scholarly journals STMO-06 SMART CYBER OPERATING THEATER REALIZED BY INTERNET OF THINGS - RESULTS OF CLINICAL STUDY FOR 56 CASES

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii19-ii19
Author(s):  
Muragaki Yoshihiro ◽  
Jun Okamoto ◽  
Taiichi Saito ◽  
Satoshi Usui ◽  
Ushio Yonezawa ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Removal Rate ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Residual Tumor ◽  
Clinical Results ◽  
Digital Data ◽  
Clinical Effects ◽  
Operating Theater ◽  
First Case

Abstract PURPOSE Unlike conventional operating rooms that provide a sterilized space, we have developed a Smart Cyber Operating Theater (SCOT) in which the room itself performs treatment as a single medical device. We report the clinical results of 3 types of SCOT. METHODS Basic SCOT packaged with intraoperative MRI (0.4Tesla) was introduced in Hiroshima University in 2016. Standard SCOT networked with middleware OPeLiNK was introduced to Shinshu University in 2018, and Hyper SCOT introduced to Tokyo Women’s Medical University in 2019. RESULTS The average of all 56 patients was 44 years old. There were 38 brain tumors (68%), 11 functional diseases (19%), and 7 orthopedic diseases (13%). Basic SCOT is used for 41 cases (/56; 73%) with 22 gliomas, 10 epilepsies, 7 bone tumors, and 2 benign brain tumors. Standard SCOT with 20 networked devices is used for 14 cases (/56; 25%) with 6 gliomas including brain stem and thalamus, 6 pituitary tumors and 2 benign brain tumors. The strategy desk can display a variety of digital data synchronized in time, and the review and comment functions also operate. It is useful for remote advice through mutual communication via strategy desk. Hyper SCOT was used in February 2019 for the first case (1/56 cases; 2%). MRI images were taken with an average of 1.3 shots with good image quality. For 46/56 neoplastic lesions (82%), additional removal of residual tumor was performed in 31/46 cases (67%), and 26/46 cases (57%) were totally removed, with an average removal rate of 89.2%. There was no reoperation (0%) within 1 month in all cases. CONCLUSIONS Three types of SCOT contributed to planned surgical outcome including maximal tumor resection without serious related complications. We will proceed with verification of clinical effects, and develop robotized devices, and utilize AI for strategy desk at Hyper SCOT.

scholarly journals Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
First Case ◽  
Common Location ◽  
Skeletal Defects ◽  
Common Diagnosis

Abstract Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

Correlation of Neurosurgical Subspecialization with Outcomes in Children with Malignant Brain Tumors

Neurosurgery ◽  
2000 ◽  
Vol 47 (4) ◽  
pp. 879-887 ◽  
Author(s):  
A. Leland Albright ◽  
Richard Sposto ◽  
Emi Holmes ◽  
Paul M. Zeltzer ◽  
Jonathan L. Finlay ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Malignant Gliomas ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Pediatric Brain Tumors ◽  
Neurological Complications ◽  
Tumor Removal ◽  
Primitive Neuroectodermal Tumors ◽  
Cancer Group ◽  
Neuroectodermal Tumors

Abstract OBJECTIVE This study was performed to evaluate the association between the type of neurosurgeon (general or pediatric) and either the extent of tumor removal or the frequency of complications in children undergoing malignant brain tumor resections. METHODS Data were analyzed from three recent Children's Cancer Group studies: two on medulloblastomas/primitive neuroectodermal tumors and one on malignant gliomas. Neurosurgeons were classified as general neurosurgeons, as designated pediatric neurosurgeons in their institutions, or as members of the American Society of Pediatric Neurosurgeons (ASPN), which requires pediatric neurosurgical experience and practice standards. RESULTS Data forms from 732 children were analyzed; 485 were from children with medulloblastomas/primitive neuroectodermal tumors, and 247 were from children with malignant gliomas. Operations were performed by 269 neurosurgeons, including 213 general neurosurgeons, 29 designated pediatric neurosurgeons, and 27 ASPN members. The mean number of operations per surgeon was 1.8, 4.9, and 7.6 for general neurosurgeons, designated pediatric neurosurgeons, and ASPN members, respectively. There was a significant relationship between the extent of tumor resection or the amount of residual tumor and the type of neurosurgeon. Designated pediatric neurosurgeons and ASPN members were more likely to remove more than 90% of the tumor and to leave less than 1.5 cc of residual tumor than were general neurosurgeons (P < 0.05). In these studies, the probability of extensive tumor removal correlated with the number of operations the neurosurgeon performed (P < 0.01). Neurological complications occurred in the following proportion of cases: general neurosurgeons, 23%; designated pediatric neurosurgeons, 32%; and ASPN members, 18%. CONCLUSION Pediatric neurosurgeons are more likely than general neurosurgeons to extensively remove malignant pediatric brain tumors. In these tumors, extent of removal has been demonstrated to influence survival.

Photodynamic Therapy of Malignant Brain Tumors: Clinical Results of, Difficulties with, Questions about, and Future Prospects for the Neurosurgical Applications

Neurosurgery ◽  
1988 ◽  
Vol 23 (5) ◽  
pp. 557-563 ◽  
Author(s):  
Carlo Perria ◽  
Martino Carai ◽  
Antonello Falzoi ◽  
Giuseppe Orunesu ◽  
Antonio Rocca ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Brain Tumors ◽  
Residual Tumor ◽  
Clinical Results ◽  
Halogen Lamp ◽  
Glial Tumors ◽  
Malignant Brain Tumors ◽  
Neurosurgical Patients ◽  
Clinical Series ◽  
Causes Of Failure

Abstract Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail.

scholarly journals Case Report: Identification of Multiple TERT and FGFR2 Gene Fusions in a Pineal Region Glioblastoma Case

2021 ◽  
Vol 11 ◽  
Author(s):  
Xing Guo ◽  
Teng Chen ◽  
Shiming Chen ◽  
Chao Song ◽  
Dezhi Shan ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Pineal Region ◽  
Proliferation Index ◽  
Gene Fusions ◽  
Who Grade ◽  
First Case ◽  
Fgfr2 Gene ◽  
Magnetic Resonance Imaging Mri ◽  
Next Generation Sequencing Ngs

As an oncogenic somatic variant, telomerase reverse transcriptase promoter (TERTp) mutations are frequently observed in adult glioblastoma (GBM). Alternatively, we report the first case of glioblastoma with TERT amplification accompanied by multiple TERT and FGFR2 gene fusions instead of TERTp mutation. A 55-year-old woman presented with dizziness, headache, and diplopia for three weeks. Magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing lobulated mass centered in the pineal region. Partial tumor resection and ventriculoperitoneal shunt were achieved, and the residual tumor was then treated with standard radiation. The tumor was diagnosed as GBM, IDH-wild type, WHO grade IV, and the Ki67 proliferation index was high (30–40%). Intriguingly, TERT amplification without TERTp mutation was identified via next generation sequencing (NGS). Further analysis revealed multiple TERT (TERT–NUBPL, MARCH6–TERT, and CJD4–TERT) and FGFR2 (CXCL17–FGFR2, SIPA1L3–FGFR2, FGFR2–SIPA1L3, and FGFR2–CEACAM1) gene fusions. After the surgery, the patient’s condition deteriorated rapidly due to the malignant nature of the tumor and she died with an overall survival of 3 months. Our report provides the molecular clue for a novel telomerase activation and maintenance mechanism in GBM.

Surgical benefits of combined awake craniotomy and intraoperative magnetic resonance imaging for gliomas associated with eloquent areas

2017 ◽  
Vol 127 (4) ◽  
pp. 790-797 ◽  
Author(s):  
Kazuya Motomura ◽  
Atsushi Natsume ◽  
Kentaro Iijima ◽  
Shunichiro Kuramitsu ◽  
Masazumi Fujii ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Awake Craniotomy ◽  
The Other ◽  
Intraoperative Mri ◽  
Awake Surgery ◽  
Eloquent Areas ◽  
Mri Studies ◽  
The Brain

OBJECTIVEMaximum extent of resection (EOR) for lower-grade and high-grade gliomas can increase survival rates of patients. However, these infiltrative gliomas are often observed near or within eloquent regions of the brain. Awake surgery is of known benefit for the treatment of gliomas associated with eloquent regions in that brain function can be preserved. On the other hand, intraoperative MRI (iMRI) has been successfully used to maximize the resection of tumors, which can detect small amounts of residual tumors. Therefore, the authors assessed the value of combining awake craniotomy and iMRI for the resection of brain tumors in eloquent areas of the brain.METHODSThe authors retrospectively reviewed the records of 33 consecutive patients with glial tumors in the eloquent brain areas who underwent awake surgery using iMRI. Volumetric analysis of MRI studies was performed. The pre-, intra-, and postoperative tumor volumes were measured in all cases using MRI studies obtained before, during, and after tumor resection.RESULTSIntraoperative MRI was performed to check for the presence of residual tumor during awake surgery in a total of 25 patients. Initial iMRI confirmed no further tumor resection in 9 patients (36%) because all observable tumors had already been removed. In contrast, intraoperative confirmation of residual tumor during awake surgery led to further tumor resection in 16 cases (64%) and eventually an EOR of more than 90% in 8 of 16 cases (50%). Furthermore, EOR benefiting from iMRI by more than 15% was found in 7 of 16 cases (43.8%). Interestingly, the increase in EOR as a result of iMRI for tumors associated mainly with the insular lobe was significantly greater, at 15.1%, than it was for the other tumors, which was 8.0% (p = 0.001).CONCLUSIONSThis study revealed that combining awake surgery with iMRI was associated with a favorable surgical outcome for intrinsic brain tumors associated with eloquent areas. In particular, these benefits were noted for patients with tumors with complex anatomy, such as those associated with the insular lobe.

Comparison of Motor Outcome in Patients Undergoing Awake vs General Anesthesia Surgery for Brain Tumors Located Within or Adjacent to the Motor Pathways

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E470-E476 ◽  
Author(s):  
Roni Zelitzki ◽  
Akiva Korn ◽  
Eti Arial ◽  
Carmit Ben-Harosh ◽  
Zvi Ram ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
General Anesthesia ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Awake Craniotomy ◽  
Motor Deficits ◽  
Surgical Removal ◽  
Motor Outcome

Abstract BACKGROUND Surgical removal of intra-axial brain tumors aims at maximal tumor resection while preserving function. The potential benefit of awake craniotomy over craniotomy under general anesthesia (GA) for motor preservation is yet unknown. OBJECTIVE To compare the clinical outcomes of patients who underwent surgery for perirolandic tumors while either awake or under GA. METHODS Between 2004 and 2015, 1126 patients underwent surgical resection of newly diagnosed intra-axial tumors in a single institution. Data from 85 patients (44 awake, 41 GA) with full dataset who underwent resections for perirolandic tumors were retrospectively analyzed. RESULTS Identification of the motor cortex required significantly higher stimulation thresholds in anesthetized patients (9.1 ± 4 vs 6.2 ± 2.7 mA for awake patients, P = .0008). There was no group difference in the subcortical threshold for motor response used to assess the proximity of the lesion to the corticospinal (pyramidal) tract. High-grade gliomas were the most commonly treated pathology. The extent of resection and residual tumor volume were not different between groups. Postoperative motor deficits were more common in the anesthetized patients at 1 wk (P = .046), but no difference between the groups was detected at 3 mo. Patients in the GA group had a longer mean length of hospitalization (10.3 vs 6.7 d for the awake group, P = .003). CONCLUSION Awake craniotomy results in a better early postoperative motor outcome and shorter hospitalization compared with patients who underwent the same surgery under GA. The finding of higher cortical thresholds for the identification of the motor cortex in anesthetized patients may suggest an inhibitory effect of anesthetic agents on motor function.

scholarly journals Acute ICA occlusion due to pituitary apoplexy resulting In Internal Carotid Artery Occlusion and Stroke: Case Report, Review of The Literature, and Treatment Rationale

2017 ◽  
Vol 1 (1) ◽  
pp. 01-03
Author(s):  
Ramu Adepu
Keyword(s):  
Tumor Resection ◽  
Rare Event ◽  
Treatment Strategies ◽  
Pituitary Tumors ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Sudden Onset ◽  
First Case ◽  
Work Up ◽  
Transsphenoidal Resection

We report the case of a 63 year-old man who presented with sudden-onset, severe headache. Work-up revealed a hemorrhagic pituitary macroadenoma. He then suffered sudden-onset aphasia and right hemiparesis. Further evaluation revealed left ICA occlusion. Emergent transsphenoidal resection of the tumor produced recanalization of the occluded ICA, but his neurological symptoms persisted. ICA occlusion following pituitary tumor apoplexy is a rare event that must be recognized early for optimal patient outcomes. We report the first case with demonstration of carotid recanalization after tumor resection, review the incidence of ICA occlusion due to pituitary tumors, describe the possible mechanisms, and recommend optimal treatment strategies.

scholarly journals Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Huan Wee Chan ◽  
Christopher Uff ◽  
Aabir Chakraborty ◽  
Neil Dorward ◽  
Jeffrey Colin Bamber
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Shear Wave Elastography ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Normal Brain ◽  
Mri Scan ◽  
Significant Difference ◽  
Brain Tumor Resection

BackgroundThe clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported.AimsTo determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”.MethodsThirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan.ResultsThe YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p < 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p < 0.001, respectively).ConclusionsSWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.

The impact of intra-operative high field magnetic resonance imaging on clinical decision making during oncologic neurosurgical procedures

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19599-19599
Author(s):  
J. S. Weinberg ◽  
K. Shah ◽  
G. Rao ◽  
E. F. Jackson ◽  
D. Suki ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Tumor ◽  
Brain Tumors ◽  
High Field ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Preoperative Imaging ◽  
Neurosurgical Procedures ◽  
The Impact

19599 Background: Existing image guided surgical (IGS) technology used during resection of brain tumors is based on preoperative imaging modalities and are limited by their inability to demonstrate extent of resection (EOR) and compensate for anatomical changes which occur as a result of surgical manipulation (e.g. brain shift, tumor resection, spinal fluid loss). Having the ability to perform MRI during brain tumor surgery obviates many of these limitations. The purpose of this study was to determine the impact of intra-operative imaging with a high field MRI on brain tumor resection. Methods: Since September 2006, a total of 23 patients with brain tumors underwent resection at The University of Texas M. D. Anderson Cancer Center with intra-operative MR guidance (BrainLAB IGS system integrated with a 1.5T Siemens Espree scanner). For each patient, appropriate imaging was performed prior to craniotomy. Resection was then performed using image guidance. Surgeons completed a questionnaire documenting the reason for the scan and provided an estimation of EOR prior to and after the intraoperative scan. Multiple intraoperative scans were performed at the discretion of the operating surgeon. Results: In 23 patients, 25 scans were performed. The patients had a diagnosis of glioma (21), lymphoma (1), and schwannoma (1). Reasons for performing a scan included: evaluate EOR in 23 (92%) or update the IGS system in 2 (8%). Surgeons indicated in 21/23 (91%) scans performed to evaluate the extent of resection that they would have terminated the surgery prior to the scan. In 9/21 cases (43%), further surgery was performed after the scan to maximize EOR. In 10/24 (42%) cases, the pre-scan estimate of residual tumor matched the post-scan amount. The amount of residual tumor was correctly assessed (within 10%) prior to review of the MRI in 19/24 cases. The correlation between the pre-scan estimation of residual tumor and actual post-scan tumor was high (correlation coefficient 0.81, p<0.05). Conclusions: High field intra- operative MRI with high spatial resolution is a useful adjunct to a neurosurgical oncology practice and alters surgical decision making in a significant number of cases. [Table: see text]

Hypophysial transposition (hypophysopexy) for radiosurgical treatment of pituitary tumors involving the cavernous sinus

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
James K. Liu ◽  
Meic H. Schmidt ◽  
Joel D. Macdonald ◽  
Randy L. Jensen ◽  
William T. Couldwell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Radiation Exposure ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Residual Tumor ◽  
Normal Pituitary Gland ◽  
Fascia Graft ◽  
Normal Functional

Stereotactic radiosurgery (SRS) is performed with increasing frequency in the treatment of residual or recurrent pituitary adenomas. Its major associated risk in these cases of residual or recurrent pituitary tumor adjacent to normal functional pituitary gland is radiation exposure to the pituitary, which frequently leads to the development of hypopituitarism. The authors describe a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual pituitary adenoma within the cavernous sinus. A sellar exploration for tumor resection is performed, the pituitary gland is transposed from the region of the cavernous sinus, and a fat and fascia graft is interposed between the normal pituitary gland and the residual tumor in the cavernous sinus. The residual tumor may then be treated with SRS. The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery and reduces radiation exposure to the normal pituitary gland.

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