Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis

Fountain, Daniel M; Bryant, Andrew; Barone, Damiano G.; Waqar, Mueez; Hart, Michael G; Bulbeck, Helen; Kernohan, Ashleigh; Watts, Colin; Jenkinson, Michael D.

doi:10.1002/14651858.cd013630.pub2

Cited by 29 publications

(35 citation statements)

References 59 publications

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“…As showed recently by group of DiMeco, current high-end 2D IOUS systems integrated with neuronavigation may be in experienced hands of a significant benefit in terms of both extent of brain tumor resections and neurological outcomes (85). However, further prospective studies are necessary to evaluate impact of IOUS on surgical results (86,87).…”

Section: Future Perspectivesmentioning

confidence: 98%

Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

et al. 2021

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While benefits of intraoperative ultrasound (IOUS) have been frequently described, data on IOUS limitations are relatively sparse. Suboptimal ultrasound imaging of some pathologies, various types of ultrasound artifacts, challenging patient positioning during some IOUS-guided surgeries, and absence of an optimal IOUS probe depicting the entire sellar region during transsphenoidal pituitary surgery are some of the most important pitfalls. This review aims to summarize prominent limitations of current IOUS systems, and to present possibilities to reduce them by using ultrasound technology suitable for a specific procedure and by proper scanning techniques. In addition, future trends of IOUS imaging optimization are described in this article.

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Section: Future Perspectivesmentioning

confidence: 98%

Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

et al. 2021

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“…[165][166][167] Several randomized controlled trials have shown that 5-ALA photodynamic diagnosis is beneficial with respect to indicating resection margins, which improves progression-free survival when compared with standard surgery, although the overall survival is not improved. 168,169 Sodium fluorescence is limited to small cohort studies without uniform results. 167,170 Intraoperative ultrasound IoUS, including microbubble contrast-enhanced and 3D ioUS, provides simultaneous visualization of tumor with the information of surrounding structures.…”

Section: Intraoperative Fluorescence Guidance Under Excitation Lightmentioning

confidence: 99%

Intraoperative MR Imaging during Glioma Resection

2022

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One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motorevoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.

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“…Using validated SRH, it will then be possible to analyze the resection borders during the intervention. In case of residual tumor, the surgeon could repeatedly add SRH results to anatomical, fluorescence [5,24], and neurophysiological [19] criteria to decide continuation or to stop resection.…”

Section: Workflow For the Exploration Of Srh-based Neurosurgical Decision-makingmentioning

confidence: 99%

Neuropathological interpretation of stimulated Raman histology images of brain and spine tumors: part B

et al. 2021

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Intraoperative histopathological examinations are routinely performed to provide neurosurgeons with information about the entity of tumor tissue. Here, we quantified the neuropathological interpretability of stimulated Raman histology (SRH) acquired using a Raman laser imaging system in a routine clinical setting without any specialized training or prior experience. Stimulated Raman scattering microscopy was performed on 117 samples of pathological tissue from 73 cases of brain and spine tumor surgeries. A board-certified neuropathologist — novice in the interpretation of SRH — assessed image quality by scoring subjective tumor infiltration and stated a diagnosis based on the SRH images. The diagnostic accuracy was determined by comparison to frozen hematoxylin–eosin (H&E)-stained sections and the ground truth defined as the definitive neuropathological diagnosis. The overall SRH imaging quality was rated high with the detection of tumor cells classified as inconclusive in only 4.2% of all images. The accuracy of neuropathological diagnosis based on SRH images was 87.7% and was non-inferior to the current standard of fast frozen H&E-stained sections (87.3 vs. 88.9%, p = 0.783). We found a substantial diagnostic correlation between SRH-based neuropathological diagnosis and H&E-stained frozen sections (κ = 0.8). The interpretability of intraoperative SRH imaging was demonstrated to be equivalent to the current standard method of H&E-stained frozen sections. Further research using this label-free innovative alternative vs. conventional staining is required to determine to which extent SRH-based intraoperative decision-making can be streamlined in order to facilitate the advancement of surgical neurooncology.

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Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis

Cited by 29 publications

References 59 publications

Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

Intraoperative MR Imaging during Glioma Resection

Neuropathological interpretation of stimulated Raman histology images of brain and spine tumors: part B

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