Intraoperative Strain Elastosonography in Brain Tumor Surgery

Abstract BACKGROUND Sonoelastography is an ultrasound imaging technique able to assess mechanical properties of tissues. Strain elastography (SE) is a qualitative sonoelastographic modality with a wide range of clinical applications, but its use in brain tumor surgery has been so far very limited. OBJECTIVE To describe the first large-scale implementation of SE in oncological neurosurgery for lesions discrimination and characterization. METHODS We analyzed retrospective data from 64 patients aiming at (i) evaluating the stiffness of the lesion and of the surrounding brain, (ii) assessing the correspondence between B-mode and SE, and (iii) performing subgroup analysis for gliomas characterization RESULTS (i) In all cases, we visualized the lesion and the surrounding brain with SE, permitting a qualitative stiffness assessment. (ii) In 90% of cases, lesion representations in B-mode and SE were superimposable with identical morphology and margins. In 64% of cases, lesion margins were sharper in SE than in B-mode. (iii) In 76% of cases, glioma margins were sharper in SE than in B-mode. Lesions morphology/dimensions in SE and in B-mode were superimposable in 89%. Low-grade (LGG) and high-grade (HGG) gliomas were significantly different in terms of stiffness and stiffness contrast between tumors and brain, LGG appearing stiffer while HGG softer than brain (all P < ·001). A threshold of 2.5 SE score had 85.7% sensitivity and 94.7% specificity in differentiating LGG from HGG. CONCLUSION SE allows to understand mechanical properties of the brain and lesions in examination and permits a better discrimination between different tissues compared to B-mode. Additionally, SE can differentiate between LGG and HGG.

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Neurogenic Pulmonary Edema Occured during the Brain Tumor Surgery - A case report

Korean Journal of Anesthesiology ◽

10.4097/kjae.1989.22.4.563 ◽

1989 ◽

Vol 22 (4) ◽

pp. 563

Author(s):

Yong Seok Oh ◽

Hoon Kang ◽

In Cheol Choi ◽

Tae Su Ham

Keyword(s):

Brain Tumor ◽

Case Report ◽

Pulmonary Edema ◽

Neurogenic Pulmonary Edema ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

The Brain

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Effect of hemostasis and electrosurgery on the development and evolution of brain tumor surgery in the late 19th and early 20th centuries

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.4.4 ◽

2005 ◽

Vol 18 (4) ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

John R. Vender ◽

Jason Miller ◽

Andy Rekito ◽

Dennis E. McDonnell

Keyword(s):

Brain Tumor ◽

Brain Tissue ◽

Surgical Management ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

The Impact ◽

Neurological Surgeon ◽

The Brain ◽

Development And Evolution ◽

Type Of Surgery

Hemostatic options available to the surgeon in the late 19th and early 20th centuries were limited. The surgical ligature was limited in value to the neurological surgeon because of the unique structural composition of brain tissue as well as the approaches and operating angles used in this type of surgery. In this manuscript the authors review the options available and the evolution of surgical hemostatic techniques and electrosurgery in the late 19th and early 20th centuries and the impact of these methods on the surgical management of tumors of the brain and its coverings.

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Mapping the Brain for Primary Brain Tumor Surgery

Malignant Brain Tumors ◽

10.1007/978-3-319-49864-5_5 ◽

2016 ◽

pp. 63-79 ◽

Cited By ~ 2

Author(s):

Emmanuel Mandonnet ◽

Hugues Duffau

Keyword(s):

Brain Tumor ◽

Primary Brain Tumor ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

The Brain

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Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period

Journal of Neurosurgery ◽

10.3171/2014.10.jns141520 ◽

2015 ◽

Vol 123 (2) ◽

pp. 325-339 ◽

Cited By ~ 141

Author(s):

Shawn L. Hervey-Jumper ◽

Jing Li ◽

Darryl Lau ◽

Annette M. Molinaro ◽

David W. Perry ◽

...

Keyword(s):

Brain Tumor ◽

Systemic Disease ◽

Awake Craniotomy ◽

Vascular Tumors ◽

Low Grade ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Mapping Procedure ◽

The University ◽

Sedation Regimen

OBJECT Awake craniotomy is currently a useful surgical approach to help identify and preserve functional areas during cortical and subcortical tumor resections. Methodologies have evolved over time to maximize patient safety and minimize morbidity using this technique. The goal of this study is to analyze a single surgeon's experience and the evolving methodology of awake language and sensorimotor mapping for glioma surgery. METHODS The authors retrospectively studied patients undergoing awake brain tumor surgery between 1986 and 2014. Operations for the initial 248 patients (1986–1997) were completed at the University of Washington, and the subsequent surgeries in 611 patients (1997–2014) were completed at the University of California, San Francisco. Perioperative risk factors and complications were assessed using the latter 611 cases. RESULTS The median patient age was 42 years (range 13–84 years). Sixty percent of patients had Karnofsky Performance Status (KPS) scores of 90–100, and 40% had KPS scores less than 80. Fifty-five percent of patients underwent surgery for high-grade gliomas, 42% for low-grade gliomas, 1% for metastatic lesions, and 2% for other lesions (cortical dysplasia, encephalitis, necrosis, abscess, and hemangioma). The majority of patients were in American Society of Anesthesiologists (ASA) Class 1 or 2 (mild systemic disease); however, patients with severe systemic disease were not excluded from awake brain tumor surgery and represented 15% of study participants. Laryngeal mask airway was used in 8 patients (1%) and was most commonly used for large vascular tumors with more than 2 cm of mass effect. The most common sedation regimen was propofol plus remifentanil (54%); however, 42% of patients required an adjustment to the initial sedation regimen before skin incision due to patient intolerance. Mannitol was used in 54% of cases. Twelve percent of patients were active smokers at the time of surgery, which did not impact completion of the intraoperative mapping procedure. Stimulation-induced seizures occurred in 3% of patients and were rapidly terminated with ice-cold Ringer's solution. Preoperative seizure history and tumor location were associated with an increased incidence of stimulation-induced seizures. Mapping was aborted in 3 cases (0.5%) due to intraoperative seizures (2 cases) and patient emotional intolerance (1 case). The overall perioperative complication rate was 10%. CONCLUSIONS Based on the current best practice described here and developed from multiple regimens used over a 27-year period, it is concluded that awake brain tumor surgery can be safely performed with extremely low complication and failure rates regardless of ASA classification; body mass index; smoking status; psychiatric or emotional history; seizure frequency and duration; and tumor site, size, and pathology.

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