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Jellema PEJ, Mannsdörfer LM, Visser F, De Luca A, Smit CLE, Hoving EW, van Baarsen KM, Lindner T, Mutsaerts HJMM, Dankbaar JW, Lequin MH, Wijnen JP. Improving advanced intraoperative MRI methods during pediatric neurosurgery. NMR IN BIOMEDICINE 2024; 37:e5124. [PMID: 38403798 DOI: 10.1002/nbm.5124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
Advanced intraoperative MR images (ioMRI) acquired during the resection of pediatric brain tumors could offer additional physiological information to preserve healthy tissue. With this work, we aimed to develop a protocol for ioMRI with increased sensitivity for arterial spin labeling (ASL) and diffusion MRI (dMRI), optimized for patient positioning regularly used in the pediatric neurosurgery setting. For ethical reasons, ASL images were acquired in healthy adult subjects that were imaged in the prone and supine position. After this, the ASL cerebral blood flow (CBF) was quantified and compared between both positions. To evaluate the impact of the RF coils setups on image quality, we compared different setups (two vs. four RF coils) by looking at T1-weighted (T1w) signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), as well as undertaking a qualitative evaluation of T1w, T2w, ASL, and dMR images. Mean ASL CBF did not differ between the surgical prone and supine positions in any of the investigated regions of interest or the whole brain. T1w SNR (gray matter: p = 0.016, 34% increase; white matter: p = 0.016, 32% increase) and CNR were higher (p = 0.016) in the four versus two RF coils setups (18.0 ± 1.8 vs. 13.9 ± 1.8). Qualitative evaluation of T1w, T2w, ASL, and dMR images resulted in acceptable to good image quality and did not differ statistically significantly between setups. Only the nonweighted diffusion image maps and corticospinal tract reconstructions yielded higher image quality and reduced susceptibility artifacts with four RF coils. Advanced ioMRI metrics were more precise with four RF coils as the standard deviation decreased. Taken together, we have investigated the practical use of advanced ioMRI during pediatric neurosurgery. We conclude that ASL CBF quantification in the surgical prone position is valid and that ASL and dMRI acquisition with two RF coils can be performed adequately for clinical use. With four versus two RF coils, the SNR of the images increases, and the sensitivity to artifacts reduces.
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Affiliation(s)
- Pien E J Jellema
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lilli M Mannsdörfer
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Fredy Visser
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
- Philips HealthCare, Best, The Netherlands
| | - Alberto De Luca
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cynthia L E Smit
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Eelco W Hoving
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kirsten M van Baarsen
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Thomas Lindner
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Henk-Jan M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Pediatric Neuro-Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jannie P Wijnen
- Centre for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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Ju JW, Hwang Y, Lee HJ. Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients. Anesth Pain Med (Seoul) 2023; 18:84-91. [PMID: 36746907 PMCID: PMC9902628 DOI: 10.17085/apm.22171] [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: 04/19/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients forwhom it is difficult to establish peripheral IV access. We aimed to investigate the feasibilityand safety of EJV cannulation in surgical patients. METHODS We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collectedclinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included anyEJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis,pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronicmedical records during the hospitalization period for surgery. RESULTS We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery(49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%).Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases.The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site(65 cases, 0.7%). There was only one case of unplanned intensive care unit admission dueto swelling related to EJV cannulation. CONCLUSIONS Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.
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Affiliation(s)
- Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoonbin Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea,Address for Correspondence: Ho-Jin Lee, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Phone: 82-2-2072-2467 FAX: 82-2-747-8363 E-mail:
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Chhikara M, Bansal S, Bansal N, Raja RM. A broken intravenous cannula in external jugular vein: A rare catastrophe managed timely. Indian J Anaesth 2022; 66:880-881. [PMID: 36654904 PMCID: PMC9842092 DOI: 10.4103/ija.ija_558_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Monika Chhikara
- Department of Anaesthesiology and Critical Care, PGIMS Rohtak, Haryana, India
| | - Sukriti Bansal
- Department of Anaesthesiology and Critical Care, PGIMS Rohtak, Haryana, India,Address for correspondence: Dr. Sukriti Bansal, House Number 967 Sector 17, HUDA Jagadhri, - 135 003 Yamunanagar, Haryana, India. E-mail:
| | - Namit Bansal
- Department of Neurology, Fortis Hospital, Mohali, Punjab, India
| | - Rameez M. Raja
- Department of Anaesthesiology and Critical Care, PGIMS Rohtak, Haryana, India
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