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Kappel AD, Jha R, Guggilapu S, Smith WJ, Feroze AH, Dmytriw AA, Vicenty-Padilla J, Alcedo Guardia RE, Gessler FA, Patel NJ, Du R, See AP, Peruzzi PP, Aziz-Sultan MA, Bernstock JD. Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era. Cancers (Basel) 2024; 16:1594. [PMID: 38672676 PMCID: PMC11049132 DOI: 10.3390/cancers16081594] [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: 03/03/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood-brain barrier (BBB) penetration, hemodynamic complexities, and drug-tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.
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Affiliation(s)
- Ari D. Kappel
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rohan Jha
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
| | - Saibaba Guggilapu
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
| | - William J. Smith
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Abdullah H. Feroze
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Adam A. Dmytriw
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Juan Vicenty-Padilla
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico (R.E.A.G.)
| | - Rodolfo E. Alcedo Guardia
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico (R.E.A.G.)
| | - Florian A. Gessler
- Department of Neurosurgery, Rostock University Hospital, 18057 Rostock, Germany
| | - Nirav J. Patel
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rose Du
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Alfred P. See
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Pier Paolo Peruzzi
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Mohammad A. Aziz-Sultan
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua D. Bernstock
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
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2
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Huang W, Ning C, Zhang R, Xu J, Chen B, Li Z, Cui Y, Shao W. Evaluation of the dual-frequency transducer for controlling thermal ablation morphology using frequency shift keying signal. Int J Hyperthermia 2022; 39:1344-1357. [PMID: 36223887 DOI: 10.1080/02656736.2022.2130999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The catheter-based ultrasound (CBUS) can reach the target tissue directly and achieve rapid treatment. The frequency shift keying (FSK) signal is proposed to regulate and evaluate tumor ablation by a miniaturized dual-frequency transducer. METHODS A dual-frequency transducer prototype (3 × 7 × 0.4 mm) was designed and fabricated for the CBUS applicator (OD: 3.8 mm) based on the fundamental frequency of 5.21 MHz and the third harmonic frequency of 16.88 MHz. Then, the acoustic fields and temperature field distributions using the FSK signals (with 0, 25, 50, 75, and 100% third harmonic frequency duty ratios) were simulated by finite element analysis. Finally, tissue ablation and temperature monitoring were performed in phantom and ex vivo tissue, respectively. RESULTS At the same input electrical power (20 W), the output acoustic power of the fundamental frequency of the transducer was 10.03 W (electroacoustic efficiencies: 50.1%), and that of the third harmonic frequency was 6.19 W (30.6%). As the third harmonic frequency duty ratios increased, the shape of thermal lesions varied from strip to droplet in simulated and phantom experimental results. The same trend was observed in ex vivo tests. CONCLUSION Dual-frequency transducers excited by the FSK signal can control the morphology of lesions. SIGNIFICANCE The acoustic power deposition of CBUS was optimized to achieve precise ablation.
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Affiliation(s)
- Wenchang Huang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Chuanlong Ning
- College of Mechanical and Electrical Engineering, Hohai University, Changzhou, Jiangsu, China
| | - Rui Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Jie Xu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Beiyi Chen
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Zhangjian Li
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yaoyao Cui
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Weiwei Shao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
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3
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Szewczyk B, Tarasek M, Campwala Z, Trowbridge R, Zhao Z, Johansen PM, Olmsted Z, Bhushan C, Fiveland E, Ghoshal G, Heffter T, Tavakkolmoghaddam F, Bales C, Wang Y, Rajamani DK, Gandomi K, Nycz C, Jeannotte E, Mane S, Nalwalk J, Burdette EC, Fischer G, Yeo D, Qian J, Pilitsis J. What happens to brain outside the thermal ablation zones? An assessment of needle-based therapeutic ultrasound in survival swine. Int J Hyperthermia 2022; 39:1283-1293. [PMID: 36162814 DOI: 10.1080/02656736.2022.2126901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND In stereotactic radiosurgery, isodose lines must be considered to determine how surrounding tissue is affected. In thermal ablative therapy, such as laser interstitial thermal therapy (LITT), transcranial MR-guided focused ultrasound (tcMRgFUS), and needle-based therapeutic ultrasound (NBTU), how the surrounding area is affected has not been well studied. OBJECTIVE We aimed to quantify the transition zone surrounding the ablation core created by magnetic resonance-guided robotically-assisted (MRgRA) delivery of NBTU using multi-slice volumetric 2-D magnetic resonance thermal imaging (MRTI) and subsequent characterization of the resultant tissue damage using histopathologic analysis. METHODS Four swine underwent MRgRA NBTU using varying duration and wattage for treatment delivery. Serial MRI images were obtained, and the most representative were overlaid with isodose lines and compared to brain tissue acquired postmortem which underwent histopathologic analysis. These results were also compared to predicted volumes using a finite element analysis model. Contralateral brain tissue was used for control data. RESULTS Intraoperative MRTI thermal isodose contours were characterized and comprehensively mapped to post-operative MRI images and qualitatively compared with histological tissue sections postmortem. NBTU 360° ablations induced smaller lesion volumes (33.19 mm3; 120 s, 3 W; 30.05 mm3, 180 s, 4 W) versus 180° ablations (77.20 mm3, 120 s, 3 W; 109.29 mm3; 180 s; 4 W). MRTI/MRI overlay demonstrated the lesion within the proximal isodose lines. The ablation-zone was characterized by dense macrophage infiltration and glial/neuronal loss as demonstrated by glial fibrillary acidic protein (GFAP) and neurofilament (NF) absence and avid CD163 staining. The transition-zone between lesion and normal brain demonstrated decreased macrophage infiltration and measured ∼345 microns (n - 3). We did not detect overt hemorrhages or signs of edema in the adjacent spared tissue. CONCLUSION We successfully performed MRgRA NBTU ablation in swine and demonstrated minimal histologic changes extended past the ablation-zone. The lesion was characterized by macrophage infiltration and glial/neuronal loss which decreased through the transition-zone.
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Affiliation(s)
- Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Zahabiya Campwala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Zhanyue Zhao
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Zachary Olmsted
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | | | | | | | | | - Charles Bales
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Yang Wang
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Dhruv Kool Rajamani
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Katie Gandomi
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Christopher Nycz
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Erin Jeannotte
- Animal Resources Facility, Albany Medical Center, Albany, NY, USA
| | - Shweta Mane
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Julia Nalwalk
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | - Gregory Fischer
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Desmond Yeo
- GE Global Research Center, Niskayuna, NY, USA
| | - Jiang Qian
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Julie Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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4
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Campwala Z, Szewczyk B, Maietta T, Trowbridge R, Tarasek M, Bhushan C, Fiveland E, Ghoshal G, Heffter T, Gandomi K, Carvalho PA, Nycz C, Jeannotte E, Staudt M, Nalwalk J, Hellman A, Zhao Z, Burdette EC, Fischer G, Yeo D, Pilitsis JG. Predicting ablation zones with multislice volumetric 2-D magnetic resonance thermal imaging. Int J Hyperthermia 2021; 38:907-915. [PMID: 34148489 PMCID: PMC9284994 DOI: 10.1080/02656736.2021.1936215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) serves as a noninvasive stereotactic system for the ablation of brain metastases; however, treatments are limited to simple geometries and energy delivery is limited by the high acoustic attenuation of the calvarium. Minimally-invasive magnetic resonance-guided robotically-assisted (MRgRA) needle-based therapeutic ultrasound (NBTU) using multislice volumetric 2-D magnetic resonance thermal imaging (MRTI) overcomes these limitations and has potential to produce less collateral tissue damage than current methods. OBJECTIVE To correlate multislice volumetric 2-D MRTI volumes with histologically confirmed regions of tissue damage in MRgRA NBTU. METHODS Seven swine underwent a total of 8 frontal MRgRA NBTU lesions. MRTI ablation volumes were compared to histologic tissue damage on brain sections stained with 2,3,5-triphenyltetrazolium chloride (TTC). Bland-Altman analyses and correlation trends were used to compare MRTI and TTC ablation volumes. RESULTS Data from the initial and third swine's ablations were excluded due to sub-optimal tissue staining. For the remaining ablations (n = 6), the limits of agreement between the MRTI and histologic volumes ranged from -0.149 cm3 to 0.252 cm3 with a mean difference of 0.052 ± 0.042 cm3 (11.1%). There was a high correlation between the MRTI and histology volumes (r2 = 0.831) with a strong linear relationship (r = 0.868). CONCLUSION We used a volumetric MRTI technique to accurately track thermal changes during MRgRA NBTU in preparation for human trials. Improved volumetric coverage with MRTI enhanced our delivery of therapy and has far-reaching implications for focused ultrasound in the broader clinical setting.
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Affiliation(s)
- Zahabiya Campwala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Teresa Maietta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | | | | | | | | | - Katie Gandomi
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Christopher Nycz
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Erin Jeannotte
- Animal Resources Facility, Albany Medical Center, Albany, NY, USA
| | - Michael Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julia Nalwalk
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Abigail Hellman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Zhanyue Zhao
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Gregory Fischer
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Desmond Yeo
- GE Global Research Center, Niskayuna, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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5
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Gandomi KY, Carvalho PAWG, Tarasek M, Fiveland EW, Bhushan C, Williams E, Neubauer P, Zhao Z, Pilitsis J, Yeo D, Nycz CJ, Burdette E, Fischer GS. Modeling of Interstitial Ultrasound Ablation for Continuous Applicator Rotation With MR Validation. IEEE Trans Biomed Eng 2021; 68:1838-1846. [PMID: 32924937 PMCID: PMC8189669 DOI: 10.1109/tbme.2020.3023849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The primary objective of cancer intervention is the selective removal of malignant cells while conserving surrounding healthy tissues. However, the accessibility, size and shape of the cancer can make achieving appropriate margins a challenge. One minimally invasive treatment option for these clinical cases is interstitial needle based therapeutic ultrasound (NBTU). In this work, we develop a finite element model (FEM) capable of simulating continuous rotation of a directional NBTU applicator. The developed model was used to simulate the thermal deposition for different rotation trajectories. The actual thermal deposition patterns for the simulated trajectories were then evaluated using magnetic resonance thermal imaging (MRTI) in a porcine skin gelatin phantom. An MRI-compatible robot was used to control the rotation motion profile of the physical NBTU applicator to match the simulated trajectory. The model showed agreement when compared to experimental measurements with Pearson correlation coefficients greater than 0.839 when comparing temperature fields within an area of 12.6 mm radius from the ultrasound applicator. The average temperature error along a 6.3 mm radius profile from the applicator was 1.27 °C. The model was able to compute 1 s of thermal deposition by the applicator in 0.2 s on average with a 0.1 mm spatial resolution and 0.5 s time steps. The developed simulation demonstrates performance suitable for real-time control which may enable robotically-actuated closed-loop conformal tumor ablation.
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6
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Chen K, Irie T, Iijima T, Morita T. Double-Parabolic-Reflectors Ultrasonic Transducer With Flexible Waveguide for Minimally Invasive Treatment. IEEE Trans Biomed Eng 2021; 68:2965-2973. [PMID: 33539290 DOI: 10.1109/tbme.2021.3057087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To treat tissues that are difficult to access, ultrasound based minimally invasive treatment (MIT) is promising. However, high-power ultrasound delivery through waveguides had been difficult which can increase treatment duration. It is our effort to design the waveguide that can transmit powerful ultrasound. METHODS The waveguide with two parabolic reflectors was proposed by us to produce high-energy-density plane wave. Use of flexible and long thin waveguide was demonstrated here. RESULTS Double Parabolic refLectors wave-guided high-power Ultrasonic tranSducer (DPLUS) including a ϕ1 mm ×1 m Nitinol thin waveguide was fabricated. It was shown that high-power ultrasound between 1 to 2 MHz can be propagated through the thin waveguide. Low-loss waveguide material was confirmed to be important to enhance output. As ultrasound is transmitted into working medium, energy mainly flows from the side surface. Temperature of target soft tissue was demonstrated to drastically increase by 10 degree in 30 seconds. CONCLUSION The developed DPLUS makes high-power ultrasound transmission in long and flexible thin waveguide possible. SIGNIFICANCE The concept of DPLUS for delivering high-power ultrasound is powerful in the field of Ultrasonics.
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7
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Franzini A, Moosa S, Prada F, Elias WJ. Ultrasound Ablation in Neurosurgery: Current Clinical Applications and Future Perspectives. Neurosurgery 2020; 87:1-10. [PMID: 31745558 DOI: 10.1093/neuros/nyz407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022] Open
Abstract
The concept of focusing high-intensity ultrasound beams for the purpose of cerebral ablation has interested neurosurgeons for more than 70 yr. However, the need for a craniectomy or a cranial acoustic window hindered the clinical diffusion of this technique. Recent technological advances, including the development of phased-array transducers and magnetic resonance imaging technology, have rekindled the interest in ultrasound for ablative brain surgery and have led to the development of the transcranial magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation procedure. In the last decade, this method has become increasingly popular, and its clinical applications are broadening. Despite the demonstrated efficacy of MRgFUS, transcranial thermal ablation using ultrasound is limited in that it can target exclusively the central region of the brain where the multiple acoustic beams are most optimally focused. On the contrary, lesioning of the cortex, the superficial subcortical areas, and regions close to the skull base is not possible with the limited treatment envelope of current phased-array transducers. Therefore, new ultrasound ablative techniques, which are not based on thermal mechanisms, have been developed and tested in experimental settings. This review describes the mechanisms by which these novel, nonthermal ablative techniques are based and also presents the current clinical applications of MRgFUS thermal ablation.
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Affiliation(s)
- Andrea Franzini
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Focused Ultrasound Foundation, Charlottesville, Virginia
| | - W Jeffrey Elias
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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8
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Daunizeau L, Nguyen A, Le Garrec M, Chapelon JY, N'Djin WA. Robot-assisted ultrasound navigation platform for 3D HIFU treatment planning: Initial evaluation for conformal interstitial ablation. Comput Biol Med 2020; 124:103941. [PMID: 32818742 DOI: 10.1016/j.compbiomed.2020.103941] [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: 05/06/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Interstitial Ultrasound-guided High Intensity Focused Ultrasound (USgHIFU) therapy has the potential to deliver ablative treatments which conform to the target tumor. In this study, a robot-assisted US-navigation platform has been developed for 3D US guidance and planning of conformal HIFU ablations. The platform was used to evaluate a conformal therapeutic strategy associated with an interstitial dual-mode USgHIFU catheter prototype (64 elements linear-array, measured central frequency f = 6.5 MHz), developed for the treatment of HepatoCellular Carcinoma (HCC). The platform included a 3D navigation environment communicating in real-time with an open research dual-mode US scanner/HIFU generator and a robotic arm, on which the USgHIFU catheter was mounted. 3D US-navigation was evaluated in vitro for guiding and planning conformal HIFU ablations using a tumor-mimic model in porcine liver. Tumor-mimic volumes were then used as targets for evaluating conformal HIFU treatment planning in simulation. Height tumor-mimics (ovoid- or disc-shaped, sizes: 3-29 cm3) were created and visualized in liver using interstitial 2D US imaging. Robot-assisted spatial manipulation of these images and real-time 3D navigation allowed reconstructions of 3D B-mode US images for accurate tumor-mimic volume estimation (relative error: 4 ± 5%). Sectorial and full-revolution HIFU scanning (angular sectors: 88-360°) could both result in conformal ablations of the tumor volumes, as soon as their radii remained ≤ 24 mm. The presented US navigation-guided HIFU procedure demonstrated advantages for developing conformal interstitial therapies in standard operative rooms. Moreover, the modularity of the developed platform makes it potentially useful for developing other HIFU approaches.
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Affiliation(s)
- L Daunizeau
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France.
| | - A Nguyen
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - M Le Garrec
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - J Y Chapelon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - W A N'Djin
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
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9
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Hellman A, Maietta T, Byraju K, Linda Park Y, Shao M, Liss A, Neubauer P, Burdette C, Ghoshal G, Qian J, Nalwalk J, Pilitsis JG. Low Intensity Focused Ultrasound Modulation of Vincristine Induced Neuropathy. Neuroscience 2020; 430:82-93. [DOI: 10.1016/j.neuroscience.2020.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/01/2023]
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10
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Prada F, Franzini A, Moosa S, Padilla F, Moore D, Solbiati L, DiMeco F, Legon W. In vitro and in vivo characterization of a cranial window prosthesis for diagnostic and therapeutic cerebral ultrasound. J Neurosurg 2020; 134:646-658. [PMID: 31899872 DOI: 10.3171/2019.10.jns191674] [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: 06/16/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors evaluated the acoustic properties of an implantable, biocompatible, polyolefin-based cranial prosthesis as a medium to transmit ultrasound energy into the intracranial space with minimal distortion for imaging and therapeutic purposes. METHODS The authors performed in vitro and in vivo studies of ultrasound transmission through a cranial prosthesis. In the in vitro phase, they analyzed the transmission of ultrasound energy through the prosthesis in a water tank using various transducers with resonance frequencies corresponding to those of devices used for neurosurgical imaging and therapeutic purposes. Four distinct, single-element, focused transducers were tested at fundamental frequencies of 500 kHz, 1 MHz, 2.5 MHz, and 5 MHz. In addition, the authors tested ultrasound transmission through the prosthesis using a linear diagnostic probe (center frequency 5.3 MHz) with a calibrated needle hydrophone in free water. Each transducer was assessed across a range of input voltages that encompassed their full minimum to maximum range without waveform distortion. They also tested the effect of the prosthesis on beam pressure and geometry. In the in vivo phase, the authors performed ultrasound imaging through the prosthesis implanted in a swine model. RESULTS Acoustic power attenuation through the prosthesis was considerably lower than that reported to occur through the native cranial bone. Increasing the frequency of the transducer augmented the degree of acoustic power loss. The degradation/distortion of the ultrasound beams passing through the prosthesis was minimal in all 3 spatial planes (XY, XZ, and YZ) that were examined. The images acquired in vivo demonstrated no spatial distortion from the prosthesis, with spatial relationships that were superimposable to those acquired through the dura. CONCLUSIONS The results of the tests performed on the polyolefin-based cranial prosthesis indicated that this is a valid medium for delivering both focused and unfocused ultrasound and obtaining ultrasound images of the intracranial space. The prosthesis may serve for several diagnostic and therapeutic ultrasound-based applications, including bedside imaging of the brain and ultrasound-guided focused ultrasound cerebral procedures.
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Affiliation(s)
- Francesco Prada
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
- 2Department of Neurosurgery, University of Virginia Health System
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
| | - Andrea Franzini
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
- 2Department of Neurosurgery, University of Virginia Health System
| | - Shayan Moosa
- 2Department of Neurosurgery, University of Virginia Health System
| | | | - David Moore
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
| | - Luigi Solbiati
- 4Department of Radiology, Humanitas Research Hospital, Rozzano, Italy
| | - Francesco DiMeco
- 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
- 5Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
- 6Department of Pathophysiology and Transplantation, Università degli studi di Milano, Italy
| | - Wynn Legon
- 2Department of Neurosurgery, University of Virginia Health System
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MacDonell J, Patel N, Fischer G, Burdette EC, Qian J, Chumbalkar V, Ghoshal G, Heffter T, Williams E, Gounis M, King R, Thibodeau J, Bogdanov G, Brooks OW, Langan E, Hwang R, Pilitsis JG. Robotic Assisted MRI-Guided Interventional Interstitial MR-Guided Focused Ultrasound Ablation in a Swine Model. Neurosurgery 2019; 84:1138-1148. [PMID: 29905844 PMCID: PMC6500887 DOI: 10.1093/neuros/nyy266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ablative lesions are current treatments for epilepsy and brain tumors. Interstitial magnetic resonance (MR) guided focused ultrasound (iMRgFUS) may be an alternate ablation technique which limits thermal tissue charring as compared to laser therapy (LITT) and can produce larger ablation patterns nearer the surface than transcranial MR guided focused ultrasound (tcMRgFUS). OBJECTIVE To describe our experience with interstitial focused ultrasound (iFUS) ablations in swine, using MR-guided robotically assisted (MRgRA) delivery. METHODS In an initial 3 animals, we optimized the workflow of the robot in the MR suite and made modifications to the robotic arm to allow range of motion. Then, 6 farm pigs (4 acute, 2 survival) underwent 7 iMRgFUS ablations using MRgRA. We altered dosing to explore differences between thermal dosing in brain as compared to other tissues. Imaging was compared to gross examination. RESULTS Our work culminated in adjustments to the MRgRA, iMRgFUS probes, and dosing, culminating in 2 survival surgeries; swine had ablations with no neurological sequelae at 2 wk postprocedure. Immediately following iMRgFUS therapy, diffusion-weighted imaging, and T1 weighted MR were accurate reflections of the ablation volume. T2 and fluid-attenuated inversion-recovery (FLAIR) images were accurate reflections of ablation volume 1-wk postprocedure. CONCLUSION We successfully performed MRgRA iFUS ablation in swine and found intraoperative and postoperative imaging to correlate with histological examination. These data are useful to validate our system and to guide imaging follow-up for thermal ablation lesions in brain tissue from our therapy, tcMRgFUS, and LITT.
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Affiliation(s)
| | - Niravkumar Patel
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Gregory Fischer
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | | | - Jiang Qian
- Department of Pathology, Albany Medical College, Albany, New York
| | | | | | | | | | - Matthew Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert King
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Gene Bogdanov
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Olivia W Brooks
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Erin Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Roy Hwang
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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