scholarly journals Intraoperative Ultrasound-Assisted Extent of Resection Assessment in Pediatric Neurosurgical Oncology

2021 ◽  
Vol 11 ◽  
Author(s):  
Andrea Carai ◽  
Alessandro De Benedictis ◽  
Tommaso Calloni ◽  
Nicola Onorini ◽  
Giovanni Paternò ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Predictive Value ◽  
Pediatric Population ◽  
Intraoperative Ultrasound ◽  
Predictive Ability ◽  
Extent Of Resection ◽  
Low Grade ◽  
Prognostic Impact ◽  
Postoperative Mri ◽  
Tumor Residue

Central nervous system tumors represent the most frequent solid malignancy in the pediatric population. Maximal safe surgical resection is a mainstay of treatment, with significant prognostic impact for the majority of histotypes. Intraoperative ultrasound (ioUS) is a widely available tool in neurosurgery to assist in intracerebral disease resection. Despite technical caveats, preliminary experiences suggest a satisfactory predictive ability, when compared to magnetic resonance imaging (MRI) studies. Most of the available evidence on ioUS applications in brain tumors derive from adult series, a scenario that might not be representative of the pediatric population. We present our preliminary experience comparing ioUS-assisted resection assessment to early post-operative MRI findings in 154 consecutive brain tumor resections at our pediatric neurosurgical unit. A high concordance was observed between ioUS and post-operative MRI. Overall ioUS demonstrated a positive predictive value of 98%, a negative predictive value of 92% in assessing the presence of tumor residue compared to postoperative MRI. Overall, sensibility and specificity were 86% and 99%, respectively. On a multivariate analysis, the only variable significantly associated to unexpected tumor residue on postoperative MRI was histology. Tumor location, patient positioning during surgery, age and initial tumor volume were not significantly associated with ioUS predictive ability. Our data suggest a very good predictive value of ioUS in brain tumor resective procedures in children. Low-grade glioma, high-grade glioma and craniopharyngioma might represent a setting deserving specific endeavours in order to improve intraoperative extent of resection assessment ability.

scholarly journals Correlation between intraoperative ultrasound and postoperative MRI in pediatric tumor surgery

2016 ◽  
Vol 18 (5) ◽  
pp. 578-584 ◽  
Author(s):  
Heather Smith ◽  
AmiLyn Taplin ◽  
Sohail Syed ◽  
Matthew A. Adamo
Keyword(s):  
Real Time ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Tumor Surgery ◽  
Resection Rate ◽  
Total Resection ◽  
Postoperative Mri

OBJECTIVE Malignant disease of the CNS is the primary etiology for deaths resulting from cancer in the pediatric population. It has been well documented that outcomes of pediatric neurosurgery rely on the extent of tumor resection. Therefore, techniques that improve surgical results have significant clinical implications. Intraoperative ultrasound (IOUS) offers real-time surgical guidance and a more accurate means for detecting residual tumor that is inconspicuous to the naked eye. The objective of this study was to evaluate the correlation of extent of resection between IOUS and postoperative MRI. The authors measured the correlation of extent of resection, negative predictive value, and sensitivity of IOUS and compared them with those of MRI. METHODS This study consisted of a retrospective review of the medical charts of all pediatric patients who underwent neurosurgical treatment of a tumor between August 2009 and July 2015 at Albany Medical Center. Included were patients who were aged ≤ 21 years, who underwent brain or spinal tumor resection, for whom IOUS was used during the tumor resection, and for whom postoperative MRI (with and without contrast) was performed within 1 week of surgery. RESULTS Sixty-two patients met inclusion criteria for the study (33 males, mean age 10.0 years). The IOUS results very significantly correlated with postoperative MRI results (φ = 0.726; p = 0.000000011; negative predictive value 86.3% [95% CI 73.7%–94.3%]). These results exemplify a 71% overall gross-total resection rate and 80% intended gross-total resection rate with the use of IOUS (i.e., excluding cases performed only for debulking purposes). CONCLUSIONS The use of IOUS may play an important role in achieving a greater extent of resection by providing real-time information on tumor volume and location in the setting of brain shift throughout the course of an operation. The authors support the use of IOUS in pediatric CNS tumor surgery to improve clinical outcomes at low cost with minimal additional operating-room time and no identified additional risk.

scholarly journals Extent of Glioma Resection on Intraoperative Ultrasound Correlates Well with Postoperative MRI Results

2019 ◽  
pp. 1-7
Author(s):  
Ahmed Aly ◽  
Radwan Noubi ◽  
Mahmoud Ragab ◽  
Khalid Abdelaziz ◽  
Simon Howarth ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Control Group ◽  
P Value ◽  
Low Grade ◽  
Ultrasound Images ◽  
Glioma Surgery ◽  
Number Of Patients

Background: Maximal surgical resection is thought to confer survival benefit for both high- and low-grade gliomas. Intraoperative imaging assists with achieving maximal surgical resection. Different intraoperative imaging modalities have been implemented, but intra-operative MRI has a high cost that may limit its uptake in resource scarce healthcare systems. Objectives: This study aims to evaluate intraoperative ultrasound as a surrogate for intra and post-operative MRI for assessing the extent of resection of glioma. Methods: A partially prospective comparative study, which compares a prospective cohort group with a historical control group. We evaluated 74 glioma patients, who all underwent surgery in a regional UK Neurosurgical centre between October 2013 and October 2017. The study population was divided into 2 groups based on the use of ultrasound to guide the resection. We compared the size of the lesion prior and after excision to evaluate the extent of resection and undertook comparison with post-operative MRI. Results: The mean extent of resection on the ultrasound images was 96.1 % and 97.7 % on the postoperative MR. Using Spearman’s correlation; extent of resection on the ultrasound images was strongly correlated with the extent of resection on the postoperative MR images (P=value <0.001). The use of intraoperative ultrasound was associated with a significant increase in the number of patients in whom 95% or greater extent of resection was achieved (Fisher’s exact test P= value 0.033). Conclusion: Intra-operative ultrasonography could provide a reliable and cheaper alternative to intraoperative MRI to improve the extent of resection in glioma surgery.

Intraoperative 3D ultrasound–guided resection of diffuse low-grade gliomas: radiological and clinical results

2020 ◽  
Vol 132 (2) ◽  
pp. 518-529 ◽  
Author(s):  
Hans Kristian Bø ◽  
Ole Solheim ◽  
Kjell-Arne Kvistad ◽  
Erik Magnus Berntsen ◽  
Sverre Helge Torp ◽  
...  
Keyword(s):  
General Anesthesia ◽  
San Francisco ◽  
Prognostic Score ◽  
Three Dimensional ◽  
Residual Tumor ◽  
Clinical Results ◽  
Extent Of Resection ◽  
3D Ultrasound ◽  
Low Grade ◽  
Postoperative Mri

OBJECTIVEExtent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)–guided resection under general anesthesia.METHODSConsecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated.RESULTSForty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)–mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI.CONCLUSIONSThree-dimensional US–guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.

scholarly journals Basic Principles of Intraoperative Ultrasound Applied to Brain Tumor Surgery

2020 ◽  
Vol 9 (02) ◽  
pp. 135-140
Author(s):  
Javier A. Jacobo ◽  
Javier Avendaño ◽  
Sergio Moreno-Jimenez ◽  
Santiago Nuñez ◽  
Rocio Mamani
Keyword(s):  
Brain Tumor ◽  
Tumor Volume ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Basic Knowledge ◽  
Full Potential ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Basic Principles ◽  
Metastatic Lesions

AbstractIntraoperative ultrasound (US) has been shown to possess great value in assessing tumor volume and localization, especially for primary resection of gliomas and metastatic lesions. Given that US is a technology that is highly user dependent, many surgeons have encountered problems with the usage of this technology, as well as interpretation of intraoperative US images, limiting its full potential. This article focuses on the basic knowledge a neurosurgeon must acquire to properly use and interpret intraoperative US to improve tumor localization and extent of resection during brain tumor surgery.

Predicting the Extent of Resection in Low-Grade Glioma by Using Intratumoral Tractography to Detect Eloquent Fascicles Within the Tumor

Neurosurgery ◽  
2020 ◽  
Author(s):  
David Mato ◽  
Carlos Velasquez ◽  
Elsa Gómez ◽  
Enrique Marco de Lucas ◽  
Juan Martino
Keyword(s):  
Predictive Value ◽  
Diffusion Tensor ◽  
Extent Of Resection ◽  
Current Treatment ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Seed Region ◽  
Eloquent Areas ◽  
Treatment Paradigm ◽  
Intraoperative Electrical Stimulation

Abstract BACKGROUND An early maximal safe surgical resection is the current treatment paradigm for low-grade glioma (LGG). Nevertheless, there are no reliable methods to accurately predict the axonal intratumoral eloquent areas and, consequently, to predict the extent of resection. OBJECTIVE To describe the functional predictive value of eloquent white matter tracts within the tumor by using a pre- and postoperative intratumoral diffusion tensor imaging (DTI) tractography protocol in patients with LGG. METHODS A preoperative intratumoral DTI-based tractography protocol, using the tumor segmented volume as the only seed region, was used to assess the tracts within the tumor boundaries in 22 consecutive patients with LGG. The reconstructed tracts were correlated with intraoperative electrical stimulation (IES)-based language and motor subcortical mapping findings and the extent of resection was assessed by tumor volumetrics. RESULTS Identification of intratumoral language and motor tracts significantly predicted eloquent areas within the tumor during the IES mapping: the positive predictive value for the pyramidal tract, the inferior fronto-occipital fasciculus, the arcuate fasciculus and the inferior longitudinal fasciculus positive was 100%, 100%, 33%, and 80%, respectively, whereas negative predictive value was 100% for all of them. The reconstruction of at least one of these tracts within the tumor was significantly associated with a lower extent of resection (67%) as opposed to the extent of resection in the cases with a negative intratumoral tractography (100%) (P &lt; .0001). CONCLUSION Intratumoral DTI-based tractography is a simple and reliable method, useful in assessing glioma resectability based on the analysis of intratumoral eloquent areas associated with motor and language tracts within the tumor.

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

2020 ◽  
Vol 82 (01) ◽  
pp. 064-074
Author(s):  
Johannes Wach ◽  
Mohammad Banat ◽  
Valeri Borger ◽  
Hartmut Vatter ◽  
Hannes Haberl ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Meta Analysis ◽  
Pediatric Brain Tumor ◽  
Extent Of Resection ◽  
Low Grade ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Guided Surgery ◽  
The Mean ◽  
Pediatric Brain

Abstract Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

scholarly journals Neutrophil-to-Lymphocyte Ratio: Can It Be Used as an Adjunct Tool to Predict Histopathological Grade of Brain Tumor?

2019 ◽  
Vol 10 (04) ◽  
pp. 648-652
Author(s):  
K. G. Ashwath ◽  
Ashish Aggarwal ◽  
Kokkula Praneeth ◽  
Navneet Singla ◽  
Kirti Gupta
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Predictive Value ◽  
P Value ◽  
Low Grade ◽  
High Grade ◽  
Histopathological Grade ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
The Mean

Abstract Background Since histopathology is available only after surgery, clinical condition and radiological characters of the tumor are important factors on which a clinician counsels the patient of brain tumor to take a decision regarding the management. Neutrophil lymphocyte ratio (NLR), a marker of inflammation can be used as a prognostic marker to predict the survival in high-grade gliomas and metastases. We evaluated the utility of NLR as an adjunct tool in predicting the histopathological grade of brain tumors. Materials and Methods One hundred sixteen patients with a diagnosis of brain tumors planned for surgical excision or biopsy were enrolled in the study. NLR was estimated in the preoperative blood sample. Patients were grouped into low- and highgrade brain tumors and their mean NLRs were analyzed. Similar evaluation was carried out between the intra- and extra-axial tumors. Results Mean age of the study group was 40.14 years with 61 males. Seventy-eight patients had low-grade tumor and 38 patients had high-grade tumor. Sixty patients had extra-axial tumors and 56 patients had intra-axial tumors. The mean NLR of low-grade tumors was 1.68 ± 0.53 and that of high-grade tumors was 3.12 ± 0.74. NLR > 2.4 can be used to identify high-grade brain tumors with a sensitivity of 80%, specificity of 92%, positive predictive value of 82.1%, negative predictive value of 91%, an excellent impact with likelihood ratio (+) of 10.1, and an odds ratio of 54.1. The mean NLR of extra-axial tumors was 1.68 + 0.62 and that of intra-axial tumors was 2.64 ± 0.91. These observations were statistically significant with p-value < 0.05. Conclusions NLR is an easily available and inexpensive marker of systemic inflammation, which varies across different histopathological grades of brain tumors. Mean NLR is higher in high-grade tumors and also intra-axial tumors with a cutoff value of NLR > 2.4 and > 2.0, respectively.

Advantages and limitations of intraoperative ultrasound strain elastography applied in brain tumor surgery: a single-center experience

2021 ◽  
Author(s):  
Santiago Cepeda ◽  
Sergio García-García ◽  
Ignacio Arrese ◽  
María Velasco-Casares ◽  
Rosario Sarabia
Keyword(s):  
Brain Tumor ◽  
Decision Tree ◽  
Cross Validation ◽  
Intraoperative Ultrasound ◽  
Classification Model ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Tissue Elasticity ◽  
Strain Elastography ◽  
Tree Classifier

Abstract Objective Strain elastography is an intraoperative ultrasound (ioUS) modality currently under development with various potential applications in neurosurgery. However, certain technical aspects and limitations have not yet been adequately explained. The objective of our work is to share the experience of our center in a case series of operated brain tumors in which we have applied strain elastography.Methods We retrospectively analyzed patients who underwent craniotomy for a brain tumor between March 2018 to March 2021. Cases with an ioUS strain elastography study were included. The elastograms were processed semi-quantitatively by decomposing the image in HSB (Hue, Saturation, Brightness) format. Subsequently, the mean tissue elasticity (MTE) values were calculated from the histogram of intensities of the pixels of the hue images. The tumor was manually segmented, and regions of interest (ROIs) were placed in the peritumoral area. An analysis was performed to correlate the histopathological groups and the tumor and peritumoral MTE values using the Kruskal-Wallis test. In addition, a classification model was developed using an algorithm based on a decision tree. Then, model predictive capacity was evaluated through 10-folds cross-validation. Finally, elastogram’s quality was assessed to discuss possible sources of artifacts and weaknesses of the ultrasound technique.Results One hundred two patients with the following histopathological diagnosis were analyzed: 43 high-grade gliomas, 11 low-grade gliomas, 28 meningiomas, and 20 metastases. The tumor MTE values ​​were significantly different between the histopathological groups, p <.001, c2 = 46.34, e2 = .45. There were also significant differences for the MTE values ​​concerning the peritumor, p<.001, c2 = 25.47, e2 = .25. The decision tree classifier showed an area under the curve (AUC) of the average over classes of 0.97, and the classification accuracy (CA) was 86%. After 10-folds cross-validation, the AUC was 0.73, and the CA was 72%. The main technical limitations found in our series were: the presence of artifacts after dural opening, the variability of the frequency and amplitude of the mechanical pulsations, and the challenge in evaluating deep lesions.Conclusion ioUS strain elastography is a fast and versatile technique that provides relevant information to adapt the surgical strategy. Furthermore, the stiffness of the tissues has a plausible histopathological correlation. For these reasons, this technique has enormous potential to be exploited in the coming years.

scholarly journals Is There a Relationship between the Elasticity of Brain Tumors, Changes in Diffusion Tensor Imaging, and Histological Findings? A Pilot Study Using Intraoperative Ultrasound Elastography

2021 ◽  
Vol 11 (2) ◽  
pp. 271
Author(s):  
Santiago Cepeda ◽  
Sergio García-García ◽  
María Velasco-Casares ◽  
Gabriel Fernández-Pérez ◽  
Tomás Zamora ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Diffusion Tensor Imaging ◽  
Linear Regression ◽  
Brain Tumors ◽  
Diffusion Tensor ◽  
Intraoperative Ultrasound ◽  
Ultrasound Elastography ◽  
Proliferation Index ◽  
Strong Positive Correlation ◽  
Non Linear

Intraoperative ultrasound elastography (IOUS-E) is a novel image modality applied in brain tumor assessment. However, the potential links between elastographic findings and other histological and neuroimaging features are unknown. This study aims to find associations between brain tumor elasticity, diffusion tensor imaging (DTI) metrics, and cell proliferation. A retrospective study was conducted to analyze consecutively admitted patients who underwent craniotomy for supratentorial brain tumors between March 2018 and February 2020. Patients evaluated by IOUS-E and preoperative DTI were included. A semi-quantitative analysis was performed to calculate the mean tissue elasticity (MTE). Diffusion coefficients and the tumor proliferation index by Ki-67 were registered. Relationships between the continuous variables were determined using the Spearman ρ test. A predictive model was developed based on non-linear regression using the MTE as the dependent variable. Forty patients were evaluated. The pathologic diagnoses were as follows: 21 high-grade gliomas (HGG); 9 low-grade gliomas (LGG); and 10 meningiomas. Cases with a proliferation index of less than 10% had significantly higher medians of MTE (110.34 vs. 79.99, p < 0.001) and fractional anisotropy (FA) (0.24 vs. 0.19, p = 0.020). We found a strong positive correlation between MTE and FA (rs (38) = 0.91, p < 0.001). A cubic spline non-linear regression model was obtained to predict tumoral MTE from FA (R2 = 0.78, p < 0.001). According to our results, tumor elasticity is associated with histopathological and DTI-derived metrics. These findings support the usefulness of IOUS-E as a complementary tool in brain tumor surgery.

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