Utility of Indocyanine Green Videoangiography with FLOW 800 Analysis in Brain Tumor Resection - Venous Protection Tchnique

Background: When it comes to central nervous system tumor resection, preserving vital venous structures to avoid devastating consequences such as brain edema and hemorrhage is important. Wheras, in clinical practice, it is difficult to obtain clear and vivid intraoperative venous visualization and blood flow analysis.Methods: We retrospectively reviewed patients underwent brain tumor resection through the application of indocyanine green videoangiography (ICG-VA) integrated with FLOW 800 from February 2019 to December 2020 and presented our clinical cases to demonstrate the process of venous preservation. Galen vein, sylvian vein and superior cerebral veins were included in our cases.Results: Clear documentations of the veins from different venous groups were obtained via ICG-VA integrated with FLOW 800, which semiquantitatively analyzed the flow dynamics. ICG-VA integrated with FLOW 800 enabled us to achieve brain tumor resection without venous injury and obstructing the venous flux.Conclusions: ICG-VA integrated with FLOW 800 is an available method for venous preservation, though further comparison between ICG-VA integrated with FLOW 800 and other techniques of intraoperative blood flow monitoring is needed.

A Complicated Course of Brain Tumor Resection in a Patient with a Left Ventricular Assist Device

Left ventricular assist devices (LVAD) are mechanical pumps that have become a standard treatment for end-stage heart failure. As patients with LVAD are living longer, the number of noncardiac surgeries performed in these patients is rising. However, these patients present a unique set of risk factors, some of which include acquired coagulopathies, anticoagulation status, and hemodynamic instability. Thus, performing noncardiac surgeries in patients with an LVAD requires a precise and complex surgical strategy with optimal communication among the surgical team. Therefore, knowledge of best perioperative approaches for patients with LVAD is urgently needed. Here, we present a detailed perioperative surgical approach in the case of a brain tumor resection for a 62-year-old patient with an LVAD whose course was complicated with a brain hematoma. Critical details include key aspects of monitoring patient hemodynamic stability and handling of anesthesia, patient positioning, and antiplatelet and anticoagulation drug therapy. This case highlights the importance for anesthesiologists to be well informed about perioperative LVAD management, as well as common complications that they may encounter.

INNV-03. DEVELOPMENT OF A NOVEL DUAL-MODALITY BALLOON IMPLANT FOR SIMULTANEOUS HIGH-DOSE-RATE BRACHYTHERAPY AND MAGNETIC NANOPARTICLE HYPERTHERMIA OF BRAIN TUMOR RESECTION CAVITIES

PURPOSE To develop a novel thermobrachytherapy (TBT) balloon implant that delivers hyperthermia and radiation simultaneously, with three specific aims: 1) to fabricate a prototype TBT balloon device; 2) to verify compatibility of all heating and radiation delivery components and evaluate heat and radiation dosimetry in full size skull/brain phantom models; and 3) to characterize in vivo heating patterns in pig brain. METHODS Five 3cm diameter TBT balloons were fabricated. Each balloon has two layers: an inner layer to be filled with saline to expand the resection cavity, and an outer layer to be filled with magnetic nanoparticle (MNP) solution to absorb energy from an external magnetic field hence generate heat. The balloon shaft houses 4 ports to fill inner and outer layers, insert a high-dose-rate brachytherapy source into the balloon center, and a fiber optic sensor into the outer layer to monitor and control balloon temperature. A 3D-printed skull phantom was filled with brain tissue-equivalent gel for in-phantom measurements of heating around a TBT balloon. Optically stimulated luminescent dosimeters and Gafchromic film were used to measure radiation dose; while motorized temperature probes placed in catheters were inserted in surrounding gel for thermal mapping. For in vivo experiments, a 1cm balloon was specifically fabricated for pigs 40-50 kg. RESULTS The presence of MNP, magnetic field, and 43-55°C heating did not affect radiation dose significantly. Thermal mapping demonstrated spherically symmetric heating in both phantom and in vivo brain tissue, where a higher concentration of MNP and stronger magnetic field of 1.6-4.5 kA/m at 133 kHz was used to achieve temperatures of 55°C in the much smaller balloon. CONCLUSION Novel dual-modality balloons have been fabricated and tested successfully in the lab and in vivo, hence providing crucial information to validate thermal modeling for combined heat and radiation treatment of brain tumor resection cavities.

Utility of Indocyanine Green Videoangiography with FLOW 800 Analysis in Brain Tumor Resection - Venous Protection Technique

Background: When it comes to central nervous system tumor resection, preserving vital venous structures to avoid devastating consequences such as brain edema and hemorrhage is important. Wheras, in clinical practice, it is difficult to obtain clear and vivid intraoperative venous visualization and blood flow analysis.Methods: We presented our clinical cases to demonstrate the process of venous preservation during surgical resection through the application of indocyanine green videoangiography (ICG-VA) integrated with FLOW 800. Galen vein, sylvian vein and superior cerebral veins of the brain were included.Results: Clear documentations of the veins from different venous groups were obtained via ICG-VA integrated with FLOW 800, which semiquantitatively analyzed the flow dynamics. ICG-VA integrated with FLOW 800 enabled us to achieve brain tumor resection without venous injury and obstructing the venous flux.Conclusions: ICG-VA integrated with FLOW 800 is an efficient method for venous preservation, though further comparison between ICG-VA integrated with FLOW 800 and other techniques of intraoperative blood flow monitoring is needed.

Bioreactance-guided fluid therapy for excision of a giant brain tumor in an infant under general anesthesia: A case report and literature review

Pediatric patients are more likely to suffer from brain tumors. Surgical resection is often the optimal treatment. Perioperative management of pediatric brain tumor resection brings great challenges to anesthesiologists, especially for fluid therapy. In this case, the infant-patient was only 69-day-old, weighed 6 kg，but she was facing a gaint brain tumor (7.9 cm × 8.1 cm × 6.7 cm) excision. The infant was at great risks such as hemorrhagic shock, cerebral edema, pulmonary edema, congestive heart failure, coagulation dysfunction, etc. However, we tried to use the parameters obtained by bioreactance-based NICOM® device (Cheetah Medical) to guide the infant’s intraoperative fluid therapy, and successfully avoided these complications and achieved a good prognosis.