Use of Frameless Stereotactic Navigation System Combined with Intraoperative Magnetic Resonance Imaging and 5-Aminolevulinic Acid

Giordano, Mario; Gallieni, Massimo; Zaed, Ismail; Samii, Amir

doi:10.1016/j.wneu.2019.07.171

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Common intraoperative diagnostic imaging techniques include intraoperative magnetic resonance (IOMR), intraoperative computed tomography (IOCT), intraoperative ultrasound (IOUS), and dyes (fluorescence). Given the problems inherent to navigation systems based on preoperative imaging, the aforementioned techniques attempt to eliminate errors produced by brain shift due to loss of cerebrospinal fluid and tumor tissue removal [8].…”

Section: Introductionmentioning

confidence: 99%

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Shi

Zhang

Yao

et al. 2021

BioMed Research International

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Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.

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Section: Introductionmentioning

confidence: 99%

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Shi

Zhang

Yao

et al. 2021

BioMed Research International

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“…Other groups have also suggested methods for intraoperative feedback of tissue [11][12][13][14]44,45]. These techniques aim to replace intraoperative pathology through optical feedback, but as the tissue is placed under the microscope after it has been sampled, further benefits are to be gained.…”

Section: Discussionmentioning

confidence: 99%

Combined Use of Frameless Neuronavigation and In Situ Optical Guidance in Brain Tumor Needle Biopsies

2023

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Brain tumor needle biopsies are performed to retrieve tissue samples for neuropathological analysis. Although preoperative images guide the procedure, there are risks of hemorrhage and sampling of non-tumor tissue. This study aimed to develop and evaluate a method for frameless one-insertion needle biopsies with in situ optical guidance and present a processing pipeline for combined postoperative analysis of optical, MRI, and neuropathological data. An optical system for quantified feedback on tissue microcirculation, gray–whiteness, and the presence of a tumor (protoporphyrin IX (PpIX) accumulation) with a one-insertion optical probe was integrated into a needle biopsy kit that was used for frameless neuronavigation. In Python, a pipeline for signal processing, image registration, and coordinate transformation was set up. The Euclidian distances between the pre- and postoperative coordinates were calculated. The proposed workflow was evaluated on static references, a phantom, and three patients with suspected high-grade gliomas. In total, six biopsy samples that overlapped with the region of the highest PpIX peak without increased microcirculation were taken. The samples were confirmed as being tumorous and postoperative imaging was used to define the biopsy locations. A 2.5 ± 1.2 mm difference between the pre- and postoperative coordinates was found. Optical guidance in frameless brain tumor biopsies could offer benefits such as quantified in situ indication of high-grade tumor tissue and indications of increased blood flow along the needle trajectory before the tissue is removed. Additionally, postoperative visualization enables the combined analysis of MRI, optical, and neuropathological data.

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“…To overcome these issues, the efficacy of FSBs with 5-ALA using violet-blue light excitation was reported. 6 , 7 ) Widhalm et al proved that strong fluorescence of the biopsy samples would provide an intraoperative histological diagnosis. However, the fluorescence of the tissue sample examined using the microscope with violet-blue light provided immediate information on the nature of the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…iMRI was also reported as an adjuvant modality for the stereotactic biopsy or electrode placement of deep brain stimulation (DBS). 1 , 10 , 11 ) Giordano et al also reported the same approach with iMRI and 5-ALA. 6 ) The superiority of iMRI compared with iCT is overpoweringly good image resolution and avoiding radiation exposure. However, the efficacy of their procedure is questionable because iMRI is also time-consuming as well as the intraoperative histological diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Frameless Stereotactic Biopsy with Intraoperative Computed Tomography "Assessment of Efficacy and Real Target Registration Error"

Ikeda

Katayama

Kawabata

et al. 2022

Neurol. Med. Chir.(Tokyo)

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Frameless stereotactic brain biopsy (FSB) with navigation system has been widely used. We reported preliminary experience of FSB with intraoperative computed tomography (iCT) and examined the usefulness of this novel adjuvant technique and real target registration error (rTRE) of FSB. The FSB with 5-aminolevulinic acid (5-ALA) and iCT was performed on 10 patients. The gadolinium-enhanced lesions on magnetic resonance image were defined as the biopsy target. In the procedure, iCTs were scanned twice, for autoregistration of the navigation system and for confirmation of the position of the actual inserted biopsy needle. The red fluorescence of the samples was observed under excitation with violet-blue light through a low-cut filter of neurosurgical microscope. The distance between the planned target and the tip of the biopsy needle in the image of iCT was calculated in a workstation for the assessment of rTRE. The median volume of the target was 12.13 mL (0.06-39.15 mL). We performed the surgical procedure in a prone position in four patients. None to faint 5-ALA-induced fluorescence was observed in six samples. There existed no sampling errors. The mean target distance between the planned and real targets of the mean rTRE of FSB was 2.7 ± 0.56 mm. The real TRE of FSB was first reported and was larger than the reported rTRE exactly calculated from the fiducial registration error. iCT guarantees accurate tumor sampling with autoregistration regardless of the surgical position and prevents inaccurate biopsy to occur even with ALA fluorescence assistance.

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Use of Frameless Stereotactic Navigation System Combined with Intraoperative Magnetic Resonance Imaging and 5-Aminolevulinic Acid

Cited by 10 publications

References 16 publications

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Application of Multiparametric Intraoperative Ultrasound in Glioma Surgery

Combined Use of Frameless Neuronavigation and In Situ Optical Guidance in Brain Tumor Needle Biopsies

Frameless Stereotactic Biopsy with Intraoperative Computed Tomography "Assessment of Efficacy and Real Target Registration Error"

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