Intraoperative tumor segmentation and volume measurement in MRI-guided glioma surgery for tumor resection rate control1

Abstract BACKGROUND: The beneficial role of the extent of resection (EOR) in glioma surgery in correlation to increased survival remains controversial. However, common literature favors maximum EOR with preservation of neurological function, which is shown to be associated with a significantly improved outcome. OBJECTIVE: In order to obtain a maximum EOR, it was examined whether high-field intraoperative magnetic resonance imaging (iMRI) combined with multimodal navigation contributes to a significantly improved EOR in glioma surgery. METHODS: Two hundred ninety-three glioma patients underwent craniotomy and tumor resection with the aid of intraoperative 1.5 T MRI and integrated multimodal navigation. In cases of remnant tumor, an update of navigation was performed with intraoperative images. Tumor volume was quantified pre- and intraoperatively by segmentation of T2 abnormality in low-grade and contrast enhancement in high-grade gliomas. RESULTS: In 25.9% of all cases examined, additional tumor mass was removed as a result of iMRI. This led to complete tumor resection in 20 cases, increasing the rate of gross-total removal from 31.7% to 38.6%. In 56 patients, additional but incomplete resection was performed because of the close location to eloquent brain areas. Volumetric analysis showed a significantly (P < .01) reduced mean percentage of tumor volume following additional further resection after iMRI from 33.5% ± 25.1% to 14.7% ± 23.3% (World Health Organization [WHO] grade I, 32.8% ± 21.9% to 6.1% ± 18.8%; WHO grade II, 24.4% ± 25.1% to 10.8% ± 11.0%; WHO grade III, 35.1% ± 27.3% to 24.8% ± 26.3%; WHO grade IV, 34.2% ± 23.7% to 1.2% ± 16.2%). CONCLUSION: MRI in conjunction with multimodal navigation and an intraoperative updating procedure enlarges tumor-volume reduction in glioma surgery significantly without higher postoperative morbidity.

Download Full-text

FLGS-01. Development of novel topical fluorescent probe for intraoperative rapid detection of glioma

Neuro-Oncology ◽

10.1093/neuonc/noab196.905 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi225-vi226

Author(s):

Shota Tanaka ◽

Yosuke Kitagawa ◽

Mako Kamiya ◽

Takenori Shimizu ◽

Yasuteru Urano ◽

...

Keyword(s):

Malignant Glioma ◽

Fluorescent Probe ◽

Rapid Detection ◽

Aminolevulinic Acid ◽

Characteristic Curve ◽

Screening Method ◽

Tumor Resection ◽

Phase Iii ◽

Glioma Surgery ◽

Two Dimensional Gel Electrophoresis

Abstract PURPOSE Fluorescence imaging is an important surgical adjunct in malignant glioma surgery. 5-aminolevulinic acid (5-ALA) has been proven effective for radical tumor resection and extended progression-free survival in a phase III randomized trial and therefore integrated into surgery for malignant glioma. Importantly, however, some limitations still exist in its use, which include false positivity and false negativity as well as inability of re-administration. In this study, we aimed to develop a novel, spray-type fluorescent probe using hydroxymethyl rhodamine green (HMRG) as a fluorescent scaffold. METHODS We have previously established a fluorescent probe library comprised of more than 320 kinds of HMRG probes. They have HMRG as a fluorescent scaffold with various types of dipeptides attached to it. Primary probe screening was performed using the homogenized tumor samples from patients with glioblastoma operated at our institution. Secondary screening followed using the selected probes and fresh tumor samples obtained from patients with glioblastoma operated from 2016 until 2018. Diced electrophoresis gel (DEG) assay, two-dimensional gel electrophoresis followed by a multi-well plate-based fluorometric assay, was performed to identify responsible enzymes for the selected probe. Further experiments with inhibitors, real-time PCR, immunohistochemistry, and western blotting were performed for confirmation. RESULTS Proline-arginine-HMRG (PR-HMRG) was selected as a candidate probe based upon the above two-step screenings. It achieved 79.4% accuracy in receiver operating characteristic curve analysis. Calpain-1 was found to be responsible to cleave PR-HMRG probe by DEG-proteome analysis. Calpain-1 protein was highly expressed in tumor tissues which reacted to PR-HMRG probe. CONCLUSIONS Our innovative screening method was able to find PR-HMRG as a novel fluorescent probe effective for rapid detection of glioblastoma. A preclinical study is planned to assess the efficacy and safety of the selected probe.

Download Full-text

Comparative Analysis on the Curative Effect of Endoscopic Submucosal Dissection and Mucosal Resection in the Treatment of Gastric Neuroendocrine Tumor

Proceedings of Anticancer Research ◽

10.26689/par.v5i5.2589 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Nannan Zhao ◽

Nan Li

Keyword(s):

Endoscopic Submucosal Dissection ◽

Neuroendocrine Tumor ◽

Reference Group ◽

Tumor Resection ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Resection Rate ◽

Mucosal Resection ◽

Submucosal Dissection

Objective: To study the therapeutic effect of endoscopic submucosal dissection and mucosal resection on gastric neuroendocrine tumor. Methods: A hundred patients with gastric neuroendocrine tumor that were treated in the Affiliated Hospital of Chifeng University from January 2016 to May 2021 were randomly selected for this research. They were divided into two groups, which were the control group (endoscopic mucosal resection) and the study group (endoscopic submucosal dissection), by the digital table method. The curative effects of the two groups were observed and compared. Results: Before operation, there were no significant differences in serum CgA, TNF-?, and IL-6 between the two groups, p > 0.05. After surgical treatment, the operation time and hospital stay of the patients in the study group were shorter than those in the control group, the amount of surgical bleeding was also less compared to the control group, and the complete tumor resection rate was higher than that in the control group (p < 0.05); the levels of IL-6 and CgA of the study group were lower than those in the control group, while the levels of TNF-? were higher than those of the control group, p < 0.05; the postoperative complication rate of the study group was lower than that of the reference group (p < 0.05). Conclusion: Endoscopic submucosal dissection is more effective for gastric neuroendocrine tumors. The resection rate of the tumor is high, and the operation risk is low.

Download Full-text

Letter to the Editor Regarding “The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection”

World Neurosurgery ◽

10.1016/j.wneu.2018.12.179 ◽

2019 ◽

Vol 125 ◽

pp. 553-554

Author(s):

Francesco Prada ◽

Ignazio G. Vetrano ◽

Massimiliano DelBene ◽

Giovanni Mauri ◽

Luca M. Sconfienza ◽

...

Keyword(s):

Tumor Resection ◽

Intraoperative Ultrasound ◽

Glioma Surgery ◽

Factors Associated ◽

Letter To The Editor ◽

Diagnostic Properties

Download Full-text

Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

Gastroenterology Report ◽

10.1093/gastro/goaa050 ◽

2020 ◽

Author(s):

Qiang Zhang ◽

Jian-Qun Cai ◽

Zhen Wang

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Operative Time ◽

Perioperative Complications ◽

Tumor Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

Download Full-text

A novel threshold criterion in transcranial motor evoked potentials during surgery for gliomas close to the motor pathway

Journal of Neurosurgery ◽

10.3171/2015.8.jns151439 ◽

2016 ◽

Vol 125 (4) ◽

pp. 795-802 ◽

Cited By ~ 10

Author(s):

Tammam Abboud ◽

Miriam Schaper ◽

Lasse Dührsen ◽

Cindy Schwarz ◽

Nils Ole Schmidt ◽

...

Keyword(s):

Evoked Potentials ◽

Motor Evoked Potentials ◽

Tumor Resection ◽

Threshold Level ◽

Neurological Deterioration ◽

Motor Deficit ◽

Percentage Increase ◽

Glioma Surgery ◽

Leg Muscles ◽

Threshold Criterion

OBJECTIVE Warning criteria for monitoring of motor evoked potentials (MEP) after direct cortical stimulation during surgery for supratentorial tumors have been well described. However, little is known about the value of MEP after transcranial electrical stimulation (TES) in predicting postoperative motor deficit when monitoring threshold level. The authors aimed to evaluate the feasibility and value of this method in glioma surgery by using a new approach for interpreting changes in threshold level involving contra- and ipsilateral MEP. METHODS Between November 2013 and December 2014, 93 patients underwent TES-MEP monitoring during resection of gliomas located close to central motor pathways but not involving the primary motor cortex. The MEP were elicited by transcranial repetitive anodal train stimulation. Bilateral MEP were continuously evaluated to assess percentage increase of threshold level (minimum voltage needed to evoke a stable motor response from each of the muscles being monitored) from the baseline set before dural opening. An increase in threshold level on the contralateral side (facial, arm, or leg muscles contralateral to the affected hemisphere) of more than 20% beyond the percentage increase on the ipsilateral side (facial, arm, or leg muscles ipsilateral to the affected hemisphere) was considered a significant alteration. Recorded alterations were subsequently correlated with postoperative neurological deterioration and MRI findings. RESULTS TES-MEP could be elicited in all patients, including those with recurrent glioma (31 patients) and preoperative paresis (20 patients). Five of 73 patients without preoperative paresis showed a significant increase in threshold level, and all of them developed new paresis postoperatively (transient in 4 patients and permanent in 1 patient). Eight of 20 patients with preoperative paresis showed a significant increase in threshold level, and all of them developed postoperative neurological deterioration (transient in 4 patients and permanent in 4 patients). In 80 patients no significant change in threshold level was detected, and none of them showed postoperative neurological deterioration. The specificity and sensitivity in this series were estimated at 100%. Postoperative MRI revealed gross-total tumor resection in 56 of 82 patients (68%) in whom complete tumor resection was attainable; territorial ischemia was detected in 4 patients. CONCLUSIONS The novel threshold criterion has made TES-MEP a useful method for predicting postoperative motor deficit in patients who undergo glioma surgery, and has been feasible in patients with preoperative paresis as well as in patients with recurrent glioma. Including contra- and ipsilateral changes in threshold level has led to a high sensitivity and specificity.

Download Full-text

Intraoperative perception and estimates on extent of resection during awake glioma surgery: overcoming the learning curve

Journal of Neurosurgery ◽

10.3171/2017.1.jns161811 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1410-1418 ◽

Cited By ~ 9

Author(s):

Darryl Lau ◽

Shawn L. Hervey-Jumper ◽

Seunggu J. Han ◽

Mitchel S. Berger

Keyword(s):

Learning Curve ◽

Tumor Resection ◽

Extent Of Resection ◽

Neurological Deficits ◽

Language Outcomes ◽

Glioma Surgery ◽

Ample Evidence ◽

Postoperative Mri ◽

Significant Difference ◽

Surgeon Experience

OBJECTIVEThere is ample evidence that extent of resection (EOR) is associated with improved outcomes for glioma surgery. However, it is often difficult to accurately estimate EOR intraoperatively, and surgeon accuracy has yet to be reviewed. In this study, the authors quantitatively assessed the accuracy of intraoperative perception of EOR during awake craniotomy for tumor resection.METHODSA single-surgeon experience of performing awake craniotomies for tumor resection over a 17-year period was examined. Retrospective review of operative reports for quantitative estimation of EOR was recorded. Definitive EOR was based on postoperative MRI. Analysis of accuracy of EOR estimation was examined both as a general outcome (gross-total resection [GTR] or subtotal resection [STR]), and quantitatively (5% within EOR on postoperative MRI). Patient demographics, tumor characteristics, and surgeon experience were examined. The effects of accuracy on motor and language outcomes were assessed.RESULTSA total of 451 patients were included in the study. Overall accuracy of intraoperative perception of whether GTR or STR was achieved was 79.6%, and overall accuracy of quantitative perception of resection (within 5% of postoperative MRI) was 81.4%. There was a significant difference (p = 0.049) in accuracy for gross perception over the 17-year period, with improvement over the later years: 1997–2000 (72.6%), 2001–2004 (78.5%), 2005–2008 (80.7%), and 2009–2013 (84.4%). Similarly, there was a significant improvement (p = 0.015) in accuracy of quantitative perception of EOR over the 17-year period: 1997–2000 (72.2%), 2001–2004 (69.8%), 2005–2008 (84.8%), and 2009–2013 (93.4%). This improvement in accuracy is demonstrated by the significantly higher odds of correctly estimating quantitative EOR in the later years of the series on multivariate logistic regression. Insular tumors were associated with the highest accuracy of gross perception (89.3%; p = 0.034), but lowest accuracy of quantitative perception (61.1% correct; p < 0.001) compared with tumors in other locations. Even after adjusting for surgeon experience, this particular trend for insular tumors remained true. The absence of 1p19q co-deletion was associated with higher quantitative perception accuracy (96.9% vs 81.5%; p = 0.051). Tumor grade, recurrence, diagnosis, and isocitrate dehydrogenase-1 (IDH-1) status were not associated with accurate perception of EOR. Overall, new neurological deficits occurred in 8.4% of cases, and 42.1% of those new neurological deficits persisted after the 3-month follow-up. Correct quantitative perception was associated with lower postoperative motor deficits (2.4%) compared with incorrect perceptions (8.0%; p = 0.029). There were no detectable differences in language outcomes based on perception of EOR.CONCLUSIONSThe findings from this study suggest that there is a learning curve associated with the ability to accurately assess intraoperative EOR during glioma surgery, and it may take more than a decade to be truly proficient. Understanding the factors associated with this ability to accurately assess EOR will provide safer surgeries while maximizing tumor resection.

Download Full-text

Intraoperative segmentation of brain tumors for open MRI guided glioma surgery

International Congress Series ◽

10.1016/j.ics.2004.03.055 ◽

2004 ◽

Vol 1268 ◽

pp. 1284 ◽

Cited By ~ 2

Author(s):

Takashi Inomata ◽

Yoshihiro Muragaki ◽

Hiroshi Iseki ◽

Takeyoshi Dohi ◽

Nobuhiko Hata

Keyword(s):

Brain Tumors ◽

Glioma Surgery ◽

Open Mri ◽

Mri Guided

Download Full-text

Initial assessment of costs and benefits of MRI-guided brain tumor resection

European Radiology ◽

10.1007/s003300000740 ◽

2000 ◽

Vol 10 (0) ◽

pp. S366-S367 ◽

Cited By ~ 10

Author(s):

K. Kowalik ◽

C. Truwit ◽

W. Hall

Keyword(s):

Brain Tumor ◽

Tumor Resection ◽

Initial Assessment ◽

Costs And Benefits ◽

Brain Tumor Resection ◽

Mri Guided

Download Full-text

Usefulness of Intraoperative Ultra Low-field Magnetic Resonance Imaging in Glioma Surgery

Operative Neurosurgery ◽

10.1227/01.neu.0000313624.77452.3c ◽

2008 ◽

Vol 63 (suppl_4) ◽

pp. ONS257-ONS267 ◽

Cited By ~ 42

Author(s):

Christian Senft ◽

Volker Seifert ◽

Elvis Hermann ◽

Kea Franz ◽

Thomas Gasser

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Tumor Resection ◽

Extent Of Resection ◽

Resonance Imaging ◽

Complete Tumor Resection ◽

Glioma Surgery ◽

Low Field ◽

Low Field Mri ◽

Complete Tumor

Abstract Objective: The aim of this study was to demonstrate the usefulness of a mobile, intraoperative 0.15-T magnetic resonance imaging (MRI) scanner in glioma surgery. Methods: We analyzed our prospectively collected database of patients with glial tumors who underwent tumor resection with the use of an intraoperative ultra low-field MRI scanner (PoleStar N-20; Odin Medical Technologies, Yokneam, Israel/Medtronic, Louisville, CO). Sixty-three patients with World Health Organization Grade II to IV tumors were included in the study. All patients were subjected to postoperative 1.5-T imaging to confirm the extent of resection. Results: Intraoperative image quality was sufficient for navigation and resection control in both high-and low-grade tumors. Primarily enhancing tumors were best detected on T1-weighted imaging, whereas fluid-attenuated inversion recovery sequences proved best for nonenhancing tumors. Intraoperative resection control led to further tumor resection in 12 (28.6%) of 42 patients with contrast-enhancing tumors and in 10(47.6%) of 21 patients with noncontrast-enhancing tumors. In contrast-enhancing tumors, further resection led to an increased rate of complete tumor resection (71.2 versus 52.4%), and the surgical goal of gross total removal or subtotal resection was achieved in all cases (100.0%). In patients with noncontrast-enhancing tumors, the surgical goal was achieved in 19 (90.5%) of 21 cases, as intraoperative MRI findings were inconsistent with postoperative high-field imaging in 2 cases. Conclusion: The use of the PoleStar N-20 intraoperative ultra low-field MRI scanner helps to evaluate the extent of resection in glioma surgery. Further tumor resection after intraoperative scanning leads to an increased rate of complete tumor resection, especially in patients with contrast-enhancing tumors. However, in noncontrast-enhancing tumors, the intraoperative visualization of a complete resection seems less specific, when compared with postoperative 1.5-T MRI.

Download Full-text