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Pesce A, Palmieri M, Pietrantonio A, Ciarlo S, Salvati M, Pompucci A. Resection of supratentorial high-grade gliomas availing of neuronavigation matched intraoperative ultrasound and Fluorescein: How far is it safe to push the resection? World Neurosurg X 2024; 23:100379. [PMID: 38645511 PMCID: PMC11027571 DOI: 10.1016/j.wnsx.2024.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Background High-Grade Gliomas are the most common primary brain malignancies and despite the multimodal treatment, and the increasing amount of adjuvant treatment options the overall prognosis remains dismal. The present investigation aims to analyze the safety profile of the use of intraoperative ultrasounds (Io-US) in a homogeneous and matched cohort of patients suffering from High-grade gliomas (HGG) operated on with or without the aid of Io-US and Fluorescein in specific relation to the incidence of neurological and functional status sequelae. Methods and materials A retrospective analysis was performed on 74 patients affected by HGG. 22 patients were treated with Io-US matched with neuronavigational system (Group A); 15 patients were treated both with the use of Io-US and Fluorescein matched with neuronavigational system (Group B); 37 patients were treated with the use of the neuronavigational system only (Group C). Primary endpoints were the extent of resection and functional outcome (measured with Karnofski Performance Status). Results Significative differences were observed in terms of a higher extent of resection in Group B. In a multivariate analysis, this data appears to be independent of the location (eloquent/non-eloquent) of the lesion and from its histology. Regarding functional outcomes, no differences were detected between the two groups. Conclusions The present study is the first that analyzes the simultaneous use of Io-US and Fluorescein, and the results demonstrate that these two instruments together could improve the extent of resection in HGG while ensuring good outcomes in terms of functional status.
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Affiliation(s)
- Alessandro Pesce
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Mauro Palmieri
- Università“La Sapienza” di Roma, Neurosurgery Division - Roma, Viale del Policlinico 155, 00161, Roma, RM, Italy
| | - Andrea Pietrantonio
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Silvia Ciarlo
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome “Tor Vergata”, 00133, Rome, RM, Italy
| | - Angelo Pompucci
- A.O. “Santa Maria Goretti”, Neurosurgery Division - Latina, Via Lucia Scaravelli, 04100, Latina, LT, Italy
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Wang M, Yu J, Zhang J, Pan Z, Chen J. Intraoperative ultrasound in recurrent gliomas surgery: Impact on residual tumor volume and patient outcomes. Front Oncol 2023; 13:1161496. [PMID: 37035181 PMCID: PMC10076842 DOI: 10.3389/fonc.2023.1161496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Background Reoperation may be beneficial for patients with recurrent gliomas. Minimizing the residual tumor volume (RTV) while ensuring the functionality of relevant structures is the goal of the reoperation of recurrent gliomas. Intraoperative ultrasound (IoUS) may be helpful for intraoperative tumor localization, intraoperative real-time imaging to guide surgical resection, and postoperative evaluation of the RTV in the reoperation for recurrent gliomas. Objective To assess the effect of real-time ioUS on minimizing RTV in recurrent glioma surgery compared to Non-ioUS. Methods We retrospectively analyzed the data from 92 patients who had recurrent glioma surgical resection: 45 were resected with ioUS guidance and 47 were resected without ioUS guidance. RTV, Karnofsky Performance Status (KPS) at 6 months after the operation, the number of recurrent patients, and the time to recurrence were evaluated. Results The average RTV in the ioUS group was significantly less than the Non-ioUS group (0.27 cm3 vs. 1.33 cm3, p = 0.0004). Patients in the ioUS group tended to have higher KPS scores at 6 months of follow-up after the operation than those in the Non-ioUS group (70.00 vs. 60.00, p = 0.0185). More patients in the Non-ioUS group experienced a recurrence than in the ioUS group (43 (91.49%) vs. 32 (71.11%), p = 0.0118). The ioUS group had a longer mean time to recurrence than the Non-ioUS group (7.9 vs. 6.3 months, p = 0.0013). Conclusion The use of ioUS-based real-time for resection of recurrent gliomas has been beneficial in terms of both RTV and postoperative outcomes, compared to the Non-ioUS group.
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Affiliation(s)
- Meiyao Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhiyong Pan
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jincao Chen,
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Baker KE, Robbins AC, Kumm ZT, Ziemke MK, Washington CW, Luzardo GD, Taylor CS, Stringer SP, Zachariah MA. Case report: Side-firing intraoperative ultrasound guided endoscopic endonasal resection of a clival chordoma. Front Oncol 2023; 13:1039159. [PMID: 36937453 PMCID: PMC10014906 DOI: 10.3389/fonc.2023.1039159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Clival chordomas are locally invasive midline skull base tumors arising from remnants of the primitive notochord. Intracranial vasculature and cranial nerve involvement of tumors in the paraclival region necessitates image guidance that provides accurate real-time feedback during resection. Several intraoperative image guidance modalities have been introduced as adjuncts to endoscopic endonasal surgery, including stereotactic neuronavigation, intraoperative ultrasound, intraoperative MRI, and intraoperative CT. Gross total resection of chordomas is associated with a lower recurrence rate; therefore, intraoperative imaging may improve long-term outcomes by enhancing the extent of resection. However, among these options, effectiveness and accessibility vary between institutions. We previously published the first use of an end-firing probe in the resection of a clival chordoma. End-firing probes provide a single field of view, primarily limited to depth estimation. In this case report, we discuss the benefits of employing a novel minimally invasive side-firing ultrasound probe as a cost-effective and time-efficient option to navigate the anatomy of the paraclival region and guide endoscopic endonasal resection of a large complex clival chordoma.
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Affiliation(s)
- Katherine E. Baker
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Austin C. Robbins
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Zeynep T. Kumm
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Michael K. Ziemke
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Chad W. Washington
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Gustavo D. Luzardo
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Charlotte S. Taylor
- Department of Radiology, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Scott P. Stringer
- Department of Otolaryngology, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Marcus A. Zachariah
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Marcus A. Zachariah,
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Simfukwe K, Iakimov I, Sufianov R, Borba L, Mastronardi L, Shumadalova A. Application of Intraoperative Ultrasound Navigation in Neurosurgery. Front Surg 2022; 9:900986. [PMID: 35620193 PMCID: PMC9127208 DOI: 10.3389/fsurg.2022.900986] [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: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Effective intraoperative image navigation techniques are necessary in modern neurosurgery. In the last decade, intraoperative ultrasonography (iUS), a relatively inexpensive procedure, has gained widespread acceptance.
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Affiliation(s)
- Keith Simfukwe
- Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- *Correspondence: Keith Simfukwe
| | - Iurii Iakimov
- Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Rinat Sufianov
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Luís Borba
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Neurosurgery, Federal University of Paraná, Curitiba, Brazil
| | - Luciano Mastronardi
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Division of Neurosurgery, San Filippo Neri Hospital, Roma, Italy
| | - Alina Shumadalova
- Depatment of General Chemistry, Bashkir State Medical University, Ufa, Russia
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Li P, Ebner M, Noonan P, Horgan C, Bahl A, Ourselin S, Shapey J, Vercauteren T. Deep learning approach for hyperspectral image demosaicking, spectral correction and high-resolution RGB reconstruction. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. IMAGING & VISUALIZATION 2021; 10:409-417. [PMID: 38013723 PMCID: PMC10461732 DOI: 10.1080/21681163.2021.1997646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 10/05/2023]
Abstract
Hyperspectral imaging is one of the most promising techniques for intraoperative tissue characterisation. Snapshot mosaic cameras, which can capture hyperspectral data in a single exposure, have the potential to make a real-time hyperspectral imaging system for surgical decision-making possible. However, optimal exploitation of the captured data requires solving an ill-posed demosaicking problem and applying additional spectral corrections. In this work, we propose a supervised learning-based image demosaicking algorithm for snapshot hyperspectral images. Due to the lack of publicly available medical images acquired with snapshot mosaic cameras, a synthetic image generation approach is proposed to simulate snapshot images from existing medical image datasets captured by high-resolution, but slow, hyperspectral imaging devices. Image reconstruction is achieved using convolutional neural networks for hyperspectral image super-resolution, followed by spectral correction using a sensor-specific calibration matrix. The results are evaluated both quantitatively and qualitatively, showing clear improvements in image quality compared to a baseline demosaicking method using linear interpolation. Moreover, the fast processing time of 45 ms of our algorithm to obtain super-resolved RGB or oxygenation saturation maps per image for a state-of-the-art snapshot mosaic camera demonstrates the potential for its seamless integration into real-time surgical hyperspectral imaging applications.
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Affiliation(s)
- Peichao Li
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Michael Ebner
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
| | - Philip Noonan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Conor Horgan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
| | - Anisha Bahl
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Sébastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
| | - Jonathan Shapey
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
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Perret C, Bertani R, Barbosa MM, Batista S, Koester SW, Maria PS, Schiavini H. Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale. Surg Neurol Int 2021; 12:512. [PMID: 34754562 PMCID: PMC8571271 DOI: 10.25259/sni_601_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care. Case Description: This patient presented with a complex exophytic plasmocytoma that was first diagnosed and erroneously approached as a subcutaneous lipoma with surgical resection in an outpatient surgical setting. This interpretive approach resulted in the failure of the procedure due to significant hemorrhage. The patient was immediately referred to neurosurgical care and transferred to our center. Admission doppler ultrasound imaging revealed absence of the frontal bone, the enriched and profuse vascularization, allowing further and proper diagnostic approach and treatment. Conclusion: Ultrasound could be a reliable, fast, and simple imaging method aiding practitioners to perform a better workup for patients with exophytic subcutaneous cranial masses.
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Affiliation(s)
- Caio Perret
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Raphael Bertani
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Mauricio Mendes Barbosa
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, Rio de Janeiro, Brazil
| | - Savio Batista
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, Rio de Janeiro, Brazil
| | - Stefan W Koester
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Paulo Santa Maria
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Hugo Schiavini
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
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