scholarly journals Surgical advances in the management of brain metastases

2021 ◽  
Vol 3 (Supplement_5) ◽  
pp. v4-v15
Author(s):  
Patrick R Ng ◽  
Bryan D Choi ◽  
Manish K Aghi ◽  
Brian V Nahed
Keyword(s):  
Brain Metastases ◽  
Functional Neuroimaging ◽  
Intraoperative Ultrasound ◽  
Complete Removal ◽  
Extent Of Resection ◽  
High Definition ◽  
Guided Surgery ◽  
Metastatic Lesions ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri

Abstract As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.

Intraoperative Ultrasound Appearance of a Pancreatic Cerebral Metastasis: A Case Report

2018 ◽  
Vol 79 (04) ◽  
pp. 337-340 ◽  
Author(s):  
Lina Barzaghi ◽  
Jody Capitanio ◽  
Andrea Cavalli ◽  
Pietro Panni ◽  
Silvia Snider ◽  
...  
Keyword(s):  
Cystic Lesion ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Resonance Imaging ◽  
Conventional Radiotherapy ◽  
Surgical Safety ◽  
History Of ◽  
Low Incidence ◽  
Magnetic Resonance Imaging Mri ◽  
First Time

Background Brain metastases (BMs) derived from pancreatic adenocarcinoma (PAC) have an extremely low incidence (0.1–0.4%) and are usually associated with a very poor prognosis. The treatment strategy is palliative and includes conventional radiotherapy, stereotactic radiosurgery, chemotherapy, and surgical resection. Case Description A 39-year-old man with a history of PAC developed a systemic tumor relapse with intracranial progression. Magnetic resonance imaging (MRI) documented a right rolandic, cortical, and cystic lesion with leptomeningeal intrasulcular extension. The intraoperative ultrasound (iUS) depicted a hyperechogenic area surrounding the anechogenic cystic lesion and allowed us to obtain gross total resection of the tumor. Conclusions To the best of our knowledge, we describe for the first time the iUS aspect of a pancreatic BM. In this case the use of iUS allowed us to increase the extent of resection and surgical safety, thus reducing the risk of new postoperative neurologic deficits.

scholarly journals Basic Principles of Intraoperative Ultrasound Applied to Brain Tumor Surgery

2020 ◽  
Vol 9 (02) ◽  
pp. 135-140
Author(s):  
Javier A. Jacobo ◽  
Javier Avendaño ◽  
Sergio Moreno-Jimenez ◽  
Santiago Nuñez ◽  
Rocio Mamani
Keyword(s):  
Brain Tumor ◽  
Tumor Volume ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Basic Knowledge ◽  
Full Potential ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Basic Principles ◽  
Metastatic Lesions

AbstractIntraoperative ultrasound (US) has been shown to possess great value in assessing tumor volume and localization, especially for primary resection of gliomas and metastatic lesions. Given that US is a technology that is highly user dependent, many surgeons have encountered problems with the usage of this technology, as well as interpretation of intraoperative US images, limiting its full potential. This article focuses on the basic knowledge a neurosurgeon must acquire to properly use and interpret intraoperative US to improve tumor localization and extent of resection during brain tumor surgery.

scholarly journals Stereotactic Body Radiation Therapy (SBRT) for a Patient with a Myocardial Metastasis: A Case Report

2021 ◽  
Vol 28 (1) ◽  
pp. 390-395
Author(s):  
Aneesh Dhar ◽  
Elysia Donovan ◽  
Darryl Leong ◽  
Sebastien J. Hotte ◽  
Anand Swaminath
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Mri Scan ◽  
Distant Disease ◽  
Cardiac Lesion ◽  
Stereotactic Body Radiation ◽  
Metastatic Lesions ◽  
Cardiac Symptoms ◽  
Myocardial Metastasis ◽  
Magnetic Resonance Imaging Mri

Metastatic lesions of the heart are rare but have the potential to cause significant morbidity. We describe the case of a patient with renal cell carcinoma who presented with shortness of breath and palpitations and was found to have a metastatic myocardial lesion causing arrythmia. He received stereotactic body radiation therapy (SBRT) to alleviate symptoms and provide local control. SBRT planning was executed using a four-dimensional computed tomography (4DCT) scan to account for respiratory and cardiac motion. Images from a planning magnetic resonance imaging (MRI) scan and a gated diagnostic MRI scan of the heart were fused with the 4DCT to assist with delineating the tumour. A dose of 30 Gy in five fractions was delivered without incident. The patient’s cardiac MRI at two months post-treatment showed stability of his cardiac lesion. He subsequently died of distant disease progression, without any recurrence of his cardiac symptoms. SBRT may be considered for patients who present with a symptomatic metastatic cardiac lesion.

scholarly journals Handling missing MRI sequences in deep learning segmentation of brain metastases: a multicenter study

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Endre Grøvik ◽  
Darvin Yi ◽  
Michael Iv ◽  
Elizabeth Tong ◽  
Line Brennhaug Nilsen ◽  
...  
Keyword(s):  
Deep Learning ◽  
Brain Metastases ◽  
Multicenter Study ◽  
Roc Curve ◽  
Inversion Recovery ◽  
Fast Spin Echo ◽  
Operating Characteristics ◽  
Test Set ◽  
Mri Sequences ◽  
Input Level

AbstractThe purpose of this study was to assess the clinical value of a deep learning (DL) model for automatic detection and segmentation of brain metastases, in which a neural network is trained on four distinct MRI sequences using an input-level dropout layer, thus simulating the scenario of missing MRI sequences by training on the full set and all possible subsets of the input data. This retrospective, multicenter study, evaluated 165 patients with brain metastases. The proposed input-level dropout (ILD) model was trained on multisequence MRI from 100 patients and validated/tested on 10/55 patients, in which the test set was missing one of the four MRI sequences used for training. The segmentation results were compared with the performance of a state-of-the-art DeepLab V3 model. The MR sequences in the training set included pre-gadolinium and post-gadolinium (Gd) T1-weighted 3D fast spin echo, post-Gd T1-weighted inversion recovery (IR) prepped fast spoiled gradient echo, and 3D fluid attenuated inversion recovery (FLAIR), whereas the test set did not include the IR prepped image-series. The ground truth segmentations were established by experienced neuroradiologists. The results were evaluated using precision, recall, Intersection over union (IoU)-score and Dice score, and receiver operating characteristics (ROC) curve statistics, while the Wilcoxon rank sum test was used to compare the performance of the two neural networks. The area under the ROC curve (AUC), averaged across all test cases, was 0.989 ± 0.029 for the ILD-model and 0.989 ± 0.023 for the DeepLab V3 model (p = 0.62). The ILD-model showed a significantly higher Dice score (0.795 ± 0.104 vs. 0.774 ± 0.104, p = 0.017), and IoU-score (0.561 ± 0.225 vs. 0.492 ± 0.186, p < 0.001) compared to the DeepLab V3 model, and a significantly lower average false positive rate of 3.6/patient vs. 7.0/patient (p < 0.001) using a 10 mm3 lesion-size limit. The ILD-model, trained on all possible combinations of four MRI sequences, may facilitate accurate detection and segmentation of brain metastases on a multicenter basis, even when the test cohort is missing input MRI sequences.

scholarly journals Effectiveness of low-field magnetic resonance imaging in diagnosing brachial plexus tumours in dogs – short communication

2015 ◽  
Vol 59 (2) ◽  
pp. 317-319
Author(s):  
Zbigniew Adamiak ◽  
Yauheni Zhalniarovich ◽  
Paulina Przyborowska ◽  
Joanna Głodek ◽  
Adam Przeworski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Resonance Imaging ◽  
Gadolinium Contrast ◽  
Gadolinium Contrast Agent ◽  
Low Field ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri ◽  
Brachial Plexus Tumours

AbstractThe aim of the study was to identify magnetic resonance imaging (MRI) sequences that contribute to a quick and reliable diagnosis of brachial plexus tumours in dogs. The tumours were successfully diagnosed in 6 dogs by the MRI with the use of SE, FSE, STIR, Turbo 3 D, 3D HYCE, and GE sequences and the gadolinium contrast agent

scholarly journals Grading of Gliomas by Using Radiomic Features on Multiple Magnetic Resonance Imaging (MRI) Sequences

2017 ◽  
Vol 23 ◽  
pp. 2168-2178 ◽  
Author(s):  
Jiang-bo Qin ◽  
Zhenyu Liu ◽  
Hui Zhang ◽  
Chen Shen ◽  
Xiao-chun Wang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri

scholarly journals Painful tic convulsif syndrome due to vertebrobasilar dolichoectasia

2011 ◽  
Vol 02 (01) ◽  
pp. 071-073 ◽  
Author(s):  
Puneet Mittal ◽  
Gaurav Mittal
Keyword(s):  
Mr Angiography ◽  
Rare Condition ◽  
Nerve Compression ◽  
Vascular Compression ◽  
Contrast Resolution ◽  
Vertebrobasilar Dolichoectasia ◽  
Basilar Arteries ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri ◽  
Painful Tic Convulsif

ABSTRACTCombined clinical presentation of hemifacial spasm and ipsilateral trigeminal neuralgia is also known as painful tic convulsif (PTC). It is a rare condition and the most common cause is vascular compression. Vertebrobasilar dolichoectasia (VBD) is characterized by dilated and tortuous vertebral and basilar arteries. VBD is an uncommon and rarely reported cause of PTC. Magnetic resonance imaging (MRI), due to its inherent excellent contrast resolution, is an excellent modality for demonstrating the nerve compression by dilated and tortuous vessels seen in this condition. For this purpose, 3D MRI sequences are especially useful like constructive interference in steady state (CISS) and MR angiography. Both of these have been reported to be helpful in the diagnosis of this condition. We report a case of PTC in which we were able to document facial and trigeminal nerve compression by VBD on MRI, using CISS and time-of-fl ight MR angiography.

scholarly journals The structure of blood–tumor barrier and distribution of chemotherapeutic drugs in non-small cell lung cancer brain metastases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ling-yun Ye ◽  
Li-xiang Sun ◽  
Xiu-hua Zhong ◽  
Xue-song Chen ◽  
Song Hu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Blood Vessels ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Chemotherapeutic Drugs ◽  
Small Cell Lung ◽  
Metastatic Lesions

Abstract Background Brain metastasis is an important cause of increased mortality in patients with non-small cell lung cancer (NSCLC). In brain metastasis, the blood–brain barrier (BBB) is frequently impaired, forming blood–tumor barrier (BTB). The efficacy of chemotherapy is usually very poor. However, the characteristics of BTB and the impacts of BTB on chemotherapeutic drug delivery remain unclear. The present study investigated the structure of BTB, as well as the distribution of routine clinical chemotherapeutic drugs in both brain and peripheral tumors. Methods Bioluminescent image was used to monitor the tumor load after intracranial injection of lung cancer Lewis cells in mice. The permeability of BBB and BTB was measured by fluorescent tracers of evans blue and fluorescein sodium. Transmission electron microscopy (TEM), immunohistochemistry and immunofluorescence were performed to analyze structural differences between BBB and BTB. The concentrations of chemotherapeutic drugs (gemcitabine, paclitaxel and pemetrexed) in tissues were assayed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results Brain metastases exhibited increased BTB permeability compared with normal BBB detected by fluorescence tracers. TEM showed abnormal blood vessels, damaged endothelial cells, thick basement membranes, impaired intercellular endothelial tight junctions, as well as increased fenestrae and pinocytotic vesicles in metastatic lesions. Immunohistochemistry and immunofluorescence revealed that astrocytes were distributed surrounded the blood vessels both in normal brain and the tumor border, but no astrocytes were found in the inner metastatic lesions. By LC-MS/MS analysis, gemcitabine showed higher permeability in brain metastases. Conclusions Brain metastases of lung cancer disrupted the structure of BBB, and this disruption was heterogeneous. Chemotherapeutic drugs can cross the BTB of brain metastases of lung cancer but have difficulty crossing the normal BBB. Among the three commonly used chemotherapy drugs, gemcitabine has the highest distribution in brain metastases. The permeability of chemotherapeutic agents is related to their molecular weight and liposolubility.

Failed visualization of clot signal in cerebral venous thrombosis on initial MR imaging

VASA ◽  
2007 ◽  
Vol 36 (4) ◽  
pp. 275-277
Author(s):  
Cioli ◽  
von Stockhausen ◽  
Jauss ◽  
Siekmann ◽  
Stolz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Spin Echo ◽  
Mr Venography ◽  
Resonance Imaging ◽  
Venous Flow ◽  
Positive Identification ◽  
Mri Sequences ◽  
Magnetic Resonance Imaging Mri

Currently, the combination of T1- and T2-weighted spin echo magnetic resonance imaging (MRI) sequences with MR venography is considered the best diagnostic tool for diagnosing cerebral venous thrombosis (CVT), because they allow positive identification of the thrombotic clot along with the disturbed venous flow signal. We report two patients in whom initial MRI with the mentioned techniques did not show a clot signal. In both patients anticoagulation was started despit lacking proof of CVT by imaging and both patients improved. Only on repeated MRI sinus clot signal could be confirmed.

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