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.

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.

Future Trends in Functional MRI

2018 ◽  
pp. 230-240
Keyword(s):  
Imaging Technique ◽  
Diffusion Imaging ◽  
Tumor Resection ◽  
Clot Lysis ◽  
Activation Patterns ◽  
Imaging Tool ◽  
Fmri Study ◽  
Activation Response ◽  
Brain Fmri ◽  
The Brain

While MRI became a standard workhorse in neurology/neurosurgery within a few years of installation of the first MRI unit, fMRI, in spite of being a powerful imaging tool, remains primarily a research tool, even though the first fMRI study was published 25 years ago. Scientifically, fMRI has made a major impact, judging by the number of PubMed citations and publications in high-impact journals. In cognitive neuroscience, fMRI is the most commonly used imaging technique in published peer-reviewed articles. fMRI is used clinically for preoperative brain mapping in neurosurgery to delineate the proximity of the lesion (tumor) to eloquent areas of the brain, with the aim of achieving adequate tumor resection with minimal functional damage to the brain. fMRI connectivity and activation maps have identified altered activation patterns and resting-state networks in psychiatric disorders like schizophrenia, bipolar disorder, autism, and Alzheimer’s disease, but fMRI is still not a standard diagnostic procedure in psychiatry. Diffusion imaging technique is being used for triaging stroke patients who are likely to respond to stroke therapy (embolectomy and/or clot lysis). Meanwhile, major collaborative fMRI studies are in progress in many institutions to collect normative data on connectivity, activation response, and behavioral response as well as correlation among them. Studies focused on specific neuropsychiatric disorders also have been initiated by the National Institutes of Health. All this is a reflection of the huge potential application of fMRI in clinical practice envisioned by the scientific community.

scholarly journals New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review

2018 ◽  
Vol 8 (11) ◽  
pp. 202 ◽  
Author(s):  
Maria Pino ◽  
Alessia Imperato ◽  
Irene Musca ◽  
Rosario Maugeri ◽  
Giuseppe Giammalva ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Low Cost ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Pubmed Database

Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.

scholarly journals Utility of Intraoperative Ultrasound in Neurosurgery

2021 ◽  
Author(s):  
Gustavo Enrique Faria Méndez ◽  
César José Roa Chacón ◽  
Nafxiel Jesus Brito Núñez ◽  
José Ramón Zerpa
Keyword(s):  
Ultrasound Guidance ◽  
Parietal Lobe ◽  
Brain Lesion ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Neurosurgical Procedures ◽  
Neurosurgical Department ◽  
Male Predominance ◽  
Ultrasound Evaluation ◽  
Dural Opening

Abstract Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected, with 5 cases, followed by the parietal lobe, with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.

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.

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.

Neuronavigation by Intraoperative Three-dimensional Ultrasound: Initial Experience during Brain Tumor Resection

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 804-812 ◽  
Author(s):  
Geirmund Unsgaard ◽  
Steinar Ommedal ◽  
Tomm Muller ◽  
Aage Gronningsaeter ◽  
Toril A. Nagelhus Hernes
Keyword(s):  
Brain Tumor ◽  
Imaging Modality ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Ultrasound Image ◽  
Intraoperative Ultrasound ◽  
Cost Effective ◽  
Ultrasound Images ◽  
Brain Tumor Resection

Abstract OBJECTIVE: Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection. METHODS: Patients were selected for inclusion in the study on the basis of the size and location of their lesion. Preoperative 3-D MRI data were registered and used for planning as in other conventional neuronavigation systems. Intraoperative 3-D ultrasound images were acquired three to six times, and tumor resection was guided on the basis of these updated 3-D images. RESULTS: Intraoperative 3-D ultrasound represents a good solution to the problem of brain shift in neuronavigation because it easily provides an updated, and hence more accurate, map of the patient's true anatomy in all phases of the operation. Ultrasound makes it possible to follow the progression of the operation, and it improves the radicality of tumor resection by detecting tumor tissue that would remain if the imaging technology had not been used (in 53% of the cases). Integration of 3-D ultrasound with navigation technology solves the orientation problem experienced previously with two-dimensional ultrasound in neurosurgery. The technology makes it possible to directly compare intraoperative ultrasound and MRI data regarding visualization of the lesion. Ultrasound image quality is useful for guiding surgical procedures. CONCLUSION: Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.

Effect of hyperosmotic blood-brain barrier disruption on transcapillary transport in canine brain tumors

1990 ◽  
Vol 72 (3) ◽  
pp. 441-449 ◽  
Author(s):  
Dennis R. Groothuis ◽  
Peter C. Warkne ◽  
Peter Molnar ◽  
Gregory D. Lapin ◽  
Michael A. Mikhael
Keyword(s):  
Drug Delivery ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Ct Scan ◽  
Compartment Model ◽  
Two Compartment Model ◽  
Before And After ◽  
Meglumine Iothalamate ◽  
The Brain ◽  
Time Point

✓ Whether hyperosmotic blood-brain barrier (BBB) disruption is a technique that can be used to increase permeability of brain-tumor capillaries and thereby transiently increase drug delivery to the brain tumor is controversial. Nine virally induced brain tumors were studied in seven dogs, before and after hyperosmotic BBB disruption with 1.4 osmolar mannitol. Each dog was studied with computerized tomography (CT) after administration of the water-soluble tracer meglumine iothalamate. Each study lasted 30 minutes. A baseline CT scan and 35 to 40 additional CT scans were obtained to provide a time-related measurement of the amount of meglumine iothalamate in tissue (Am(t)), and 30 plasma samples were collected to provide the time-related measurement of meglumine iothalamate in plasma (Cp(t)). The data were analyzed by three different methods: 1) a two-compartment model and nonlinear curve fitting were used to calculate K1 (blood-to-tissue or influx constant), k2 (tissue-to-blood or efflux constant), and Vp (plasma vascular space); 2) K1 values were calculated with a two-compartment model, assuming no efflux, at the time point for each CT scan; and 3) a “tissue advantage ratio” was calculated that expressed the ratio of tissue uptake of meglumine iothalamate at each time point, comparing values before and after BBB disruption. Regardless of which method of data analysis was used, there was a marked and significant increase in transcapillary transport of meglumine iothalamate to tumor-free brain regions, while there was only a small, transient, and insignificant increase to the brain tumors. Although there were often marked increases in delivery to cortex in the same hemisphere as the tumors, there was no significant increase to brain immediately surrounding the tumors, perhaps due to altered circulatory dynamics in this region. These data raise serious questions as to the wisdom of using this technique to increase drug delivery to brain tumors in patients and strongly support the continued study of this technique in experimental brain tumors before it is used in patients.

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