scholarly journals Intraoperative MRI Features of Absorbable Oxidized Regenerated Cellulose During Cerebral Glioma Surgery

2018 ◽  
Vol 24 (1) ◽  
pp. 16-20
Author(s):  
Ricardo Ramina ◽  
Maurício Coelho Neto ◽  
Alessandra B. Nascimento ◽  
Ronaldo Vosgerau
Keyword(s):  
Tumor Resection ◽  
Intraoperative Mri ◽  
Regenerated Cellulose ◽  
Low Grade ◽  
Oxidized Regenerated Cellulose ◽  
Glioma Surgery ◽  
Hyperintense Signal ◽  
Mri Features ◽  
Cerebral Gliomas ◽  
Resection Borders

Objectives: Foreign body reaction to absorbable hemostatic agents may mimick recurrent brain tumor or abscess on postoperative MRI. Their appearance on intraoperative MRI and their use as resection borders marker have been not previously described. This study evaluates the intraoperative MRI appearance of absorbable oxidized regenerated cellulose in surgery of cerebralgliomas. Methods: 72 patients with cerebral gliomas were intraoperatively examined with high field MRI (1.5 T). 32 patients presented low-grade and 40 high-grade gliomas. After tumor resection the tumor bed was covered with absorbable oxidized regenerated cellulose. Results: The absorbable hemostat presented a hyperintense signal on MRI-T1 sequences in all patients. Tumor remnants under the hemostatic agent could be identified. Conclusions: Oxidized Regenerated Cellulose can be easily observed as a hyperintense signal lining covering the borders of the surgical cavity on intraoperative MRI-T1 sequences. It may be a useful marker of tumor resection borders of cerebral gliomas. 

Intraoperative MRI and FLAIR Analysis: Implications for low-grade glioma surgery

2019 ◽  
Author(s):  
Myriam Edjlali ◽  
Loïc Ploton ◽  
Claude-Alain Maurage ◽  
Christine Delmaire ◽  
Jean-Pierre Pruvo ◽  
...  
Keyword(s):  
Low Grade Glioma ◽  
Intraoperative Mri ◽  
Low Grade ◽  
Glioma Surgery

scholarly journals Symptomatic Epileptic Seizures in Patients with Brain Gliomas

2021 ◽  
Vol 10 (3) ◽  
pp. 549-557
Author(s):  
D. I. Abzalova ◽  
A. V. Prirodov ◽  
M. V. Sinkin
Keyword(s):  
Antiepileptic Drugs ◽  
Tumor Resection ◽  
Epileptic Seizures ◽  
Low Grade ◽  
Drug Resistant ◽  
Newly Diagnosed ◽  
New Antiepileptic Drugs ◽  
Cerebral Gliomas ◽  
Brain Gliomas

Introduction. Epileptic seizures are an important problem that significantly worsens the quality of patients’ life with both newly diagnosed and recurrent brain gliomas.Review. The analysis of domestic and foreign literature showed that low-grade gliomas, this symptom occurs on average in 76%, with high-grade gliomas – in 21% of patients. Despite the maximum allowable tumor resection, it is likely that epileptic seizures persist in 18-64% of patients, and in 5% of patients they first appear in the postoperative period. From 15 to 50% of epileptic seizures in cerebral gliomas are drug-resistant. In patients undergoing chemotherapy, it is better to use new antiepileptic drugs because their cross-effects are minimal.Conclusion. There is no generally accepted algorithm for prescribing and discontinuing antiepileptic drugs in patients with symptomatic epileptic seizures with cerebral gliomas. Further research is needed to determine the optimal combination and dosage regimen of antiepileptic drugs, especially during chemotherapy.

scholarly journals Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

2016 ◽  
Vol 124 (6) ◽  
pp. 1585-1593 ◽  
Author(s):  
Jie Zhang ◽  
Dong-Xiao Zhuang ◽  
Cheng-Jun Yao ◽  
Ching-Po Lin ◽  
Tian-Liang Wang ◽  
...  
Keyword(s):  
Mr Spectroscopy ◽  
Tumor Resection ◽  
Three Dimensional ◽  
High Grade Glioma ◽  
Radiotherapy Planning ◽  
Low Grade ◽  
Structural Imaging ◽  
Glioma Surgery ◽  
Extensive Resection ◽  
Glioma Resection

OBJECT The extent of resection is one of the most essential factors that influence the outcomes of glioma resection. However, conventional structural imaging has failed to accurately delineate glioma margins because of tumor cell infiltration. Three-dimensional proton MR spectroscopy (1H-MRS) can provide metabolic information and has been used in preoperative tumor differentiation, grading, and radiotherapy planning. Resection based on glioma metabolism information may provide for a more extensive resection and yield better outcomes for glioma patients. In this study, the authors attempt to integrate 3D 1H-MRS into neuronavigation and assess the feasibility and validity of metabolically based glioma resection. METHODS Choline (Cho)–N-acetylaspartate (NAA) index (CNI) maps were calculated and integrated into neuronavigation. The CNI thresholds were quantitatively analyzed and compared with structural MRI studies. Glioma resections were performed under 3D 1H-MRS guidance. Volumetric analyses were performed for metabolic and structural images from a low-grade glioma (LGG) group and high-grade glioma (HGG) group. Magnetic resonance imaging and neurological assessments were performed immediately after surgery and 1 year after tumor resection. RESULTS Fifteen eligible patients with primary cerebral gliomas were included in this study. Three-dimensional 1H-MRS maps were successfully coregistered with structural images and integrated into navigational system. Volumetric analyses showed that the differences between the metabolic volumes with different CNI thresholds were statistically significant (p < 0.05). For the LGG group, the differences between the structural and the metabolic volumes with CNI thresholds of 0.5 and 1.5 were statistically significant (p = 0.0005 and 0.0129, respectively). For the HGG group, the differences between the structural and metabolic volumes with CNI thresholds of 0.5 and 1.0 were statistically significant (p = 0.0027 and 0.0497, respectively). All patients showed no tumor progression at the 1-year follow-up. CONCLUSIONS This study integrated 3D MRS maps and intraoperative navigation for glioma margin delineation. Optimum CNI thresholds were applied for both LGGs and HGGs to achieve resection. The results indicated that 3D 1H-MRS can be integrated with structural imaging to provide better outcomes for glioma resection.

scholarly journals Intraoperative contrast-enhanced ultrasound for cerebral glioma resection and the relationship with microvessel density

2019 ◽  
Author(s):  
Jia Wang ◽  
Xi Liu ◽  
Yilin Yang ◽  
Yunyou Duan
Keyword(s):  
Real Time ◽  
Microvessel Density ◽  
Color Doppler ◽  
Tumor Resection ◽  
Low Grade ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Cerebral Gliomas ◽  
Before And After ◽  
The Relationship

ABSTRACTPurposeWe studied the value of intraoperative contrast-enhanced ultrasound (iCEUS) for real-time monitoring of resection of cerebral gliomas, and analyzed the relationship between CEUS parameters and microvessel density (MVD) of different pathologic grades of cerebral gliomas.Materials and MethodsICEUS was performed in 49 patients with cerebral gliomas. The enhancement characteristics of cerebral gliomas were observed before and after tumor resection. The number of microvessels was counted by immunostaining with anti-CD34. Differences in these quantitative parameters in cerebral gliomas were compared and subjected to a correlation analysis with MVD.ResultsThe color Doppler flow classification within lesions were significantly different before and after iCEUS (p<0.05). The assessment of iCEUS parameters and tumor MVD showed that cerebral gliomas of different pathological grades had different characteristics. The time-to-peak (Tmax) was significantly shorter, the peak intensity (PI) and MVD were significantly higher in high-grade cerebral gliomas than in low-grade cerebral gliomas (p<0.05). According to the immunostaining, PI was positively (r=0.637) correlated with MVD and Tmax was negatively (r=–0.845) correlated with MVD.ConclusionICEUS may determine the borders of lesions more clearly, indicate the microvascular perfusion in real time, and be helpful in understanding the cerebral gliomas grade.

scholarly journals DDIS-02. DEVELOPMENT OF NOVEL SPRAY-TYPE FLUORESCENT PROBES FOR GLIOBLASTOMA DETECTION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi65-vi65
Author(s):  
Yosuke Kitagawa ◽  
Shota Tanaka ◽  
Yugo Kuriki ◽  
Kyoko Yamamoto ◽  
Takahide Nejo ◽  
...  
Keyword(s):  
Fluorescent Probes ◽  
Tumor Resection ◽  
Proteome Analysis ◽  
Progression Free Survival ◽  
Fluorescent Labeling ◽  
Detection Methods ◽  
Clinical Samples ◽  
Low Grade ◽  
Glioma Surgery ◽  
Labeling System

Abstract PURPOSE: ALA is commonly used as an intraoperative tool in malignant glioma surgery, which has been proven effective for radical tumor resection and extended progression-free survival. However, there are some limitations in its use, such as false positivity, false negativity, and inability of re-administration. We aim to develop a novel fluorescent labeling system which can be repeatedly administered by spray during surgery, using hydroxymethyl rhodamine green (HMRG) as fluorescent scaffold originally designed at our university for cancer detection. [Methods]Primary probe screening was performed using the homogenized glioblastoma (GBM) samples with the fluorescent probe library comprised of more than 320 kinds of HMRG fluorescent scaffold combined with various types of dipeptides. Second probe screening was performed using fresh GBM specimens and the selected probes in primary screening. To identify the responsible enzymes, diced electrophoresis gel (DEG) assay was performed. This method utilizes the combination of two dimensional electrophoresis (isoelectric point and molecular weight) and a multiwell-plate-based fluorometric assay to find protein spots with the specified activities. [Results] The prominent probes were selected based upon the above two-step screenings. We identified two enzymes by proteome analysis and experiments using inhibitors, which was further confirmed with real-time PCR and western blotting. [Discussion] This screening methodology is innovative in that it is based on selecting probes from the probe library that respond to clinical samples rather than creating probes from the responsible enzymes. Practical fluorescent probes can be established even for low-grade gliomas, which would be a breakthrough for rapid intraoperative diagnosis in glioma surgery. [Conclusion] HMRG-based aminopeptidase fluorescent probes may be effective for GBM detection.

scholarly journals BOT-03 INVESTIGATION OF NOVEL SPRAY TYPE FLUORESCENT PROBE FOR GLIOBLASTOMA DETECTION

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii12-ii12
Author(s):  
Yosuke Kitagawa ◽  
Shota Tanaka ◽  
Yugo Kuriki ◽  
Kyoko Yamamoto ◽  
Taijun Hana ◽  
...  
Keyword(s):  
Fluorescent Probe ◽  
Fluorescent Probes ◽  
Tumor Resection ◽  
Proteome Analysis ◽  
Progression Free Survival ◽  
Fluorescent Labeling ◽  
Clinical Samples ◽  
Low Grade ◽  
Glioma Surgery ◽  
Labeling System

Abstract PURPOSE 5-ALA is commonly used as an intraoperative tool in malignant glioma surgery, which has been proven effective for radical tumor resection and extended progression-free survival. However, there are some limitations in its use, such as false positivity, false negativity, and inability of re-administration. We aim to develop a novel fluorescent labeling system which can be repeatedly administered by spray during surgery, using hydroxymethyl rhodamine green (HMRG) as fluorescent scaffold originally designed at our university for cancer detection. METHODS Primary probe screening was performed using the homogenized glioblastoma (GBM) samples with the fluorescent probe library comprised of more than 320 kinds of HMRG fluorescent scaffold combined with various types of dipeptides. Second probe screening was performed using fresh GBM specimens and the selected probes in primary screening. To identify the responsible enzymes, diced electrophoresis gel (DEG) assay was performed. This method utilizes the combination of two dimensional electrophoresis (isoelectric point and molecular weight) and a multiwell-plate-based fluorometric assay to find protein spots with the specified activities. RESULTS The prominent probes were selected based upon the above two-step screenings. We identified two enzymes by proteome analysis and experiments using inhibitors, which was further confirmed with real-time PCR and western blotting. DISCUSSION This screening methodology is innovative in that it is based on selecting probes from the probe library that respond to clinical samples rather than creating probes from the responsible enzymes. Practical fluorescent probes can be established even for low-grade gliomas, which would be a breakthrough for rapid intraoperative diagnosis in glioma surgery. CONCLUSION HMRG-based aminopeptidase fluorescent probes may be effective for GBM detection.

scholarly journals Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

2021 ◽  
Vol 11 ◽  
Author(s):  
Dhiego Chaves De Almeida Bastos ◽  
Parikshit Juvekar ◽  
Yanmei Tie ◽  
Nick Jowkar ◽  
Steve Pieper ◽  
...  
Keyword(s):  
Real Time ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Residual Tumor ◽  
Intraoperative Mri ◽  
Recent Experience ◽  
Low Grade ◽  
Challenges And Opportunities ◽  
Real Time Information ◽  
Time Information

IntroductionNeuronavigation greatly improves the surgeon’s ability to approach, assess and operate on brain tumors, but tends to lose its accuracy as the surgery progresses and substantial brain shift and deformation occurs. Intraoperative MRI (iMRI) can partially address this problem but is resource intensive and workflow disruptive. Intraoperative ultrasound (iUS) provides real-time information that can be used to update neuronavigation and provide real-time information regarding the resection progress. We describe the intraoperative use of 3D iUS in relation to iMRI, and discuss the challenges and opportunities in its use in neurosurgical practice.MethodsWe performed a retrospective evaluation of patients who underwent image-guided brain tumor resection in which both 3D iUS and iMRI were used. The study was conducted between June 2020 and December 2020 when an extension of a commercially available navigation software was introduced in our practice enabling 3D iUS volumes to be reconstructed from tracked 2D iUS images. For each patient, three or more 3D iUS images were acquired during the procedure, and one iMRI was acquired towards the end. The iUS images included an extradural ultrasound sweep acquired before dural incision (iUS-1), a post-dural opening iUS (iUS-2), and a third iUS acquired immediately before the iMRI acquisition (iUS-3). iUS-1 and preoperative MRI were compared to evaluate the ability of iUS to visualize tumor boundaries and critical anatomic landmarks; iUS-3 and iMRI were compared to evaluate the ability of iUS for predicting residual tumor.ResultsTwenty-three patients were included in this study. Fifteen patients had tumors located in eloquent or near eloquent brain regions, the majority of patients had low grade gliomas (11), gross total resection was achieved in 12 patients, postoperative temporary deficits were observed in five patients. In twenty-two iUS was able to define tumor location, tumor margins, and was able to indicate relevant landmarks for orientation and guidance. In sixteen cases, white matter fiber tracts computed from preoperative dMRI were overlaid on the iUS images. In nineteen patients, the EOR (GTR or STR) was predicted by iUS and confirmed by iMRI. The remaining four patients where iUS was not able to evaluate the presence or absence of residual tumor were recurrent cases with a previous surgical cavity that hindered good contact between the US probe and the brain surface.ConclusionThis recent experience at our institution illustrates the practical benefits, challenges, and opportunities of 3D iUS in relation to iMRI.

Volumetric Assessment of Glioma Removal by Intraoperative High-field Magnetic Resonance Imaging

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 358-371 ◽  
Author(s):  
Christopher Nimsky ◽  
Atsushi Fujita ◽  
Oliver Ganslandt ◽  
Boris von Keller ◽  
Rudolf Fahlbusch
Keyword(s):  
Magnetic Resonance ◽  
High Field ◽  
Tumor Volume ◽  
Tumor Resection ◽  
World Health ◽  
Low Grade ◽  
High Grade ◽  
Resonance Imaging ◽  
Glioma Surgery ◽  
Health Organization

Abstract OBJECTIVE: To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) for further reduction of tumor volume in glioma surgery. METHODS: From April 2002 to June 2003, 182 neurosurgical procedures were performed with a 1.5-T magnetic resonance system. Among patients who underwent these procedures, 47 patients with gliomas (14 with World Health Organization Grade I or II glioma, and 33 with World Health Organization Grade III or IV glioma) who underwent craniotomy were investigated retrospectively. Completeness of tumor resection and volumetric analysis were assessed with intraoperative imaging data. RESULTS: Surgical procedures were influenced by iMRI in 36.2% of operations, and surgery was continued to remove residual tumor. Additional further resection significantly reduced the percentage of final tumor volume compared with first iMRI scan (6.9% ± 10.3% versus 21.4% ± 13.8%; P &lt; 0.001). Percentages of final tumor volume also were significantly reduced in both low-grade (10.3% ± 11.5% versus 25.8% ± 16.3%; P &lt; 0.05) and high-grade gliomas (5.4% ± 9.9% versus 19.5% ± 13.0%; P &lt; 0.001). Complete resection was achieved finally in 36.2% of all patients (low-grade, 57.1%; high-grade, 27.3%). Among the 17 patients in whom complete tumor resection was achieved, 7 complete resections (41.2%) were attributable to further tumor removal after iMRI. We did not encounter unexpected events attributable to high-field iMRI, and standard neurosurgical equipment could be used safely. CONCLUSION: Despite extended resections, introduction of high-field iMRI in conjunction with functional navigation did not translate into an increased risk of postoperative deficits. The use of high-field iMRI increased radicality in glioma surgery without additional morbidity.

scholarly journals Evaluation of the extent of resection and detection of ischemic lesions with intraoperative MRI in glioma surgery: is intraoperative MRI superior to early postoperative MRI?

2019 ◽  
Vol 131 (1) ◽  
pp. 209-216 ◽  
Author(s):  
Yosuke Masuda ◽  
Hiroyoshi Akutsu ◽  
Eiichi Ishikawa ◽  
Masahide Matsuda ◽  
Tomohiko Masumoto ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Early Postoperative Period ◽  
Intraoperative Mri ◽  
Glioma Surgery ◽  
Ischemic Lesion ◽  
Postoperative Mri ◽  
Reactive Changes

OBJECTIVEMRI scans obtained within 48–72 hours (early postoperative MRI [epMRI]), prior to any postoperative reactive changes, are recommended for the accurate assessment of the extent of resection (EOR) after glioma surgery. Diffusion-weighted imaging (DWI) enables ischemic lesions to be detected and distinguished from the residual tumor. Prior studies, however, revealed that postoperative reactive changes were often present, even in epMRI. Although intraoperative MRI (iMRI) is widely used to maximize safe resection during glioma surgery, it is unclear whether iMRI is superior to epMRI when evaluating the EOR, because it theoretically shows fewer postoperative reactive changes. In addition, the ability to detect ischemic lesions using iMRI has not been investigated.METHODSThe authors retrospectively analyzed prospectively collected data in 30 patients with glioma (22 and 8 patients with enhancing and nonenhancing lesions, respectively) who underwent tumor resection. These patients had received preoperative MRI within 24 hours prior to surgery, postresection radiological evaluation with iMRI during surgery, and epMRI within 24 hours after surgery, with all neuroimaging performed using identical 1.5T MRI scanners. The authors compared iMRI or epMRI with preoperative MRI, and defined a postoperative reactive change as a new postoperative enhancement or T2 high-intensity area (HIA), if this lesion was outside of the preoperative original tumor location. In addition, postoperative ischemia was evaluated on DWI. The iMRI and epMRI findings were compared in terms of 1) postoperative reactive changes, 2) evaluation of the EOR, and 3) presence of ischemic lesion on DWI.RESULTSIn patients with enhancing lesions, a new enhancement was seen in 8 of 22 patients (36.4%) on iMRI and in 12 of 22 patients (54.5%) on epMRI. In patients with nonenhancing lesions, a new T2 HIA was seen in 4 of 8 patients (50.0%) on iMRI and in 7 of 8 patients (87.5%) on epMRI. A discrepancy between the EOR measured on iMRI and epMRI was noted in 5 of the 22 patients (22.7%) with enhancing lesions, and in 3 of the 8 patients (37.5%) with nonenhancing lesions. The occurrence of ischemic lesions on DWI was found in 5 of 30 patients (16.7%) on iMRI, whereas it was found in 16 of 30 patients (53.3%) on epMRI (p = 0.003); ischemic lesions were underestimated on iMRI in 11 patients.CONCLUSIONSOverall, given the lower incidence of postoperative reactive changes on iMRI, it was superior to epMRI in evaluating the EOR in patients with glioma, both with enhancing and nonenhancing lesions. However, because ischemic lesions can be overlooked on iMRI, the authors recommend only the additional DWI scan during the early postoperative period. Clinicians need to be mindful about not overestimating the presence of residual tumor on epMRI due to the high incidence of postoperative reactive changes.

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