The Impact of Workflow and Volumetric Feedback on Frameless Image-guided Neurosurgery

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS170-ONS176
Author(s):  
Peter A. Woerdeman ◽  
Peter W.A. Willems ◽  
Herke J. Noordmans ◽  
Cornelis A.F. Tulleken ◽  
Jan W.B. van der Sprenkel
Keyword(s):  
Functional Data ◽  
Tumor Resection ◽  
Clinical Results ◽  
Neurosurgical Procedures ◽  
The Novel ◽  
Image Guided ◽  
Interactive Interface ◽  
The Impact ◽  
The Brain ◽  
Visual Interface

Abstract Objective: During image-guided neurosurgery, if the surgeon is not fully orientated to the surgical position, he or she will briefly shift attention toward the visualization interface of an image guidance station, receiving only momentary “point-in-space” information. The aim of this study was to develop a novel visual interface for neuronavigation during brain tumor surgery, enabling intraoperative feedback on the entire progress of surgery relative to the anatomy of the brain and its pathology, regardless of the interval at which the surgeon chooses to look. Methods: New software written in Java (Sun Microsystems, Inc., Santa Clara, CA) was developed to visualize the cumulative recorded instrument positions intraoperatively. This allowed surgeons to see all previous instrument positions during the elapsed surgery. This new interactive interface was then used in 17 frameless image-guided neurosurgical procedures. The purpose of the first 11 cases was to obtain clinical experience with this new interface. In these cases, workflow and volumetric feedback (WVF) were available at the surgeons' discretion (Protocol A). In the next 6 cases, WVF was provided only after a complete resection was claimed (Protocol B). Results: With the novel interactive interface, dynamics of surgical resection, displacement of cortical anatomy, and digitized functional data could be visualized intraoperatively. In the first group (Protocol A), surgeons expressed the view that WVF had affected their decision making and aided resection (10 of 11 cases). In 3 of 6 cases in the second group (Protocol B), tumor resections were extended after evaluation of WVF. By digitizing the cortical surface, an impression of the cortical shift could be acquired in all 17 cases. The maximal cortical shift measured 20 mm, but it typically varied between 0 and 10 mm. Conclusion: Our first clinical results suggest that the embedding of WVF contributes to improvement of surgical awareness and tumor resection in image-guided neurosurgery in a swift and simple manner.

scholarly journals Radiopharmaceutical and Eu3+ doped gadolinium oxide nanoparticles mediated triple-excited fluorescence imaging and image-guided surgery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojing Shi ◽  
Caiguang Cao ◽  
Zeyu Zhang ◽  
Jie Tian ◽  
Zhenhua Hu
Keyword(s):  
Fluorescent Probes ◽  
Signal Intensity ◽  
Tumor Imaging ◽  
Tumor Resection ◽  
Optical Signal ◽  
Gadolinium Oxide ◽  
Image Guided Surgery ◽  
Guided Surgery ◽  
Image Guided ◽  
The Impact

AbstractCerenkov luminescence imaging (CLI) is a novel optical imaging technique that has been applied in clinic using various radionuclides and radiopharmaceuticals. However, clinical application of CLI has been limited by weak optical signal and restricted tissue penetration depth. Various fluorescent probes have been combined with radiopharmaceuticals for improved imaging performances. However, as most of these probes only interact with Cerenkov luminescence (CL), the low photon fluence of CL greatly restricted it’s interaction with fluorescent probes for in vivo imaging. Therefore, it is important to develop probes that can effectively convert energy beyond CL such as β and γ to the low energy optical signals. In this study, a Eu3+ doped gadolinium oxide (Gd2O3:Eu) was synthesized and combined with radiopharmaceuticals to achieve a red-shifted optical spectrum with less tissue scattering and enhanced optical signal intensity in this study. The interaction between Gd2O3:Eu and radiopharmaceutical were investigated using 18F-fluorodeoxyglucose (18F-FDG). The ex vivo optical signal intensity of the mixture of Gd2O3:Eu and 18F-FDG reached 369 times as high as that of CLI using 18F-FDG alone. To achieve improved biocompatibility, the Gd2O3:Eu nanoparticles were then modified with polyvinyl alcohol (PVA), and the resulted nanoprobe PVA modified Gd2O3:Eu (Gd2O3:Eu@PVA) was applied in intraoperative tumor imaging. Compared with 18F-FDG alone, intraoperative administration of Gd2O3:Eu@PVA and 18F-FDG combination achieved a much higher tumor-to-normal tissue ratio (TNR, 10.24 ± 2.24 vs. 1.87 ± 0.73, P = 0.0030). The use of Gd2O3:Eu@PVA and 18F-FDG also assisted intraoperative detection of tumors that were omitted by preoperative positron emission tomography (PET) imaging. Further experiment of image-guided surgery demonstrated feasibility of image-guided tumor resection using Gd2O3:Eu@PVA and 18F-FDG. In summary, Gd2O3:Eu can achieve significantly optimized imaging property when combined with 18F-FDG in intraoperative tumor imaging and image-guided tumor resection surgery. It is expected that the development of the Gd2O3:Eu nanoparticle will promote investigation and application of novel nanoparticles that can interact with radiopharmaceuticals for improved imaging properties. This work highlighted the impact of the nanoprobe that can be excited by radiopharmaceuticals emitting CL, β, and γ radiation for precisely imaging of tumor and intraoperatively guide tumor resection.

COVID-19, the Brain, and the Future: Is Infection by the Novel Coronavirus a Harbinger of Neurodegeneration?

2021 ◽  
Vol 21 ◽  
Author(s):  
Adejoke Onaolapo ◽  
Olakunle Onaolapo
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Severe Acute Respiratory Syndrome ◽  
Neurodegenerative Diseases ◽  
Central Nervous System Involvement ◽  
The Novel ◽  
Novel Coronavirus ◽  
The Impact ◽  
The Brain

: The possible impact of viral infections on the development or pathogenesis of neurodegenerative disorders remains largely unknown. However, there have been reports associating the influenza virus pandemic and long-term infection with the Japanese encephalitis virus with the development of post-encephalitic Parkinsonism or von Economo encephalitis. In the last one year plus, there has been a worldwide pandemic arising from infection with the novel coronavirus or severe acute respiratory syndrome coronavirus (SARS-CoV)-2 which causes a severe acute respiratory syndrome that has become associated with central nervous system symptoms or complications. Its possible central nervous system involvement is in line with emerging scientific evidence which shows that the human respiratory coronaviruses can enter the brain, infect neural cells, persist in the brain, and cause activation of myelin-reactive T cells. Currently, there is a dearth of scientific information on the acute or possible long-term impact of infection with SARS-CoV-2 on the development of dementias and/or neurodegenerative diseases. This is not unrelated to the fact that the virus is ‘new’, and its effects on humans are still being studied. This narrative review examines extant literature for the impact of corona virus infections on the brain; as it considers the possibility that coronavirus disease 2019 (COVID-19) could increase the risk for the development of neurodegenerative diseases or hasten their progression.

scholarly journals Intraoperative Imaging Modalities and Compensation for Brain Shift in Tumor Resection Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-18 ◽  
Author(s):  
Siming Bayer ◽  
Andreas Maier ◽  
Martin Ostermeier ◽  
Rebecca Fahrig
Keyword(s):  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Imaging Systems ◽  
Imaging Modalities ◽  
Neurosurgical Procedures ◽  
Brain Shift ◽  
Web Tool ◽  
Modeling Methods ◽  
Image Guided ◽  
Tissue Manipulation

Intraoperative brain shift during neurosurgical procedures is a well-known phenomenon caused by gravity, tissue manipulation, tumor size, loss of cerebrospinal fluid (CSF), and use of medication. For the use of image-guided systems, this phenomenon greatly affects the accuracy of the guidance. During the last several decades, researchers have investigated how to overcome this problem. The purpose of this paper is to present a review of publications concerning different aspects of intraoperative brain shift especially in a tumor resection surgery such as intraoperative imaging systems, quantification, measurement, modeling, and registration techniques. Clinical experience of using intraoperative imaging modalities, details about registration, and modeling methods in connection with brain shift in tumor resection surgery are the focuses of this review. In total, 126 papers regarding this topic are analyzed in a comprehensive summary and are categorized according to fourteen criteria. The result of the categorization is presented in an interactive web tool. The consequences from the categorization and trends in the future are discussed at the end of this work.

Waterjet dissection of the brain: experimental and first clinical results

1998 ◽  
Vol 89 (5) ◽  
pp. 861-864 ◽  
Author(s):  
Jürgen Piek ◽  
Christian Wille ◽  
Rolf Warzok ◽  
Michael-Robert Gaab
Keyword(s):  
Clinical Results ◽  
New Method ◽  
Surrounding Tissue ◽  
Histological Evaluation ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
New Device ◽  
Waterjet Dissection ◽  
The Brain ◽  
Fine Print

✓ Control of bleeding during dissection is a problem that is still not completely resolved in neurosurgical procedures. To overcome this problem in some settings, the authors, in close collaboration with their institution, developed a new device for blunt dissection of brain tumors that is based on a waterjet technique. This report describes their first experimental and clinical experience with this new method. Numerous cutting experiments were performed in porcine cadaver brains. The best results were obtained using pressures from 4 to 6 bars with a 100-jxm tip, which produced very small, precise cuts. Histological evaluation showed no disruption or vacuolization of the surrounding tissue. The authors have used the new device in nine patients (seven with gliomas and two undergoing temporal lobe resections for epilepsy), and no complications have been observed. The waterjet device allowed dissection of the brain tissue while even small exposed vessels were spared injury. The instrument was found to be easy to use. Future investigations will concentrate on adapting this new method to endoscopic surgery and evaluating fluids with low surface tension to avoid foaming and bubbling during open surgery.

scholarly journals Enhanced registration of ultrasound volumes by segmentation of resection cavity in neurosurgical procedures

2020 ◽  
Vol 15 (12) ◽  
pp. 1963-1974
Author(s):  
Luca Canalini ◽  
Jan Klein ◽  
Dorothea Miller ◽  
Ron Kikinis
Keyword(s):  
Automatic Segmentation ◽  
Tumor Resection ◽  
Neurosurgical Procedures ◽  
Ultrasound Images ◽  
Registration Process ◽  
Resection Cavity ◽  
Direct Mapping ◽  
Before And After ◽  
The Brain ◽  
Dice Index

Abstract Purpose Neurosurgeons can have a better understanding of surgical procedures by comparing ultrasound images obtained at different phases of the tumor resection. However, establishing a direct mapping between subsequent acquisitions is challenging due to the anatomical changes happening during surgery. We propose here a method to improve the registration of ultrasound volumes, by excluding the resection cavity from the registration process. Methods The first step of our approach includes the automatic segmentation of the resection cavities in ultrasound volumes, acquired during and after resection. We used a convolution neural network inspired by the 3D U-Net. Then, subsequent ultrasound volumes are registered by excluding the contribution of resection cavity. Results Regarding the segmentation of the resection cavity, the proposed method achieved a mean DICE index of 0.84 on 27 volumes. Concerning the registration of the subsequent ultrasound acquisitions, we reduced the mTRE of the volumes acquired before and during resection from 3.49 to 1.22 mm. For the set of volumes acquired before and after removal, the mTRE improved from 3.55 to 1.21 mm. Conclusions We proposed an innovative registration algorithm to compensate the brain shift affecting ultrasound volumes obtained at subsequent phases of neurosurgical procedures. To the best of our knowledge, our method is the first to exclude automatically segmented resection cavities in the registration of ultrasound volumes in neurosurgery.

scholarly journals Intraoperative ultrasound in neurosurgical procedures

2020 ◽  
Author(s):  
V A Kiran Kumar ◽  
N A Sai Kiran ◽  
Girija Kumari ◽  
Ranabir Pal ◽  
V Umamaheswar Reddy ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Basal Ganglia ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Neurosurgical Procedures ◽  
Ultrasound Localization ◽  
Imaging Tool ◽  
Before And After ◽  
The Brain ◽  
Complete Tumor

Abstract The objective of the present study was to study the utility and the effectiveness of intraoperative ultrasound in neurosurgical procedures and to assess the outcome.Material and MethodsIn this prospective study, operative procedures by a single surgeon under intraoperative ultrasound localization for basal ganglia/thalamic haematoma or traumatic brain contusions or brain tumours were included. Ultrasound scanning of the brain was performed before and after the excision of the lesion and during the procedure to verify the extent of removal of the lesion.Results74 patients underwent surgery for brain tumor/basal ganglia bleed/head injury with hemorrhagic contusion with the help of intraoperative ultrasound. Gross tumor resection was noted in 25 out of 36 cases of brain tumors (69.44%), complete evacuation of hematoma was noted in 14 out of 34 cases(41.2%) of basal ganglia bleed and in 2 out of 4 cases (50%) of intracerebral contusion. As per Modified Rankin scale (MRS)score, among the brain tumor cases, all patients had fared well in recovery and had better MRS scores except in one patient who expired during postoperative period.ConclusionsIoUS is a widely accessible, cheap, portable and less space occupying and reliable imaging tool to follow and modify the surgical plan in real time, and is more accurate and helpful in complete tumor resection, evacuation of intracerebral bleeds and contusions, and biopsy of deep seated lesions. It is easy and safe to handle with no risk of radiation.

Advancing neurosurgery with image-guided robotics

2009 ◽  
Vol 111 (6) ◽  
pp. 1141-1149 ◽  
Author(s):  
Shawna Pandya ◽  
Jason W. Motkoski ◽  
Cesar Serrano-Almeida ◽  
Alexander D. Greer ◽  
Isabelle Latour ◽  
...  
Keyword(s):  
Phase I ◽  
Tumor Resection ◽  
Neurosurgical Procedures ◽  
Localization Error ◽  
Clinical Integration ◽  
Registration System ◽  
Image Guided ◽  
Overall Performance ◽  
The Mean ◽  
Navigation Accuracy

Robotic systems are being introduced into surgery to extend human ability. NeuroArm represents a potential change in the way surgery is performed; this is the first image-guided, MR-compatible surgical robot capable of both microsurgery and stereotaxy. This paper presents the first surgical application of neuroArm in an investigation of microsurgical performance, navigation accuracy, and Phase I clinical studies. To evaluate microsurgical performance, 2 surgeons performed microsurgery (splenectomy, bilateral nephrectomy, and thymectomy) in a rodent model using neuroArm and conventional techniques. Two senior residents served as controls, using the conventional technique only (8 rats were used in each of the 3 treatment groups; the 2 surgeons each treated 4 rats from each group). Total surgery time, blood loss, thermal injury, vascular injury, and animal death due to surgical error were recorded and converted to an overall performance score. All values are reported as the mean ± SEM when normally distributed and as the median and interquartile range when not. Surgeons were slower using neuroArm (1047 ± 69 seconds) than with conventional microsurgical techniques (814 ± 54 seconds; p = 0.019), but overall performance was equal (neuroArm: 1110 ± 82 seconds; microsurgery: 1075 ± 136 seconds; p = 0.825). Using microsurgery, the surgeons had overall performance scores equal to those of the control resident surgeons (p = 0.141). To evaluate navigation accuracy, the localization error of neuroArm was compared with an established system. Nanoparticles were implanted at predetermined bilateral targets in a cadaveric model (4 specimens) using image guidance. The mean localization error of neuroArm (4.35 ± 1.68 mm) proved equal to that of the conventional navigation system (10.4 ± 2.79 mm; p = 0.104). Using the conventional system, the surgeon was forced to retract the biopsy tool to correct the angle of entry in 2 of 4 trials. To evaluate Phase I clinical integration, the role of neuroArm was progressively increased in 5 neurosurgical procedures. The impacts of neuroArm on operating room (OR) staff, hardware, software, and registration system performance were evaluated. NeuroArm was well received by OR staff and progressively integrated into patient cases, starting with draping in Case 1. In Case 2 and all subsequent cases, the robot was registered. It was used for tumor resection in Cases 3–5. Three incidents involving restrictive cable length, constrictive draping, and reregistration failure were resolved. In Case 5, the neuroArm safety system successfully mitigated a hardware failure. NeuroArm performs as well and as accurately as conventional techniques, with demonstrated safety technology. Clinical integration was well received by OR staff, and successful tumor resection validates the surgical applicability of neuroArm.

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]

scholarly journals Can Open Science be a Tool to Dismantle Claims of Hardwired Brain Sex Differences? Opportunities and Challenges for Feminist Researchers

2021 ◽  
pp. 036168432110376
Author(s):  
Sofia Persson ◽  
Madeleine Pownall
Keyword(s):  
Sex Differences ◽  
Evolutionary Psychology ◽  
Gender Equality ◽  
Data Sharing ◽  
Gender Stereotypes ◽  
Open Science ◽  
The Novel ◽  
Registration Data ◽  
The Impact ◽  
The Brain

Feminist scholars have long been concerned with claims of hardwired brain sex differences emanating from neuroscience and evolutionary psychology. Past criticisms of these claims have rightfully questioned the impact of this research on gender equality, pointing out how findings can be used to vindicate gender stereotypes. In this article, we appraise the brain sex differences literature through the lens of open science, a movement aimed at improving the robustness and reliability of science. In this discussion, we offer a feminist evaluation of the strategies (e.g., pre-registration, data sharing, and accountability) provided by open science, and we question whether these may be the novel and disruptive tools needed to dismantle claims about hardwired brain sex differences. We suggest that open science strategies can be useful in challenging some of these claims, and we note that promising initiatives are already being developed in neuroscience and allied fields. We end by acknowledging the distinct challenges that feminist researchers wishing to engage in open science face, particularly in the context of limited diversity. We conclude that open science presents considerable opportunity for feminist researchers, and that it will be crucial for feminists to be involved in shaping the future of this movement.

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