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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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Oelschlägel M, Polanski WH, Morgenstern U, Steiner G, Kirsch M, Koch E, Schackert G, Sobottka SB. Characterization of cortical hemodynamic changes following sensory, visual, and speech activation by intraoperative optical imaging utilizing phase-based evaluation methods. Hum Brain Mapp 2022; 43:598-615. [PMID: 34590384 PMCID: PMC8720199 DOI: 10.1002/hbm.25674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
Alterations within cerebral hemodynamics are the intrinsic signal source for a wide variety of neuroimaging techniques. Stimulation of specific functions leads due to neurovascular coupling, to changes in regional cerebral blood flow, oxygenation and volume. In this study, we investigated the temporal characteristics of cortical hemodynamic responses following electrical, tactile, visual, and speech activation for different stimulation paradigms using Intraoperative Optical Imaging (IOI). Image datasets from a total of 22 patients that underwent surgical resection of brain tumors were evaluated. The measured reflectance changes at different light wavelength bands, representing alterations in regional cortical blood volume (CBV), and deoxyhemoglobin (HbR) concentration, were assessed by using Fourier-based evaluation methods. We found a decrease of CBV connected to an increase of HbR within the contralateral primary sensory cortex (SI) in patients that were prolonged (30 s/15 s) electrically stimulated. Additionally, we found differences in amplitude as well as localization of activated areas for different stimulation patterns. Contrary to electrical stimulation, prolonged tactile as well as prolonged visual stimulation are provoking increases in CBV within the corresponding activated areas (SI, visual cortex). The processing of the acquired data from awake patients performing speech tasks reveals areas with increased, as well as areas with decreased CBV. The results lead us to the conclusion, that the CBV decreases in connection with HbR increases in SI are associated to processing of nociceptive stimuli and that stimulation type, as well as paradigm have a nonnegligible impact on the temporal characteristics of the following hemodynamic response.
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Affiliation(s)
- Martin Oelschlägel
- Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Clinical Sensoring and Monitoring, Dresden, Saxony, Germany
| | - Witold H Polanski
- Department of Neurosurgery, Technische Universität Dresden, Carl Gustav Carus University Hospital Dresden, Dresden, Saxony, Germany
| | - Ute Morgenstern
- Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Institute of Biomedical Engineering, Dresden, Saxony, Germany
| | - Gerald Steiner
- Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Clinical Sensoring and Monitoring, Dresden, Saxony, Germany
| | - Matthias Kirsch
- Department of Neurosurgery, Technische Universität Dresden, Carl Gustav Carus University Hospital Dresden, Dresden, Saxony, Germany.,Department of Neurosurgery, Asklepios Kliniken Schildautal Seesen, Seesen, Saxony, Germany
| | - Edmund Koch
- Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Clinical Sensoring and Monitoring, Dresden, Saxony, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Technische Universität Dresden, Carl Gustav Carus University Hospital Dresden, Dresden, Saxony, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, Technische Universität Dresden, Carl Gustav Carus University Hospital Dresden, Dresden, Saxony, 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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Nahm W, Hornberger C, Morgenstern U, Sobottka SB. Optical imaging methods in medicine: how can we escape the plausibility trap? BIOMED ENG-BIOMED TE 2018; 63:507-510. [PMID: 30243014 DOI: 10.1515/bmt-2018-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Werner Nahm
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Christoph Hornberger
- Faculty of Engineering, Wismar University of Applied Sciences, 23966 Wismar, Germany
| | - Ute Morgenstern
- Institute of Biomedical Engineering, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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