9 Going from Scan to Plan in a Glioma Surgery

Abstract The goal of glioma surgery is maximal safe resection in order to provide optimal tumor control and survival benefit to the patient. There are multiple imaging modalities beyond traditional contrast-enhanced magnetic resonance imaging (MRI) that have been incorporated into the preoperative workup of patients presenting with gliomas. The aim of these imaging modalities is to identify cortical and subcortical areas of eloquence, and their relationship to the lesion. In this article, multiple modalities are described with an emphasis on the underlying technology, clinical utilization, advantages, and disadvantages of each. functional MRI and its role in identifying hemispheric dominance and areas of language and motor are discussed. The nuances of magnetoencephalography and transcranial magnetic stimulation in localization of eloquent cortex are examined, as well as the role of diffusion tensor imaging in defining normal white matter tracts in glioma surgery. Lastly, we highlight the role of stimulated Raman spectroscopy in intraoperative histopathological diagnosis of tissue to guide tumor resection. Tumors may shift the normal arrangement of functional anatomy in the brain; thus, utilization of multiple modalities may be helpful in operative planning and patient counseling for successful surgery.

Download Full-text

MS-2 Minimally invasive glioma surgery with navigation system and tubular retractor

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.009 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii2-ii3

Author(s):

Kazuhiko Kurozumi

Keyword(s):

Navigation System ◽

Diffusion Tensor ◽

Therapeutic Option ◽

Normal Brain ◽

Navigation Systems ◽

Glioma Surgery ◽

Tubular Retractor ◽

Neuronavigation System ◽

Magnetic Resonance Imaging Mri ◽

Neurological Surgery

Abstract Navigation systems are reliable and safe for neurological surgery. Navigation is an attractive and innovative therapeutic option. Recently, endo and exoscopic surgeries have been gradually increasing in neurosurgery. We are currently trialing to use 4K and 8K systems to improve the accuracy and safety of our surgical procedures. Surgeries for deep-seated tumors are challenging because of the difficulty in creating a corridor and observing the interface between lesions and the normal area. In total, 315 patients underwent surgery at Okayama University between 2017 and 2019. Among them, we experienced 92 glioma surgeries using navigation systems. Preoperatively, we performed computed tomography imaging and contrast-enhanced magnetic resonance imaging (MRI) for the neuronavigation system. We experienced Curve(TM) Image Guided Surgery (BrainLab, Munich, Germany). The surgical trajectory was planned with functional MRI and diffusion tensor imaging to protect the eloquent area and critical vasculature of the brain. We used a clear plastic tubular retractor system, the ViewSite Brain Access System, for surgery of deep seated gliomas. We gently inserted and placed the ViewSite using the neuronavigation. The tumor was observed and resected through the ViewSite tubular retractor under a microscope and endoscope. If the tumor was large, we switched the ViewSite tubular retractor to brain spatulas to identify the boundary between the normal brain and lesion. We are currently using the combination of the tubular retractor and brain spatulas using navigation system. Here, we present and analyze our preoperative simulation, surgical procedure, and outcomes.

Download Full-text

Ex vivo ultrasonic samples of human brain tumors in the molecular era

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa014 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Alastair J Kirby ◽

José P Lavrador ◽

Istvan Bodi ◽

Francesco Vergani ◽

Ranjeev Bhangoo ◽

...

Keyword(s):

Dna Methyltransferase ◽

Cellular Proliferation ◽

Aminolevulinic Acid ◽

Ex Vivo ◽

Methylation Status ◽

Protoporphyrin Ix ◽

Intratumor Heterogeneity ◽

Power Relationship ◽

Surgical Biopsy ◽

Glioma Surgery

Abstract Background Gliomas are composed of multiple clones of tumor cells. This intratumor heterogeneity contributes to the ability of gliomas to resist treatment. It is vital that gliomas are fully characterized at a molecular level when a diagnosis is made to maximize treatment effectiveness. Methods We collected ultrasonic tissue fragments during glioma surgery. Large tissue fragments were separated in the operating theater and bathed continuously in oxygenated artificial cerebrospinal fluid to keep them alive. The ex vivo tissue fragments were transferred to a laboratory and incubated in 5-aminolevulinic acid (5-ALA). 5-ALA is metabolized to Protoporphyrin IX (PpIX), which accumulates in glioma cells and makes them fluorescent. The molecular and neuropathological features of the PpIX fluorescent ultrasonic tissue fragments were studied. Results We show that PpIX fluorescence can rapidly identify tissue fragments infiltrated by glioma in the laboratory. Ultrasonic tissue fragments from the tumor core provided molecular and neuropathological information about the glioma that was comparable to the surgical biopsy. We characterized the heterogeneity within individual gliomas by studying ultrasonic tissue fragments from different parts of the tumor. We found that gliomas exhibit a power relationship between cellular proliferation and tumor infiltration. Tissue fragments that deviate from this relationship may contain foci of more malignant glioma. The methylation status of the O6-methylguanine DNA methyltransferase gene promoter varied within each glioma. Conclusions Ex vivo ultrasonic tissue fragments can be rapidly screened for glioma infiltration. They offer a viable platform to characterize heterogeneity within individual gliomas, thereby enhancing their diagnosis and treatment.

Download Full-text

Use of 5-aminolevulinic acid in fluorescence-guided resection of meningioma with high risk of recurrence

Journal of Neurosurgery ◽

10.3171/jns.2007.106.6.1070 ◽

2007 ◽

Vol 106 (6) ◽

pp. 1070-1074 ◽

Cited By ~ 68

Author(s):

Yoshinaga Kajimoto ◽

Toshihiko Kuroiwa ◽

Shin-Ichi Miyatake ◽

Tsugumichi Ichioka ◽

Minoru Miyashita ◽

...

Keyword(s):

High Risk ◽

Tumor Tissue ◽

Aminolevulinic Acid ◽

Superior Sagittal Sinus ◽

Residual Tumor ◽

Strong Fluorescence ◽

Glioma Surgery ◽

Risk Of Recurrence ◽

Sagittal Sinus ◽

Atypical Meningiomas

✓It has been established that fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is useful in glioma surgery. The authors report on a 65-year-old woman who had a huge atypical left-hemisphere meningioma, which extended into the skull and to the superior sagittal sinus and demonstrated fluorescence in response to administration of 5-ALA. After the tumor was removed, the operative field was observed under the fluorescent mode of a fluorescence surgical microscopy system. Several minute areas of residual tumor tissue were visualized as strong fluorescence behind the vein and sinus, in a part of the hypertrophic dura, and along the edge of the skull. These remnants were completely removed. The authors concluded that fluorescence-guided resection using 5-ALA is useful in cases of atypical meningiomas with a high risk of recurrence.

Download Full-text

Long-term evaluation of cognition after glioma surgery in eloquent areas

Journal of Neuro-Oncology ◽

10.1007/s11060-013-1275-3 ◽

2013 ◽

Vol 116 (1) ◽

pp. 153-160 ◽

Cited By ~ 49

Author(s):

Djaina Satoer ◽

Evy Visch-Brink ◽

Marion Smits ◽

Alfred Kloet ◽

Caspar Looman ◽

...

Keyword(s):

Glioma Surgery ◽

Eloquent Areas ◽

Term Evaluation

Download Full-text

Efficacy of 5-aminolevulinic acid-induced fluorescence detection in malignant glioma surgery

International Congress Series ◽

10.1016/j.ics.2004.03.324 ◽

2004 ◽

Vol 1268 ◽

pp. 1290

Author(s):

Takashi Maruyama ◽

Yoshihiro Muragaki ◽

Masahiko Tanaka ◽

Hiroshi Iseki ◽

Ichiro Sakuma ◽

...

Keyword(s):

Malignant Glioma ◽

Fluorescence Detection ◽

Aminolevulinic Acid ◽

Glioma Surgery

Download Full-text

Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery

Scientific Reports ◽

10.1038/s41598-021-95505-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Stefanos Voglis ◽

Aimee Hiller ◽

Anna-Sophie Hofer ◽

Lazar Tosic ◽

Oliver Bozinov ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Brain Injuries ◽

Infarct Volume ◽

False Negative ◽

Size Estimation ◽

Glioma Surgery ◽

Postoperative Mri ◽

Diffusion Weighted ◽

Tumor Types ◽

Additional Resection

AbstractIntraoperatively acquired diffusion-weighted imaging (DWI) sequences in cranial tumor surgery are used for early detection of ischemic brain injuries, which could result in impaired neurological outcome and their presence might thus influence the neurosurgeon’s decision on further resection. The phenomenon of false-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) has only been reported in single cases and therefore yet needs to be further analyzed. This retrospective single-center study’s objective was the identification and characterization of false-negative DWI findings in ioMRI with new or enlarged ischemic areas on postoperative MRI (poMRI). Out of 225 cranial tumor surgeries with intraoperative DWI sequences, 16 cases with no additional resection after ioMRI and available in-time poMRI (< 14 days) were identified. Of these, a total of 12 cases showed false-negative DWI in ioMRI (75%). The most frequent tumor types were oligodendrogliomas and glioblastomas (4 each). In 5/12 cases (41.7%), an ischemic area was already present in ioMRI, however, volumetrically increased in poMRI (mean infarct growth + 2.1 cm3; 0.48–3.6), whereas 7 cases (58.3%) harbored totally new infarcts on poMRI (mean infarct volume 0.77 cm3; 0.05–1.93). With this study we provide the most comprehensive series of false-negative DWI findings in ioMRI that were not followed by additional resection. Our study underlines the limitations of intraoperative DWI sequences for the detection and size-estimation of hyperacute infarction. The awareness of this phenomenon is crucial for any neurosurgeon utilizing ioMRI.

Download Full-text