scholarly journals COT-13 Luminance analysis of 5-aminolevulinic acid using Image J for malignant brain tumor

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi30-vi30
Author(s):  
Takashi Kon ◽  
Yusuke Kobayashi ◽  
Yosuke Sato ◽  
Katsuyoshi Shimizu ◽  
Tohru Mizutani
Keyword(s):  
Brain Tumor ◽  
Malignant Glioma ◽  
Aminolevulinic Acid ◽  
Malignant Gliomas ◽  
Malignant Brain Tumor ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Maximum Luminance ◽  
Brain Tumor Surgery ◽  
Average Maximum

Abstract Purpose: For malignant brain tumor surgery, photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) is useful for maximal removal of the tumor. Although it has the advantage of identifying the presence or absence of residual tumors during surgery, there are variations in positive rates, and the classification is limited, based on visual inspection such as Stummer’s classification (strong, vague, none). We analyzed the luminance of positive findings using software Image J for brain tumor surgery using 5-ALA, and we report the results. Materials and Methods: From April 2018 to March 2021, 31 patients with suspected malignant glioma before surgery were included. Intraoperative 5-ALA positive findings were analyzed by software Image J (Wayne Rasband: NIH), the luminance was measured with a histogram, and compared the maximum luminance titer. Results: Among the positive cases, the average maximum luminance value for malignant glioma was 101 (50–168), which consisted of 11 cases of Glioblastoma, 1 case of Oligodendroglioma, and 1 case of anaplastic astrocytoma. The average maximum brightness of metastatic brain tumors is lower than that of malignant gliomas, even if they are visually strong, 83.5 (28–121). Conclusions: Even if it is visually strong in the conventional Stummer classification, it may be possible to classify in detail by analyzing luminance with Image J. In addition, more objective index is necessary to classify the vague findings.

scholarly journals MS-1 Surgical strategy for brain tumor based on molecular and functional connectomics profiles

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii2-ii2
Author(s):  
Tatsuya Abe
Keyword(s):  
Overall Survival ◽  
Brain Tumor ◽  
Standard Procedure ◽  
Awake Craniotomy ◽  
Surgical Strategy ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract It is reported that the development of new perioperative motor deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. The maximum safe resection without any neurological deficits is required to improve overall survival in patients with brain tumor. Surgery is performed with various modalities, such as neuro-monitoring, photodynamic diagnosis, neuro-navigation, awake craniotomy, intraoperative MRI, and so on. Above all, awake craniotomy technique is now the standard procedure to achieve the maximum safe resection in patients with brain tumor. It is well known that before any treatment, gliomas generate globally (and not only focally) altered functional connectomics profiles, with various patterns of neural reorganization allowing different levels of cognitive compensation. Therefore, perioperative cortical mapping and elucidation of functional network, neuroplasticity and reorganization are important for brain tumor surgery. On the other hand, recent studies have proposed several gene signatures as biomarkers for different grades of gliomas from various perspectives. Then, we aimed to identify these biomarkers in pre-operative and/or intra-operative periods, using liquid biopsy, immunostaining and various PCR methods including rapid genotyping assay. In this presentation, we would like to demonstrate our surgical strategy based on molecular and functional connectomics profiles.

scholarly journals STMO-12 Efforts for safe malignant brain tumor surgery at our hospital

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi13-vi13
Author(s):  
Yusuke Kobayashi ◽  
Yosuke Satou ◽  
Takashi Kon ◽  
Daisuke Tanioka ◽  
Katsuyoshi Shimizu ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pyramidal Tract ◽  
Removal Rate ◽  
Karnofsky Performance Status ◽  
Premotor Cortex ◽  
Performance Status ◽  
Motor Evoked Potential ◽  
Malignant Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract Although maximal safe resection is the current standard for glioblastoma surgery, its safety and removal rate conflict with each other. Electrophysiological monitoring, such as motor evoked potential monitoring and awake craniotomy, can be utilized as safety measures; not all facilities can perform them. Herein, we present a representative case report on our efforts for a safe malignant brain tumor surgery. Case: A 77-year-old woman with glioblastoma in the premotor cortex presented with seizure of the upper left lower limb. Her pyramidal tract ran from the medial bottom to the posterior of the tumor. We performed excision from the site using the lowest gamma entropy. We then removed all parts of the tumor, with the exception of the pyramidal tract infiltration, and no paralysis was observed. She was definitively diagnosed with glioblastoma and is currently on maintenance chemotherapy. As a preoperative examination, we performed cerebrovascular angiography. We then performed various other tests to ascertain the patient’s condition. Considering lesions that affect language, Wada tests were performed regardless of laterality. For all patients with epilepsy onset, preoperative 256-channel electroencephalogram measurement and intraoperative the gamma entropy analysis were performed to confirm epileptogenicity. Considering lesions that affect eloquence, subdural electrodes were placed and brain function mapping was performed the next day. Based on the results, the safest cortical incision site and excision range were determined, and excision was performed on the following day. Of the 14 operated glioblastoma cases after November 2018, more than 85% of the contrast-enhanced lesions were completely removed in 7 cases, partially removed in 5 cases, and underwent biopsy in 2 cases. Postoperative Karnofsky performance status scores remained unchanged in 11 cases, improved in 1 case, and deteriorated in 2 cases. Our efforts have resulted in safe and sufficient removal of malignant brain tumors during surgery.

scholarly journals Fluorescence-Guided Resection of Malignant Glioma with 5-ALA

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Sadahiro Kaneko ◽  
Sadao Kaneko
Keyword(s):  
Malignant Glioma ◽  
Anticancer Agents ◽  
Aminolevulinic Acid ◽  
Malignant Gliomas ◽  
Protoporphyrin Ix ◽  
Time Spectrum ◽  
Photodynamic Diagnosis ◽  
Promising Technique ◽  
New Methods ◽  
New Treatments

Malignant gliomas are extremely difficult to treat with no specific curative treatment. On the other hand, photodynamic medicine represents a promising technique for neurosurgeons in the treatment of malignant glioma. The resection rate of malignant glioma has increased from 40% to 80% owing to 5-aminolevulinic acid-photodynamic diagnosis (ALA-PDD). Furthermore, ALA is very useful because it has no serious complications. Based on previous research, it is apparent that protoporphyrin IX (PpIX) accumulates abundantly in malignant glioma tissues after ALA administration. Moreover, it is evident that the mechanism underlying PpIX accumulation in malignant glioma tissues involves an abnormality in porphyrin-heme metabolism, specifically decreased ferrochelatase enzyme activity. During resection surgery, the macroscopic fluorescence of PpIX to the naked eye is more sensitive than magnetic resonance imaging, and the alert real time spectrum of PpIX is the most sensitive method. In the future, chemotherapy with new anticancer agents, immunotherapy, and new methods of radiotherapy and gene therapy will be developed; however, ALA will play a key role in malignant glioma treatment before the development of these new treatments. In this paper, we provide an overview and present the results of our clinical research on ALA-PDD.

389 Advanced Intraoperative Navigated Ultrasound in Brain Tumor Surgery Lessons Learnt from a Personal Experience of 300 Cases

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 293-293
Author(s):  
Aliasgar V Moiyadi
Keyword(s):  
Brain Tumor ◽  
Malignant Gliomas ◽  
Tumor Resection ◽  
3D Ultrasound ◽  
Small Subset ◽  
Neurosurgical Procedures ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Resection Control ◽  
Tumor Residue

Abstract INTRODUCTION Navigated 3D-ultrasound (nUS) is a powerful and multi-purpose adjunct during tumor resections. We review our cumulative results in a dedicated neuro-oncology service spanning a six year period, highlighting its role in glioma surgery. METHODS Since 2011 we have been used a navigated 3D ultrasound system for intraoperative image guidance during brain tumor surgery in 300 cases. A prospectively updated database was queried to retrieve demographic, clinico-radiological and pathological details. Specifically, we evaluated the utility of the IOUS in different setups and assessed its predictive accuracy and impact on extent of resection (EOR) as well as survival in gliomas. RESULTS >300 (204 males/96 females) brain tumors were operated [197 high grade gliomas, 28 LGG, 24 Meningiomas, and 51 other tumors]. Radical resection/debulking was intended in 270 (90%). In 30 (10%), only frameless biopsy was performed. The US was intended for resection control in 219 (73%) tumors, most of them being intrinsic gliomas. Intermediate scans prompted further resection in 101 cases (46%). A final resection control scan was performed in 176 cases (confirming complete excision in 99, and residual tumor which could not be further resected in 77). The nUS was a very useful tool in tumor surgery, providing a good diagnostic accuracy (85-90%) in predicting tumor residue. It also helped us improve the EOR in malignant gliomas as well as non-enhancing gliomas. In the subset of resectable tumors, the gross total resection rate was 88%. Further, in a small subset of malignant gliomas, we demonstrated that it helps extend tumor resection beyond the contrast enhancement zone. In GBMs, in a multivariate model, use of the nUS was an independent predictor of survival. CONCLUSION Considering the ease of use, widespread accessibility and low-cost nature, IOUS can be a potentially useful adjunct during a range of neurosurgical procedures, especially tumor resections.

The role of 5-aminolevulinic acid in brain tumor surgery: a systematic review

2016 ◽  
Vol 39 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Nicholas Ferraro ◽  
Eric Barbarite ◽  
Trevine R. Albert ◽  
Emmanuel Berchmans ◽  
Ashish H. Shah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Tumor ◽  
Aminolevulinic Acid ◽  
Tumor Surgery ◽  
Brain Tumor Surgery
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