scholarly journals Contemporary intraoperative visualization for GBM with use of exoscope, 5-ALA fluorescence-guided surgery and tractography

2022 ◽  
Vol 6 (1) ◽  
pp. V5
Keyword(s):  
Diffusion Tensor ◽  
High Grade Glioma ◽  
Brain Regions ◽  
High Grade ◽  
Glioma Surgery ◽  
Guided Surgery ◽  
Word Finding ◽  
Patient Consent ◽  
Dti Fiber Tracking ◽  
Intraoperative Visualization

Maximal safe resection is the primary goal of glioma surgery. By incorporating improved intraoperative visualization with the 3D exoscope combined with 5-ALA fluorescence, in addition to neuronavigation and diffusion tensor imaging (DTI) fiber tracking, the safety of resection of tumors in eloquent brain regions can be maximized. This video highlights some of the various intraoperative adjuncts used in brain tumor surgery for high-grade glioma. In this case, the authors highlight the resection of a left posterior temporal lobe high-grade glioma in a 33-year-old patient, who initially presented with seizures, word-finding difficulty, and right-sided weakness. They demonstrate the multiple surgical adjuncts used both before and during surgical resection, and how multiple adjuncts can be effectively orchestrated to make surgery in eloquent brain areas safer for patients. Patient consent was obtained for publication. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21174

Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas

Neurosurgery ◽  
2021 ◽  
Author(s):  
Fraser Henderson Jr ◽  
Drew Parker ◽  
Anupa A Vijayakumari ◽  
Mark Elliott ◽  
Timothy Lucas ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Diffusion Tensor ◽  
Free Water ◽  
High Grade Glioma ◽  
Fiber Tracking ◽  
High Grade ◽  
Peritumoral Edema ◽  
Fiber Tractography ◽  
Motor Pathways

Abstract BACKGROUND A limitation of diffusion tensor imaging (DTI)-based tractography is peritumoral edema that confounds traditional diffusion-based magnetic resonance metrics. OBJECTIVE To augment fiber-tracking through peritumoral regions by performing novel edema correction on clinically feasible DTI acquisitions and assess the accuracy of the fiber-tracks using intraoperative stimulation mapping (ISM), task-based functional magnetic resonance imaging (fMRI) activation maps, and postoperative follow-up as reference standards. METHODS Edema correction, using our bi-compartment free water modeling algorithm (FERNET), was performed on clinically acquired DTI data from a cohort of 10 patients presenting with suspected high-grade glioma and peritumoral edema in proximity to and/or infiltrating language or motor pathways. Deterministic fiber-tracking was then performed on the corrected and uncorrected DTI to identify tracts pertaining to the eloquent region involved (language or motor). Tracking results were compared visually and quantitatively using mean fiber count, voxel count, and mean fiber length. The tracts through the edematous region were verified based on overlay with the corresponding motor or language task-based fMRI activation maps and intraoperative ISM points, as well as at time points after surgery when peritumoral edema had subsided. RESULTS Volume and number of fibers increased with application of edema correction; concordantly, mean fractional anisotropy decreased. Overlay with functional activation maps and ISM-verified eloquence of the increased fibers. Comparison with postsurgical follow-up scans with lower edema further confirmed the accuracy of the tracts. CONCLUSION This method of edema correction can be applied to standard clinical DTI to improve visualization of motor and language tracts in patients with glioma-associated peritumoral edema.

scholarly journals Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis

2018 ◽  
Vol 161 (1) ◽  
pp. 99-107 ◽  
Author(s):  
Jasper Kees Wim Gerritsen ◽  
Lidia Arends ◽  
Markus Klimek ◽  
Clemens Maria Franciscus Dirven ◽  
Arnaud Jean-Pierre Edouard Vincent
Keyword(s):  
Meta Analysis ◽  
High Grade Glioma ◽  
High Grade ◽  
Glioma Surgery ◽  
Surgery Outcome

scholarly journals High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery

2015 ◽  
pp. nov113 ◽  
Author(s):  
Kumar Abhinav ◽  
Fang-Cheng Yeh ◽  
Alireza Mansouri ◽  
Gelareh Zadeh ◽  
Juan C. Fernandez-Miranda
Keyword(s):  
White Matter ◽  
High Grade Glioma ◽  
High Grade ◽  
Fiber Tractography ◽  
High Definition ◽  
Glioma Surgery ◽  
White Matter Tracts

scholarly journals SURG-05. NAVIGATED INTRA-OPERATIVE 2-D ULTRASOUND VS STANDARD NEURONAVIGATION IN HIGH GRADE GLIOMA SURGERY

2018 ◽  
Vol 20 (suppl_6) ◽  
pp. vi251-vi251
Author(s):  
Alessandro Moiraghi ◽  
Francesco Prada ◽  
Alberto Delaidelli ◽  
Cristina Goga ◽  
Ramona Guatta ◽  
...  
Keyword(s):  
High Grade Glioma ◽  
High Grade ◽  
Glioma Surgery

scholarly journals Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome

2019 ◽  
Author(s):  
Alessandro Moiraghi ◽  
Francesco Prada ◽  
Alberto Delaidelli ◽  
Ramona Guatta ◽  
Adrien May ◽  
...  
Keyword(s):  
Real Time ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intraoperative Ultrasound ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Glioma Surgery ◽  
Supratentorial Gliomas ◽  
The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter. OBJECTIVE To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN. METHODS We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated. RESULTS The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01). CONCLUSION The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

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