Navigable 3D-Ultrasound Facilitates Supra-Radical Resections beyond the Contrast-Enhancing Boundaries in Malignant Gliomas

Dubey, Shubhi; Janu, Amit; Chaudhari, Suresh; Moiyadi, Aliasgar

doi:10.1055/s-0035-1570005

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…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

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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.

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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

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“…[3] упор при определении типа опухоли делается на молекулярно-биологические особенности новообразований, так как считается, что именно реализованные клеткой свойства ее генома и эпигенома содержат в себе ключ к новым методам диагностики и терапии новообразований мозга [4][5][6]. На сегодняшний день стандартом лечения глиальных опухолей головного мозга является комбинированное лечение -радикальное либо сверхрадикальное (иссечение тканей за границей контрастируемой части опухоли) нейрохирургическое вмешательство с использованием современных систем интраоперационной навигации и визуализации в сочетании с последующими химиотерапией и лучевой терапией [1, [7][8][9][10][11][12][13]. В ходе операции хирург сталкивается с серьезными вызовами, требующими быстрого ответа на ряд непростых вопросов.…”

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The role of lipid metabolism disorders, atypical isoforms of protein kinase C, and mutational status of cytosolic and mitochondrial forms of isocitrate dehydrogenase in carcinogenesis of glial tumors

Никитин¹,

Потапов²,

Ryzhova³

et al. 2018

Vopr. neirokhir.

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The relationship between molecular genetic and metabolic disorders is one of the challenges of modern oncology. In this review, we consider lipid metabolism and its changes as one of the factors of oncogenesis of glial tumors. Also, we demonstrate that the genome and the metabolome are interconnected by a large number of links, and the metabolic pathways, during their reorganization, are able to drastically affect the genetic structure of the cell and, in particular, cause its tumor transformation. Our own observations and analysis of the literature data allow us to conclude that mass spectrometry is a highly accurate current method for assessing metabolic disorders at the cellular level. The use of mass spectrometry during surgery allows the neurosurgeon to obtain real-time data on the level of specific molecular markers in the resected tissue, thereby bringing intraoperative navigation techniques to the molecular level. The generation of molecular fingerprints for each tumor significantly complements the available neuroimaging, molecular genetic, and immunohistochemical data.

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“…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 ]. Large systematic reviews and meta-analyses have also indicated that IOUS can be a very useful adjunct to improve the resections of gliomas [ 15 , 16 ].…”

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

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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.

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Navigable 3D-Ultrasound Facilitates Supra-Radical Resections beyond the Contrast-Enhancing Boundaries in Malignant Gliomas

Cited by 4 publications

References 9 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

The role of lipid metabolism disorders, atypical isoforms of protein kinase C, and mutational status of cytosolic and mitochondrial forms of isocitrate dehydrogenase in carcinogenesis of glial tumors

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

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