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Polanski WH, Oelschlägel M, Juratli TA, Wahl H, Krukowski PM, Morgenstern U, Koch E, Steiner G, Schackert G, Sobottka SB. Topographic Mapping of the Primary Sensory Cortex Using Intraoperative Optical Imaging and Tactile Irritation. Brain Topogr 2023; 36:1-9. [PMID: 36446998 PMCID: PMC9834102 DOI: 10.1007/s10548-022-00925-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
The determination of exact tumor boundaries within eloquent brain regions is essential to maximize the extent of resection. Recent studies showed that intraoperative optical imaging (IOI) combined with median nerve stimulation is a helpful tool for visualization of the primary sensory cortex (PSC). In this technical note, we describe a novel approach of using IOI with painless tactile irritation to demonstrate the feasibility of topographic mapping of different body regions within the PSC. In addition, we compared the IOI results with preoperative functional MRI (fMRI) findings. In five patients with tumors located near the PSC who received tumor removal, IOI with tactile irritation of different body parts and fMRI was applied. We showed that tactile irritation of the hand in local and general anesthesia leads to reliable changes of cerebral blood volume during IOI. Hereby, we observed comparable IOI activation maps regarding the median nerve stimulation, fMRI and tactile irritation of the hand. The tactile irritation of different body areas revealed a plausible topographic distribution along the PSC. With this approach, IOI is also suitable for awake surgeries, since the tactile irritation is painless compared with median nerve stimulation and is congruent to fMRI findings. Further studies are ongoing to standardize this method to enable a broad application within the neurosurgical community.
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Affiliation(s)
- Witold H. Polanski
- Department of Neurosurgery, University Hospital of Dresden, Fiedlerstr. 74, 01307 Dresden, Germany
| | - Martin Oelschlägel
- Clinical Sensoring and Monitoring, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
| | - Tareq A. Juratli
- Department of Neurosurgery, University Hospital of Dresden, Fiedlerstr. 74, 01307 Dresden, Germany
| | - Hannes Wahl
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Pawel M. Krukowski
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Ute Morgenstern
- Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Edmund Koch
- Clinical Sensoring and Monitoring, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
| | - Gerald Steiner
- Clinical Sensoring and Monitoring, Faculty of Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, 01307 Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital of Dresden, Fiedlerstr. 74, 01307 Dresden, Germany
| | - Stephan B. Sobottka
- Department of Neurosurgery, University Hospital of Dresden, Fiedlerstr. 74, 01307 Dresden, Germany
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Mühle R, Ernst H, Sobottka SB, Morgenstern U. Workflow and hardware for intraoperative hyperspectral data acquisition in neurosurgery. BIOMED ENG-BIOMED TE 2020; 66:/j/bmte.ahead-of-print/bmt-2019-0333/bmt-2019-0333.xml. [PMID: 32706748 DOI: 10.1515/bmt-2019-0333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/27/2020] [Indexed: 01/18/2023]
Abstract
To prevent further brain tumour growth, malignant tissue should be removed as completely as possible in neurosurgical operations. Therefore, differentiation between tumour and brain tissue as well as detecting functional areas is very important. Hyperspectral imaging (HSI) can be used to get spatial information about brain tissue types and characteristics in a quasi-continuous reflection spectrum. In this paper, workflow and some aspects of an adapted hardware system for intraoperative hyperspectral data acquisition in neurosurgery are discussed. By comparing an intraoperative with a laboratory setup, the influences of the surgical microscope are made visible through the differences in illumination and a pixel- and wavelength-specific signal-to-noise ratio (SNR) calculation. Due to the significant differences in shape and wavelength-dependent intensity of light sources, it can be shown which kind of illumination is most suitable for the setups. Spectra between 550 and 1,000 nm are characterized of at least 40 dB SNR in laboratory and 25 dB in intraoperative setup in an area of the image relevant for evaluation. A first validation of the intraoperative hyperspectral imaging hardware setup shows that all system parts and intraoperatively recorded data can be evaluated. Exemplarily, a classification map was generated that allows visualization of measured properties of raw data. The results reveal that it is possible and beneficial to use HSI for wavelength-related intraoperative data acquisition in neurosurgery. There are still technical facts to optimize for raw data detection prior to adapting image processing algorithms to specify tissue quality and function.
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Affiliation(s)
- Richard Mühle
- Faculty of Electrical and Computer Engineering, Institute of Biomedical Engineering, Technische Universität Dresden, 01062Dresden, Germany
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307Dresden, Germany
| | - Hannes Ernst
- Faculty of Electrical and Computer Engineering, Institute of Biomedical Engineering, Technische Universität Dresden, 01062Dresden, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307Dresden, Germany
| | - Ute Morgenstern
- Faculty of Electrical and Computer Engineering, Institute of Biomedical Engineering, Technische Universität Dresden, 01062Dresden, Germany
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Oelschlägel M, Meyer T, Morgenstern U, Wahl H, Gerber J, Reiß G, Koch E, Steiner G, Kirsch M, Schackert G, Sobottka SB. Mapping of language and motor function during awake neurosurgery with intraoperative optical imaging. Neurosurg Focus 2020; 48:E3. [PMID: 32006940 DOI: 10.3171/2019.11.focus19759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
Intraoperative optical imaging (IOI) is a marker-free, contactless, and noninvasive imaging technique that is able to visualize metabolic changes of the brain surface following neuronal activation. Although it has been used in the past mainly for the identification of functional brain areas under general anesthesia, the authors investigated the potential of the method during awake surgery. Measurements were performed in 10 patients who underwent resection of lesions within or adjacent to cortical language or motor sites. IOI was applied in 3 different scenarios: identification of motor areas by using finger-tapping tasks, identification of language areas by using speech tasks (overt and silent speech), and a novel approach-the application of IOI as a feedback tool during direct electrical stimulation (DES) mapping of language. The functional maps, which were calculated from the IOI data (activity maps), were qualitatively compared with the functional MRI (fMRI) and the electrophysiological testing results during the surgical procedure to assess their potential benefit for surgical decision-making.The results reveal that the intraoperative identification of motor sites with IOI in good agreement with the preoperatively acquired fMRI and the intraoperative electrophysiological measurements is possible. Because IOI provides spatially highly resolved maps with minimal additional hardware effort, the application of the technique for motor site identification seems to be beneficial in awake procedures. The identification of language processing sites with IOI was also possible, but in the majority of cases significant differences between fMRI, IOI, and DES were visible, and therefore according to the authors' findings the IOI results are too unspecific to be useful for intraoperative decision-making with respect to exact language localization. For this purpose, DES mapping will remain the method of choice.Nevertheless, the IOI technique can provide additional value during the language mapping procedure with DES. Using a simple difference imaging approach, the authors were able to visualize and calculate the spatial extent of activation for each stimulation. This might enable surgeons in the future to optimize the mapping process. Additionally, differences between tumor and nontumor stimulation sites were observed with respect to the spatial extent of the changes in cortical optical properties. These findings provide further evidence that the method allows the assessment of the functional state of neurovascular coupling and is therefore suited for the delineation of pathologically altered tissue.
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Affiliation(s)
- Martin Oelschlägel
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Tobias Meyer
- 2ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden
| | - Ute Morgenstern
- 3Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden
| | - Hannes Wahl
- 4Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden
| | - Johannes Gerber
- 4Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden
| | - Gilfe Reiß
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
| | - Edmund Koch
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Gerald Steiner
- 1Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden
| | - Matthias Kirsch
- 5Department of Neurosurgery, Asklepios Kliniken Schildautal Seesen; and
| | - Gabriele Schackert
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
| | - Stephan B Sobottka
- 6Department of Neurosurgery, Carl Gustav Carus University Hospital, Technische Universität Dresden, Saxony, Germany
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Oelschlägel M, Meyer T, Schackert G, Kirsch M, Sobottka SB, Morgenstern U. Intraoperative optical imaging of metabolic changes after direct cortical stimulation – a clinical tool for guidance during tumor resection? ACTA ACUST UNITED AC 2018; 63:587-594. [DOI: 10.1515/bmt-2017-0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/24/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Brain tumor resection is even today one of the most challenging disciplines in neurosurgery. The current state of the art for the identification of tumor tissue during the surgical procedure comprises a wide variety of different tools, each with its own limitations and drawbacks. In this paper, we present a novel approach, the use of optical imaging in connection with direct electrical cortical stimulation (DCS), for identification of impaired tumor tissue and functional intact normal brain tissue under intraoperative conditions. Measurements with an optical imaging setup were performed as a proof of concept on three patients who underwent tumor resection of superficial gliomas. Direct electrical stimulations were applied on tumor tissue and surrounding brain tissue in each patient and characteristic features from the observed changes in the optical properties were compared between the different groups. The results reveal that in all patients a differentiation between non-functional tumor tissue and functional intact brain tissue was possible, and the technique might be a useful clinical tool in the future.
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Affiliation(s)
- Martin Oelschlägel
- Faculty of Electrical and Computer Engineering, Technische Universität Dresden , Institut für Biomedizinische Technik , D – 01307 Dresden , Germany , Phone: +49 351 463 32118, Fax: +49 351 463 36026
| | - Tobias Meyer
- Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering , Technische Universität Dresden , 01307 Dresden , Germany
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft m.b.H. , 01307 Dresden , Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus , Technische Universität Dresden , 01307 Dresden , Germany
| | - Matthias Kirsch
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus , Technische Universität Dresden , 01307 Dresden , Germany
| | - Stephan B. Sobottka
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus , Technische Universität Dresden , 01307 Dresden , Germany
| | - Ute Morgenstern
- Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering , Technische Universität Dresden , 01307 Dresden , Germany
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Morone KA, Neimat JS, Roe AW, Friedman RM. Review of functional and clinical relevance of intrinsic signal optical imaging in human brain mapping. NEUROPHOTONICS 2017; 4:031220. [PMID: 28630881 PMCID: PMC5466092 DOI: 10.1117/1.nph.4.3.031220] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/12/2017] [Indexed: 05/30/2023]
Abstract
Intrinsic signal optical imaging (ISOI) within the first decade of its use in humans showed its capacity as a precise functional mapping tool. It is a powerful tool that can be used intraoperatively to help a surgeon to directly identify functional areas of the cerebral cortex. Its use is limited to the intraoperative setting as it requires a craniotomy and durotomy for direct visualization of the brain. It has been applied in humans to study language, somatosensory and visual cortices, cortical hemodynamics, epileptiform activity, and lesion delineation. Despite studies showing clear evidence of its usefulness in clinical care, its clinical use in humans has not grown. Impediments imposed by imaging in a human operating room setting have hindered such work. However, recent studies have been aimed at overcoming obstacles in clinical studies establishing the benefits of its use to patients. This review provides a description of ISOI and its use in human studies with an emphasis on the challenges that have hindered its widespread use and the recent studies that aim to overcome these hurdles. Clinical studies establishing the benefits of its use to patients would serve as the impetus for continued development and use in humans.
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Affiliation(s)
- Katherine A. Morone
- Vanderbilt University Medical Center, Department of Neurology, Nashville, Tennessee, United States
| | - Joseph S. Neimat
- University of Louisville School of Medicine, Department of Neurosurgery, Louisville, Kentucky, United States
| | - Anna W. Roe
- Oregon Health and Science University, Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States
- Zhejiang University, Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, HuaJiaChi Campus, Hangzhou, China
| | - Robert M. Friedman
- Oregon Health and Science University, Division of Neuroscience, Oregon National Primate Research Center, Beaverton, Oregon, United States
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Hirvonen LM, Suhling K. Photon Counting Imaging with an Electron-Bombarded Pixel Image Sensor. SENSORS (BASEL, SWITZERLAND) 2016; 16:E617. [PMID: 27136556 PMCID: PMC4883308 DOI: 10.3390/s16050617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/08/2016] [Accepted: 04/25/2016] [Indexed: 11/21/2022]
Abstract
Electron-bombarded pixel image sensors, where a single photoelectron is accelerated directly into a CCD or CMOS sensor, allow wide-field imaging at extremely low light levels as they are sensitive enough to detect single photons. This technology allows the detection of up to hundreds or thousands of photon events per frame, depending on the sensor size, and photon event centroiding can be employed to recover resolution lost in the detection process. Unlike photon events from electron-multiplying sensors, the photon events from electron-bombarded sensors have a narrow, acceleration-voltage-dependent pulse height distribution. Thus a gain voltage sweep during exposure in an electron-bombarded sensor could allow photon arrival time determination from the pulse height with sub-frame exposure time resolution. We give a brief overview of our work with electron-bombarded pixel image sensor technology and recent developments in this field for single photon counting imaging, and examples of some applications.
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Affiliation(s)
- Liisa M Hirvonen
- Department of Physics, King's College London, Strand, London WC2R 2LS, UK.
| | - Klaus Suhling
- Department of Physics, King's College London, Strand, London WC2R 2LS, UK.
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7
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Nitschke P, Bork U, Plodeck V, Podlesek D, Sobottka SB, Schackert G, Weitz J, Kirsch M. [Importance of preoperative and intraoperative imaging for operative strategies]. Chirurg 2016; 87:179-88. [PMID: 26939896 DOI: 10.1007/s00104-016-0163-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy.
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Affiliation(s)
- P Nitschke
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Bork
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - V Plodeck
- Institut für Radiologie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - D Podlesek
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S B Sobottka
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Schackert
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Carl Gustav Carus Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Kirsch
- Klinik und Poliklinik für Neurochirurgie und Experimental Neuroimaging Laboratory, Carl Gustav Carus Universitätsklinikum Dresden, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Hirvonen LM, Jiggins S, Sergent N, Zanda G, Suhling K. Photon counting imaging with an electron-bombarded CCD: towards a parallel-processing photoelectronic time-to-amplitude converter. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2014; 85:123102. [PMID: 25554267 DOI: 10.1063/1.4901935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We have used an electron-bombarded CCD for optical photon counting imaging. The photon event pulse height distribution was found to be linearly dependent on the gain voltage. We propose on this basis that a gain voltage sweep during exposure in an electron-bombarded sensor would allow photon arrival time determination with sub-frame exposure time resolution. This effectively uses an electron-bombarded sensor as a parallel-processing photoelectronic time-to-amplitude converter, or a two-dimensional photon counting streak camera. Several applications that require timing of photon arrival, including Fluorescence Lifetime Imaging Microscopy, may benefit from such an approach. A simulation of a voltage sweep performed with experimental data collected with different acceleration voltages validates the principle of this approach. Moreover, photon event centroiding was performed and a hybrid 50% Gaussian/Centre of Gravity + 50% Hyperbolic cosine centroiding algorithm was found to yield the lowest fixed pattern noise. Finally, the camera was mounted on a fluorescence microscope to image F-actin filaments stained with the fluorescent dye Alexa 488 in fixed cells.
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Affiliation(s)
- Liisa M Hirvonen
- Department of Physics, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Stephen Jiggins
- Department of Physics, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Nicolas Sergent
- Department of Physics, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Gianmarco Zanda
- Department of Physics, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Klaus Suhling
- Department of Physics, King's College London, Strand, London WC2R 2LS, United Kingdom
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