Neuronavigation in the surgical management of brain tumors: current and future trends

Orringer, Daniel A.; Golby, Alexandra J.; Jólesz, Ferenc A.

doi:10.1586/erd.12.42

Cited by 197 publications

(127 citation statements)

References 95 publications

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“…Registration between the image space and the surgical space is the preliminary step, and it can be accomplished by identifying corresponding landmarks or surfaces [1,2]. Image guidance can support the surgeon during many types of surgery, such as resections aimed at the removal of brain tumors or of epileptogenic zones.…”

Section: Introductionmentioning

confidence: 99%

A method for the assessment of time-varying brain shift during navigated epilepsy surgery

et al. 2015

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Purpose Image guidance is widely used in neurosurgery. Tracking systems (neuronavigators) allow registering the preoperative image space to the surgical space. The localization accuracy is influenced by technical and clinical factors, such as brain shift. This paper aims at providing quantitative measure of the time-varying brain shift during open epilepsy surgery, and at measuring the pattern of brain deformation with respect to three potentially meaningful parameters: craniotomy area, craniotomy orientation and gravity vector direction in the images reference frame. Methods We integrated an image-guided surgery system with 3D Slicer, an open-source package freely available in the Internet. We identified the preoperative position of several cortical features in the image space of 12 patients, inspecting both the multiplanar and the 3D reconstructions. We subsequently repeatedly tracked their position in the surgical space. Therefore, we measured the cortical shift, following its time-related changes and estimating its correlation with gravity and craniotomy normal directions. Results The mean of the median brain shift amount is 9.64 mm (SD = 4.34 mm). The brain shift amount resulted not correlated with respect to the gravity direction, the craniotomy normal, the angle between the gravity and the craniotomy normal and the craniotomy area. Conclusions Our method, which relies on cortex surface 3D measurements, gave results, which are consistent with liter-

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Section: Introductionmentioning

confidence: 99%

A method for the assessment of time-varying brain shift during navigated epilepsy surgery

et al. 2015

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“…Image-guided neuro-navigation systems represent a routine tool in neurosurgery but they are based on preoperative imaging, so they have to be considered a dynamic but not a real-time technique [1]. The accuracy of this system during surgery is maximum before the craniotomy but decreases with the progress of surgical manipulation; this worsening is inevitable, and it is due to two main factors: the first, socalled brain shift, is caused by the effect of the gravity on the brain, brain swelling and escape of cerebrospinal fluid (CSF); the second is due to parenchymal deformation caused by surgical maneuvers [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

et al. 2014

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The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.Keywords Navigation Á Brain shift Á Intraoperative imaging Á Ultrasound Á Brain tumor Á Fusion imaging Sommario Il principale difetto della neurochirurgia guidata da immagini è il basarsi su immagini acquisite prima dell'intervento, che per ovvie ragioni non possono tenere conto di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti e l'asportazione di tessuto patologico. L'ecografia intra-operatoria (iUS) sta acquisendo sempre maggior rilevanza in ambito neurochirurgico ma è limitata dalla difficoltosa interpretazione dell'orientamento delle immagini e dalla scarsa panoramicità. In questo articolo descriviamo la nostra tecnica di neuronavigazione real-time basata sull'ecografia intra-operatoria. Fino ad ora abbiamo impiegato la fusione d'immagini tra la risonanza magnetica (MRI) pre-operatoria e l'iUS in 67 pazienti affetti da neoplasie cerebrali. La pianificazione dell'intervento e l'approccio chirurgico è basata sulla (MRI) pre-operatoria mentre l'intervento è guidato dall'iUS. Basandosi sull'iUS è possibile correggere la calibrazione delle immagini (MRI) pre-operatorie correggendo il brain-shift, aggiornando continuamente le due modalità. L'ecografia intra-operatoria permette una eccellente identificazione dei target, dei margini e delle strutture circostanti. L'uso del navigatore basato su (MRI) pre-operatoria è utile nella comprensione delle immagini ecografiche soprattutto per quanto riguarda l'orientazione e la visione panoramica. Le correzione del sistema di neuronavigazione basate sull'iUS sono accurate e utili nel caso di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti ...

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“…7,16,18 Fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) allows the identification of tumor tissue with great accuracy, but only on the surface of the surgical cavity; to categorize an area as 5-ALA positive, it is necessary to expose and evaluate it in blue light. In other words, 5-ALA does not allow a complete overview of the tumor; for example, 5-ALA cannot show a residual mass if its surface is not directly exposed.…”

mentioning

confidence: 99%

Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection

Prada¹,

Bene²,

Fornaro³

et al. 2016

FOC

105

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OBJECTIVE The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection. METHODS The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence. RESULTS In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings. CONCLUSIONS As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.

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Neuronavigation in the surgical management of brain tumors: current and future trends

Cited by 197 publications

References 95 publications

A method for the assessment of time-varying brain shift during navigated epilepsy surgery

A method for the assessment of time-varying brain shift during navigated epilepsy surgery

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection

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