Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas

Barbagallo, Giuseppe; Palmucci, Stefano; Visocchi, Massimiliano; Paratore, Sabrina; Attinà, Giancarlo; Sortino, Giuseppe; Albanese, Vincenzo; Certo, Francesco

doi:10.1227/neu.0000000000001112

Cited by 30 publications

(40 citation statements)

References 24 publications

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“…Sixty-four studies describe the clinical use of fluorescent agents [1, 3, 5, 6, 9, 11, 13–16, 22–26, 28–31, 33–35, 37, 38, 40–42, 44, 49, 52–54, 58, 64–66, 69, 71, 74, 75, 78, 80–82, 84–87, 89, 92, 94, 97–101, 105–107, 109, 110, 113, 115, 118]. Three ways of labeling tumor cells were identified in the literature: (1) passive, (2) metabolic, and (3) molecular labeling.…”

Section: Resultsmentioning

confidence: 99%

“…Forty-four clinical studies described the use of 5-ALA for glioma surgery [3, 5, 6, 13–16, 22, 24–26, 28, 30, 31, 33, 34, 37, 40–42, 44, 66, 69, 74, 75, 78, 81, 82, 84, 85, 87, 89, 94, 97–101, 105, 106, 109, 110, 113, 115], of which only six studies included LGGs [28, 33, 84, 109, 110, 113]. 5-ALA is the only fluorescent agent that has been tested in an RCT.…”

Section: Resultsmentioning

confidence: 99%

“…The study by Stummer et al showed a higher GTR rate for the 5-ALA group compared to the group that was operated without 5-ALA (65 vs. 35%) [99]. In observational studies, the rate of GTR after 5-ALA administration ranges from 25 to 94.3% for HGGs [3, 5, 6, 14, 16, 22, 24, 25, 30, 31, 34, 40, 42, 44, 69, 75, 82, 87, 89, 94, 98, 99, 105, 106, 113]. However, studies that included a control group all confirm a significantly higher GTR rate in the FGS group [14, 24, 82, 94, 99].…”

Section: Resultsmentioning

confidence: 99%

“…To increase the accuracy of LGGs, FGS was combined with intra-operative confocal microscopy [84] or an intraoperative probe for quantitative fluorescence measurement [109]. Other intraoperative techniques used to increase the extent of glioma resection are photodynamic therapy (PDT) [26], iMRI [14, 30, 34, 40, 78, 85], intra-operative CT [5], exoscope imaging [6, 75], fluorescence spectrometry [37, 100], confocal microscopy [84], and intraoperative mapping [22, 89]. …”

Section: Resultsmentioning

confidence: 99%

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Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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BackgroundFluorescence-guided surgery (FGS) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection in glioma surgery. In this paper, we systematically review all clinically tested fluorescent agents for application in FGS for glioma and all preclinically tested agents with the potential for FGS for glioma.MethodsWe searched the PubMed and Embase databases for all potentially relevant studies through March 2016. We assessed fluorescent agents by the following outcomes: rate of gross total resection (GTR), overall and progression-free survival, sensitivity and specificity in discriminating tumor and healthy brain tissue, tumor-to-normal ratio of fluorescent signal, and incidence of adverse events.ResultsThe search strategy resulted in 2155 articles that were screened by titles and abstracts. After full-text screening, 105 articles fulfilled the inclusion criteria evaluating the following fluorescent agents: 5-aminolevulinic acid (5-ALA) (44 studies, including three randomized control trials), fluorescein (11), indocyanine green (five), hypericin (two), 5-aminofluorescein-human serum albumin (one), endogenous fluorophores (nine) and fluorescent agents in a pre-clinical testing phase (30). Three meta-analyses were also identified.Conclusions5-ALA is the only fluorescent agent that has been tested in a randomized controlled trial and results in an improvement of GTR and progression-free survival in high-grade gliomas. Observational cohort studies and case series suggest similar outcomes for FGS using fluorescein. Molecular targeting agents (e.g., fluorophore/nanoparticle labeled with anti-EGFR antibodies) are still in the pre-clinical phase, but offer promising results and may be valuable future alternatives.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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“…Another solution is the use of intraoperative MR imaging, CT, or US (10)(11)(12)(13)(14). The first two modalities take into TECHNICAL DEVELOPMENTS: Contrast-enhanced MR Imaging versus Contrast-enhanced US for Glioblastoma Prada et al started to study the contrast material kinetics in the lesion from the arrival in major vessels to the washout; usually the cine clip was registered for at least 100 seconds (range, 100-300 seconds), enabling study of the lesion on both the main axis and the entire volume, along with whole vascular phases.…”

Section: Implication For Patient Carementioning

confidence: 99%

Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using Intraoperative Fusion Imaging

et al. 2017

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Supported by the Seventh Framework Programme (grant 602 923).q RSNA, 2017 Purpose:To compare contrast material enhancement of glioblastoma multiforme (GBM) with intraoperative contrast-enhanced ultrasonography (US) versus that with preoperative gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging by using real-time fusion imaging. Materials andMethods:Ten patients with GBM were retrospectively identified by using routinely collected, anonymized data. Navigated contrastenhanced US was performed after intravenous administration of contrast material before tumor resection. All patients underwent tumor excision with navigated intraoperative US guidance with use of fusion imaging between real-time intraoperative US and preoperative MR imaging. With use of fusion imaging, glioblastoma contrast enhancement at contrast-enhanced US (regarding location, morphologic features, margins, dimensions, and pattern) was compared with that at gadolinium-enhanced T1-weighted MR imaging. Results:Fusion imaging for virtual navigation enabled matching of realtime contrast-enhanced US scans to corresponding coplanar preoperative gadolinium-enhanced T1-weighted MR images in all cases, with a positional discrepancy of less than 2 mm. Contrast enhancement of gadolinium-enhanced T1-weighted MR imaging and contrast-enhanced US was superimposable in all cases with regard to location, margins, dimensions, and morphologic features. The qualitative analysis of contrast enhancement pattern demonstrated a similar distribution in contrast-enhanced US and gadolinium-enhanced T1-weighted MR imaging in nine patients: Seven lesions showed peripheral inhomogeneous ring enhancement, and two lesions showed a prevalent nodular pattern. In one patient, the contrast enhancement pattern differed between the two modalities: Contrast-enhanced US showed enhancement of the entire bulk of the tumor, whereas gadolinium-enhanced T1-weighted MR imaging demonstrated peripheral contrast enhancement. Conclusion:Glioblastoma contrast enhancement with contrast-enhanced US is superimposable on that provided with preoperative gadolinium-enhanced T1-weighted MR imaging regarding location, margins, morphologic features, and dimensions, with a similar enhancement pattern in most cases. Thus, contrast-enhanced US is of potential use in the surgical management of GBM.q RSNA, 2017

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Surgical Margin Assessment and Cancer Localization in Children

Pio

Davidoff

Abdelhafeez

2023

Pediatric Surgical Oncology

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Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas

Cited by 30 publications

References 24 publications

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Contrast-enhanced MR Imaging versus Contrast-enhanced US: A Comparison in Glioblastoma Surgery by Using Intraoperative Fusion Imaging

Surgical Margin Assessment and Cancer Localization in Children

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