Intraoperative Ultrasound Technology in Neuro-Oncology Practice—Current Role and Future Applications

Moiyadi, Aliasgar

doi:10.1016/j.wneu.2016.05.083

Cited by 45 publications

(25 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ultrasound is a relatively cheap, direct, and repeatable tool for detecting both high- and low-grade lesions and large surrounding vessels. It requires a long learning curve due to the difficulty in interpreting the echoic signal and the probes are still bulky and wired, making its frequent (real-time indeed) use impractical 5, 42, 43, 44. In addition, its main limitations are the inability to scan sonically hidden corners and the low contrast and spatial resolution: 8% of surgeons have labelled as poor its image quality 5 .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Magnetic Resonance Imaging–Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System

Pichierri

Bradley

Iyer

2019

World Neurosurgery: X

View full text Add to dashboard Cite

Background Despite the most recent surgical aids and tools, surgical removal of infiltrating brain tumors remains a challenge. Unclear margins, edematous areas, and infiltrative behavior are the main causes for failing gross total removals. Also, excessive resection of peri-tumoral tissue often carries risks of damaging the nearby functioning cortical and subcortical structures with an unacceptable decrease in patient's quality of life and postoperative functional status, and the risk of making patients not eligible to adjuvant treatments. Awake surgery and intraoperative magnetic resonance imaging (ioMRI) are among the most effective aids in preventing damage to functional brain while maximizing the extent of resection. Methods We present our series of 46 patients operated on at Southmead Hospital (North Bristol NHS Trust) in between July 2014 and February 2017 using ioMRI plus or minus awake surgery. Setting, patient features, indications, type and size of tumors, surgical times, extent of resection, morbidity, and survival are analyzed and discussed. Results Overall, ioMRI check led to a +43% resections in Group 1 and +58% in Group 2. In grade 2 tumors, GTR was 46% in Group 1 and 55% in Group 2 (41% in control group). In grade 3 tumors, GTR was 57% in Group 1 and 66% in Group 2 (30% in control group). In Grade 4 tumors, GTR was 63% in Group 1, 66% in Group 2 (36% in control group). In terms of theatre occupation, the use of ioMRI added 1/2 operative session; the addition of awake surgery implied the use of another 1/2 operative session. Morbidity did not differ among the groups, with low incidence of permanent post-operative deficits (<5%). Group 2 OS was statistically longer when compared to the control group. Conclusions Using ioMRI together with awake surgery is demanding for the anesthetic team, staff nurses, and for the patient. Nevertheless, low morbidity, greater total resections rates, and longer survival suggest its use is effective in making more approachable gliomas of all grades that we would consider “complex” due to their intrinsic features or locations.

show abstract

Section: Discussionmentioning

confidence: 99%

Intraoperative Magnetic Resonance Imaging–Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System

Pichierri

Bradley

Iyer

2019

World Neurosurgery: X

View full text Add to dashboard Cite

show abstract

“…In glioma surgery residual tumor has a great impact on the overall survival rate but also on progression-free survival (Coburger et al, 2016; Moiyadi, 2016; Petridis et al, 2015). For the optimal outcome after surgery a balance has to be established between maximization of surgical cytoreduction and minimization of new permanent neurological deficits to preserve and prolong the patient's resulting quality of life (Prada et al, 2016; Renovanz et al, 2014; Yong and Lonser, 2011).…”

Section: Introductionmentioning

confidence: 99%

Automatic and efficient MRI-US segmentations for improving intraoperative image fusion in image-guided neurosurgery

Nitsch

Klein

Dammann

et al. 2019

NeuroImage: Clinical

View full text Add to dashboard Cite

Knowledge of the exact tumor location and structures at risk in its vicinity are crucial for neurosurgical interventions. Neuronavigation systems support navigation within the patient's brain, based on preoperative MRI (preMRI). However, increasing tissue deformation during the course of tumor resection reduces navigation accuracy based on preMRI. Intraoperative ultrasound (iUS) is therefore used as real-time intraoperative imaging. Registration of preMRI and iUS remains a challenge due to different or varying contrasts in iUS and preMRI. Here, we present an automatic and efficient segmentation of B-mode US images to support the registration process. The falx cerebri and the tentorium cerebelli were identified as examples for central cerebral structures and their segmentations can serve as guiding frame for multi-modal image registration. Segmentations of the falx and tentorium were performed with an average Dice coefficient of 0.74 and an average Hausdorff distance of 12.2 mm. The subsequent registration incorporates these segmentations and increases accuracy, robustness and speed of the overall registration process compared to purely intensity-based registration. For validation an expert manually located corresponding landmarks. Our approach reduces the initial mean Target Registration Error from 16.9 mm to 3.8 mm using our intensity-based registration and to 2.2 mm with our combined segmentation and registration approach. The intensity-based registration reduced the maximum initial TRE from 19.4 mm to 5.6 mm, with the approach incorporating segmentations this is reduced to 3.0 mm. Mean volumetric intensity-based registration of preMRI and iUS took 40.5 s, including segmentations 12.0 s.

show abstract

“…The initial phase of the learning curve is long, but the use of nUS can substantially shorten this phase. In our experience, IOUS is a very useful tool for the treatment of all kinds of brain tumors [ 3 , 9 ]. It is particularly useful for targeted biopsies [ 10 ] as well as the resection of intra-axial tumors [ 11 - 14 ].…”

Section: Discussionmentioning

confidence: 99%

Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology

Yeole¹,

Singh²,

Mishra³

et al. 2020

Ultrasonography

View full text Add to dashboard Cite

Intraoperative imaging has become one of the most important adjuncts in neurosurgery, especially in the surgical treatment of intra-axial tumors. Navigation and intraoperative magnetic resonance imaging have limitations, and intraoperative ultrasonography (IOUS) has emerged as a versatile and multifaceted alternative. With technological advances in ultrasound scanners and newer multifunctional probes, the potential of IOUS is increasingly being utilized in the resection of tumors. The addition of image guidance to IOUS has exponentially increased the power of this technique. Navigated ultrasonography (nUS) can now overcome many of the limitations of conventional standalone two-dimensional ultrasonography. In this pictorial essay, we outline our nUS technique (both two-and three-dimensional) for the resection of intra-axial tumors with illustrated examples highlighting the various steps and corresponding benefits of the technique.

show abstract

Intraoperative Ultrasound Technology in Neuro-Oncology Practice—Current Role and Future Applications

Cited by 45 publications

References 107 publications

Intraoperative Magnetic Resonance Imaging–Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System

Intraoperative Magnetic Resonance Imaging–Guided Glioma Resections in Awake or Asleep Settings and Feasibility in the Context of a Public Health System

Automatic and efficient MRI-US segmentations for improving intraoperative image fusion in image-guided neurosurgery

Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology

Contact Info

Product

Resources

About