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Rajwani KM, Lavrador JP, Oviedova A, Gullan R, Ashkan K, Vergani F, Bhangoo R. Intraoperative ultrasound to aid resection of a peritorcular meningioma: a technical note. J Surg Case Rep 2021; 2021:rjab462. [PMID: 34733473 PMCID: PMC8560207 DOI: 10.1093/jscr/rjab462] [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: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a peritorcular meningioma involving major venous sinuses, which was removed using a venous sparing approach with the aid of intraoperative ultrasound. We found ultrasound to be a useful adjunct as it enabled us to get real-time information about the location of venous structures, their function and demonstrate dynamic changes in blood flow during surgery.
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Affiliation(s)
| | | | - Anna Oviedova
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital, London, UK
| | | | | | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital, London, UK
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From Grey Scale B-Mode to Elastosonography: Multimodal Ultrasound Imaging in Meningioma Surgery-Pictorial Essay and Literature Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:925729. [PMID: 26101779 PMCID: PMC4458537 DOI: 10.1155/2015/925729] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/10/2015] [Indexed: 11/17/2022]
Abstract
The main goal in meningioma surgery is to achieve complete tumor removal, when possible, while improving or preserving patient neurological functions. Intraoperative imaging guidance is one fundamental tool for such achievement. In this regard, intra-operative ultrasound (ioUS) is a reliable solution to obtain real-time information during surgery and it has been applied in many different aspect of neurosurgery. In the last years, different ioUS modalities have been described: B-mode, Fusion Imaging with pre-operative acquired MRI, Doppler, contrast enhanced ultrasound (CEUS), and elastosonography.
In this paper, we present our US based multimodal approach in meningioma surgery. We describe all the most relevant ioUS modalities and their intraoperative application to obtain precise and specific information regarding the lesion for a tailored approach in meningioma surgery. For each modality, we perform a review of the literature accompanied by a pictorial essay based on our routinely use of ioUS for meningioma resection.
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Tang H, Zhang H, Xie Q, Gong Y, Zheng M, Wang D, Zhu H, Chen X, Zhou L. Application of CUSA Excel ultrasonic aspiration system in resection of skull base meningiomas. Chin J Cancer Res 2015; 26:653-7. [PMID: 25561762 DOI: 10.3978/j.issn.1000-9604.2014.12.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/04/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection. METHODS Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old (the mean age was 48.5 years old). Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge. RESULTS All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation. CONCLUSIONS This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.
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Affiliation(s)
- Hailiang Tang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Haishi Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Mingzhe Zheng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiancheng Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Liangfu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Calligaris D, Norton I, Feldman DR, Ide JL, Dunn IF, Eberlin LS, Cooks RG, Jolesz FA, Golby AJ, Santagata S, Agar NY. Mass spectrometry imaging as a tool for surgical decision-making. JOURNAL OF MASS SPECTROMETRY : JMS 2013; 48:1178-87. [PMID: 24259206 PMCID: PMC3957233 DOI: 10.1002/jms.3295] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 05/18/2023]
Abstract
Despite significant advances in image-guided therapy, surgeons are still too often left with uncertainty when deciding to remove tissue. This binary decision between removing and leaving tissue during surgery implies that the surgeon should be able to distinguish tumor from healthy tissue. In neurosurgery, current image-guidance approaches such as magnetic resonance imaging (MRI) combined with neuronavigation offer a map as to where the tumor should be, but the only definitive method to characterize the tissue at stake is histopathology. Although extremely valuable information is derived from this gold standard approach, it is limited to very few samples during surgery and is not practically used for the delineation of tumor margins. The development and implementation of faster, comprehensive, and complementary approaches for tissue characterization are required to support surgical decision-making--an incremental and iterative process with tumor removed in multiple and often minute biopsies. The development of atmospheric pressure ionization sources makes it possible to analyze tissue specimens with little to no sample preparation. Here, we highlight the value of desorption electrospray ionization as one of many available approaches for the analysis of surgical tissue. Twelve surgical samples resected from a patient during surgery were analyzed and diagnosed as glioblastoma tumor or necrotic tissue by standard histopathology, and mass spectrometry results were further correlated to histopathology for critical validation of the approach. The use of a robust statistical approach reiterated results from the qualitative detection of potential biomarkers of these tissue types. The correlation of the mass spectrometry and histopathology results to MRI brings significant insight into tumor presentation that could not only serve to guide tumor resection, but that is also worthy of more detailed studies on our understanding of tumor presentation on MRI.
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Affiliation(s)
- David Calligaris
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Isaiah Norton
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Daniel R. Feldman
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115
| | - Jennifer L. Ide
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Ian F. Dunn
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Livia S. Eberlin
- Department of Chemistry and Center for Analytical Instrumentation Development, Purdue University, West Lafayette, IN 47907
| | - R. Graham Cooks
- Department of Chemistry and Center for Analytical Instrumentation Development, Purdue University, West Lafayette, IN 47907
| | - Ferenc A. Jolesz
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Alexandra J. Golby
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
| | - Sandro Santagata
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115
| | - Nathalie Y. Agar
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Chemistry and Center for Analytical Instrumentation Development, Purdue University, West Lafayette, IN 47907
- Corresponding author: Dr. Nathalie Y.R. Agar Departments of Neurosurgery and Radiology, Brigham and Women’s Hospital, and Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115. , +1617/525-7374
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