase surgical time significantly and provides optimal visualization of intra-axial brain lesions and residual tumor.
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Affiliation(s)
| | - Laura Salgado-Lopez
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA; Universitat Autònoma de Barcelona (Doctorat), Barcelona, Spain
| | | | | | | | | | | | - Joan Molet Teixidó
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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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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Shetty P, Yeole U, Singh V, Moiyadi A. Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes. Neurosurg Focus 2021; 50:E14. [PMID: 33386014 DOI: 10.3171/2020.10.focus20550] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative imaging is increasingly being used for resection control in diffuse gliomas, in which the extent of resection (EOR) is important. Intraoperative ultrasound (iUS) has emerged as a highly effective tool in this context. Navigated ultrasound (NUS) combines the benefits of real-time imaging with the benefits of navigation guidance. In this study, the authors investigated the use of NUS as an intraoperative adjunct for resection control in gliomas. METHODS The authors retrospectively analyzed 210 glioma patients who underwent surgery using NUS at their center. The analysis included intraoperative decision-making, diagnostic accuracy, and operative outcomes, particularly EOR and related factors influencing this. RESULTS US-defined gross-total resection (GTR) was achieved in 57.6% of patients. Intermediate resection control scans were evaluable in 115 instances. These prompted a change in the operative decision in 42.5% of cases (the majority being further resection of unanticipated residual tumor). Eventual MRI-defined GTR rates were similar (58.6%), although the concordance between US and MRI was 81% (170/210 cases). There were 21 false positives and 19 false negatives with NUS, resulting in a sensitivity of 78%, specificity of 83%, positive predictive value of 77%, and negative predictive value of 84%. A large proportion of patients (13/19 patients, 68%) with false-negative results eventually had near-total resections. Tumor resectability, delineation, enhancement pattern, eloquent location, and US image resolution significantly influenced the GTR rate, though only resectability and eloquent location were significant on multivariate analysis. CONCLUSIONS NUS is a useful intraoperative adjunct for resection control in gliomas, detecting unanticipated tumor residues and positively influencing the course of the resection, eventually leading to higher resection rates. Nevertheless, resection is determined by the innate resectability of the tumor and its relationship to eloquent location, reinforcing the need to combine iUS with functional mapping techniques to optimize resections.
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Affiliation(s)
- Prakash Shetty
- 1Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, and.,2Homi Bhabha National Institute, Mumbai, India
| | - Ujwal Yeole
- 1Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, and.,2Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- 1Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, and.,2Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- 1Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, and.,2Homi Bhabha National Institute, Mumbai, India
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He K, Chi C, Li D, Zhang J, Niu G, Lv F, Wang J, Che W, Zhang L, Ji N, Zhu Z, Tian J, Chen X. Resection and survival data from a clinical trial of glioblastoma multiforme-specific IRDye800-BBN fluorescence-guided surgery. Bioeng Transl Med 2021; 6:e10182. [PMID: 33532584 PMCID: PMC7823121 DOI: 10.1002/btm2.10182] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
Supra-maximum surgical tumor resection without neurological damage is highly valuable for treatment and prognosis of patients with glioblastoma multiforme (GBM). We developed a GBM-specific fluorescence probe using IRDye800CW (peak absorption/emission, 778/795 nm) and bombesin (BBN), which (IRDye800-BBN) targets the gastrin-releasing peptide receptor, and evaluated the image-guided resection efficiency, sensitivity, specificity, and survivability. Twenty-nine patients with newly diagnosed GBM were enrolled. Sixteen hours preoperatively, IRDye800-BBN (1 mg in 20 ml sterile water) was intravenously administered. A customized fluorescence surgical navigation system was used intraoperatively. Postoperatively, enhanced magnetic resonance images were used to assess the residual tumor volume, calculate the resection extent, and confirm whether complete resection was achieved. Tumor tissues and nonfluorescent brain tissue in adjacent noneloquent boundary areas were harvested and assessed for diagnostic accuracy. Complete resection was achieved in 82.76% of patients. The median extent of resection was 100% (range, 90.6-100%). Eighty-nine samples were harvested, including 70 fluorescence-positive and 19 fluorescence-negative samples. The sensitivity and specificity of IRDye800-BBN were 94.44% (95% CI, 85.65-98.21%) and 88.24% (95% CI, 62.25-97.94%), respectively. Twenty-five patients were followed up (median, 13.5 [3.1-36.0] months), and 14 had died. The mean preoperative and immediate and 6-month postoperative Karnofsky performance scores were 77.9 ± 11.8, 71.3 ± 19.2, and 82.6 ± 14.7, respectively. The median overall and progression-free survival were 23.1 and 14.1 months, respectively. In conclusion, GBM-specific fluorescent IRDye800-BBN can help neurosurgeons identify the tumor boundary with sensitivity and specificity, and may improve survival outcomes.
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Affiliation(s)
- Kunshan He
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineBeihang UniversityBeijingChina
- CAS Key Laboratory of Molecular Imaging, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Chongwei Chi
- CAS Key Laboratory of Molecular Imaging, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases (NCRC‐ND)BeijingChina
| | - Jingjing Zhang
- Department of Nuclear Medicine, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Gang Niu
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN)National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH)BethesdaMarylandUSA
| | - Fangqiao Lv
- Department of Cell Biology, School of Basic Medical SciencesCapital Medical UniversityBeijingChina
| | - Junmei Wang
- Department of Neuropathology, Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina
| | - Wenqiang Che
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases (NCRC‐ND)BeijingChina
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases (NCRC‐ND)BeijingChina
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases (NCRC‐ND)BeijingChina
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineBeihang UniversityBeijingChina
- CAS Key Laboratory of Molecular Imaging, Institute of AutomationChinese Academy of SciencesBeijingChina
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN)National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH)BethesdaMarylandUSA
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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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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: 23] [Impact Index Per Article: 4.6] [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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