The role of optical spectroscopy in epilepsy surgery in children

Fluorescence in neurosurgery: its therapeutic and diagnostic significance - a comprehensive review

This review provides a comprehensive overview of the therapeutic and diagnostic implications of fluorescence imaging in neurosurgery. Fluorescence imaging has become a valuable intraoperative visualization and guidance tool, facilitating precise surgical interventions. The therapeutic role of fluorescence is examined, including its application in photodynamic therapy and tumor-targeted therapy. It also explores its diagnostic capabilities in tumor detection, margin assessment, and blood-brain barrier evaluation. Drawing from clinical and preclinical studies, the review underscores the growing evidence supporting the efficacy of fluorescence imaging in neurosurgical practice. Furthermore, it discusses current limitations and future directions, emphasizing the potential for emerging technologies to enhance the utility and accessibility of fluorescence imaging, ultimately improving patient outcomes in neurosurgery.

Single-stage resection of bottom-of-a-sulcus dysplasia involving eloquent cortex using navigated transcranial magnetic stimulation and intraoperative modalities

BACKGROUND

Focal cortical dysplasia (FCD) is a common etiology of refractory epilepsy, particularly in children. Surgical management is potentially curative, but poses the challenge of distinguishing the border between ictogenic regions of dysplasia and functionally critical brain tissue. Bottom-of-a-sulcus dysplasia (BOSD) amplifies this challenge, due to difficulties in physiologic mapping of the deep tissue.

METHODS

We report a one-stage resection of a dysplasia-associated seizure focus abutting and involving the hand and face primary motor cortex. In doing so, we describe our surgical planning integrating neuronavigated transcranial magnetic stimulation (nTMS) for functional motor mapping, combined with intraoperative ultrasonography, intracranial electroencephalography, and magnetic resonance imaging (MRI). A 5-year-old girl with intractable focal epilepsy was referred to our comprehensive epilepsy program. Despite attentive pharmacotherapy, she experienced status epilepticus and up to 70 seizures per day, accompanied by multiple side effects from her antiseizure medication. A right frontal BOSD in close proximity to the hand motor area of the precentral gyrus was identified on MRI. Postoperatively, she is seizure-free for over 1 year with no hand deficit.

CONCLUSION

Although technically complex, single-stage resection taking advantage of comprehensive surgical planning with optimized fusion of functional mapping and intraoperative modalities merits consideration given the invasiveness of a two-stage approach for limited added value. Integrated pre-surgical nTMS allowed for mapping of eloquent cortex without invasive electrocortical stimulation.

A Highly Elastic and Autofluorescent Poly(xylitol-dodecanedioic Acid) for Tissue Engineering

In spite of the vast research on developing a highly elastic polymer for tissue regeneration, using a renewable resource and a simple, environment-friendly synthesis route to synthesize an elastic polymer has not been successfully achieved yet. The objective of this study was to use a simple melt condensation polymerization method to develop an elastic polymer for tissue regeneration applications. A nature-derived renewable, nontoxic, and inexpensive monomer, xylitol, and a cross-linking agent, dodecanedioic acid, were used to synthesize the new polymer named poly(xylitol-dodecanedioic acid) (PXDDA). Its physicochemical and biological properties were fully characterized. Fourier transform infrared (FTIR) results confirmed the formation of ester bonding in the polymer structure, and thermal analysis results demonstrated that the polymer was completely amorphous. The polymer is highly elastic. Increasing the molar ratio of dodecanedioic acid resulted in lower elasticity, higher hydrophobicity, and lower glass transition temperature. Further, the polymer degradation rate and in vitro dye release from the polymer also became slower when the amount of dodecanedioic acid in the composite increased. Biocompatibility studies showed that both the polymeric materials and the degraded products of the polymer did not show any toxicity. Instead, this new polymer significantly promoted cell adhesion and proliferation, compared to a widely used polymer, poly(lactic acid), and tissue culture plates. Interestingly, the PXDDA polymer demonstrated autofluorescent properties. Overall, these results suggest that a new, elastic, biodegradable polymer has been successfully synthesized, and it holds great promise for biomedical applications in drug delivery and tissue engineering.

Imaging preictal hemodynamic changes in neocortical epilepsy

OBJECT

The ability to predict seizure occurrence is extremely important to trigger abortive therapies and to warn patients and their caregivers. Optical imaging of hemodynamic parameters such as blood flow, blood volume, and tissue and hemoglobin oxygenation has already been shown to successfully localize epileptic events with high spatial and temporal resolution. The ability to actually predict seizure occurrence using hemodynamic parameters is less well explored.

METHODS

In this article, the authors critically review data from the literature on neocortical epilepsy and optical imaging, and they discuss the preictal hemodynamic changes and their application in neurosurgery.

RESULTS

Recent optical mapping studies have demonstrated preictal hemodynamic changes in both human and animal neocortex.

CONCLUSIONS

Optical measurements of blood flow and oxygenation may become increasingly important for predicting and localizing epileptic events. The ability to successfully predict ictal onsets may be useful to trigger closed-loop abortive therapies.

In vivo imaging of epileptic activity using 2-NBDG, a fluorescent deoxyglucose analog

Accurately locating epileptic foci has great importance in advancing the treatment of epilepsy. In this study, epileptic seizures were first induced by intracortical injection of 4-aminopyridine in rats. A fluorescent deoxyglucose substitute, 2-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-2-deoxyglucose (2-NBDG), was then continuously injected via the tail vein. Brain glucose metabolism was subsequently monitored by fluorescence imaging of 2-NBDG. The initial uptake rate of 2-NBDG at the injection site of 4-aminopyridine significantly exceeded that of the control injection site, which indicated local hypermetabolism induced by seizures. Our results show that 2-NBDG can be used for localizing epileptic foci.

Optical imaging in vivo with a focus on paediatric disease: technical progress, current preclinical and clinical applications and future perspectives

To obtain information on the occurrence and location of molecular events as well as to track target-specific probes such as antibodies or peptides, drugs or even cells non-invasively over time, optical imaging (OI) technologies are increasingly applied. Although OI strongly contributes to the advances made in preclinical research, it is so far, with the exception of optical coherence tomography (OCT), only very sparingly applied in clinical settings. Nevertheless, as OI technologies evolve and improve continuously and represent relatively inexpensive and harmful methods, their implementation as clinical tools for the assessment of children disease is increasing. This review focuses on the current preclinical and clinical applications as well as on the future potential of OI in the clinical routine. Herein, we summarize the development of different fluorescence and bioluminescence imaging techniques for microscopic and macroscopic visualization of microstructures and biological processes. In addition, we discuss advantages and limitations of optical probes with distinct mechanisms of target-detection as well as of different bioluminescent reporter systems. Particular attention has been given to the use of near-infrared (NIR) fluorescent probes enabling observation of molecular events in deeper tissue.

Noise and stray light characterization of a compact CCD spectrophotometer used in biomedical applications

In recent years, new generation spectrophotometers are increasingly used in biomedical applications. Handheld spectrophotometers, offering compactness, versatility, and low cost, have facilitated a broad array of applications in biomedical optics. However, despite the popularity and the diverse range of applications, a detailed characterization of many of these new spectrophotometers in terms of stray light and noise characteristics is missing from the literature. Such a popular instrument (USB2000) is characterized in detail with particular focus and emphasis on its noise and stray light characteristics. The results of the analysis may be useful to numerous users of this and other similar instruments in a diverse range of applications.