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image guided brain surgery

François-Xavier Ferracci, Hugues Duffau
Radical glioma resection improves overall survival, both in low-grade and high-grade glial tumors. However, preservation of the quality of life is also crucial. Areas covered: Due to the diffuse feature of gliomas, which invade the central nervous system, and due to considerable variations of brain organization among patients, an individual cerebral mapping is mandatory to solve the classical dilemma between the oncological and functional issues. Because functional neuroimaging is not reliable enough, intraoperative electrical stimulation, especially in awake patients benefiting from a real-time cognitive monitoring, is the best way to increase the extent of resection while sparing eloquent neural networks...
March 9, 2018: Expert Review of Neurotherapeutics
Giovanni Tringali, Beatrice Bono, Ivano Dones, Roberto Cordella, Giuseppe Didato, Flavio Villani, Francesco Prada
BACKGROUND: Type II focal cortical dysplasia is the most common malformation of cortical development associated with drug resistant epilepsy and susceptible to surgical resection. Although advanced imaging modalities are nowadays capable to detect the majority of such cortical disorders, it is still a challenge for the surgeon to visualize them intraoperatively. The lack of direct boundaries' identification between normal brain and subtle dysplastic tissue may explain poor results in terms of seizure-free patients compared to other forms of epilepsy...
March 3, 2018: World Neurosurgery
Antonin Levy, Corinne Faivre-Finn, Baktiar Hasan, Eleonora De Maio, Anna S Berghoff, Nicolas Girard, Laurent Greillier, Sylvie Lantuéjoul, Mary O'Brien, Martin Reck, Anne-Marie C Dingemans, Silvia Novello, Thierry Berghmans, Benjamin Besse, Lizza Hendriks
BACKGROUND: Brain metastases (BM) are frequent in non-small cell lung cancer (NSCLC) patients, but there is a lack of evidence-based management of this patient group. We aimed to capture a snapshot of routine BM management in Europe to identify relevant research questions for future clinical trials. METHODS: An EORTC Lung Cancer Group (LCG) online survey containing questions on NSCLC BM screening and treatment was distributed between 16/02/17 and 15/06/17 to worldwide EORTC LCG members, and through several European scientific societies in the thoracic oncology field...
February 20, 2018: European Journal of Cancer
Kislay Kishore, Manish Beniwal, Shilpa Rao, K V L N Rao, Vikas Vazhayil, Dwarkanath Srinivas, Sampath Somanna
BACKGROUND: Abscess co-existing within a brain tumor is a rare entity. Case reports in literature primarily consist of sellar pathology and parenchymal lesions including meningioma, glioma, and metastases. We report a case of glioblastoma with an intra-tumoral abscess in a middle-aged lady with no prior invasive procedure or systemic focus of infection. CASE DESCRIPTION: A 45-year old lady presented with new onset generalized seizures and rapidly progressive left hemiparesis...
February 14, 2018: World Neurosurgery
Vivek Tandon, Michael Lang, Poodipedi Sarat Chandra, Ashwini Sharan, Ajay Garg, Manjari Tripathi
BACKGROUND: A stereotactically placed laser fiber can deliver thermal energy to an epileptogenic focus in brain. This procedure is done under intraoperative (thermography) magnetic resonance imaging (MRI) guidance. Thermoablation can lead to edema in surrounding area and can cause secondary insult. In this case report of three cases, we have quantified the edema produced after laser ablation, with sequential MRI in immediate post-operative period. CASE DESCRIPTION(S): Three patients of intractable epilepsy underwent proper neurological and neuro-radiological workup to localize the site of epileptogenic foci...
February 6, 2018: World Neurosurgery
Anahita Fathi Kazerooni, Mahnaz Nabil, Mehdi Zeinali Zadeh, Kavous Firouznia, Farid Azmoudeh-Ardalan, Alejandro F Frangi, Christos Davatzikos, Hamidreza Saligheh Rad
BACKGROUND: Targeted localized biopsies and treatments for diffuse gliomas rely on accurate identification of tissue subregions, for which current MRI techniques lack specificity. PURPOSE: To explore the complementary and competitive roles of a variety of conventional and quantitative MRI methods for distinguishing subregions of brain gliomas. STUDY TYPE: Prospective. POPULATION: Fifty-one tissue specimens were collected using image-guided localized biopsy surgery from 10 patients with newly diagnosed gliomas...
February 7, 2018: Journal of Magnetic Resonance Imaging: JMRI
Evgenii Belykh, Eric J Miller, Danying Hu, Nikolay L Martirosyan, Eric C Woolf, Adrienne C Scheck, Vadim A Byvaltsev, Peter Nakaji, Leonard Y Nelson, Eric J Seibel, Mark C Preul
OBJECTIVE: Fluorescence-guided surgery with protoporphyrin IX (PpIX) as a photodiagnostic marker is gaining acceptance for resection of malignant gliomas. Current wide-field imaging technologies do not have sufficient sensitivity to detect low PpIX concentrations. We evaluated a scanning fiber endoscope (SFE) for detection of PpIX fluorescence in gliomas and compared it with an operating microscope (OPMI) equipped with fluorescence module and a benchtop confocal laser scanning microscope (CLSM)...
January 31, 2018: World Neurosurgery
Harith Akram, Viswas Dayal, Philipp Mahlknecht, Dejan Georgiev, Jonathan Hyam, Thomas Foltynie, Patricia Limousin, Enrico De Vita, Marjan Jahanshahi, John Ashburner, Tim Behrens, Marwan Hariz, Ludvic Zrinzo
The ventral intermediate nucleus (VIM) of the thalamus is an established surgical target for stereotactic ablation and deep brain stimulation (DBS) in the treatment of tremor in Parkinson's disease (PD) and essential tremor (ET). It is centrally placed on a cerebello-thalamo-cortical network connecting the primary motor cortex, to the dentate nucleus of the contralateral cerebellum through the dentato-rubro-thalamic tract (DRT). The VIM is not readily visible on conventional MR imaging, so identifying the surgical target traditionally involved indirect targeting that relies on atlas-defined coordinates...
2018: NeuroImage: Clinical
Artem Rozumenko, Valentyn Kliuchka, Volodymir Rozumenko, Vera Semenova, Sergii Kolesnyk, Zoja Fedorenko
The increased interest in the application of lasers in neuro-oncology prompted us to present our experience of using the laser technologies in the treatment of cerebral gliomas. The aim of the study was to evaluate the clinical efficacy of image-guided laser surface thermal therapy (LSTT) and its influence on survival of patients with glioblastoma (GBM).Data of 91 patients (49 males, 42 females, mean age 51.4 years, range 23-70 years) with supratentorial GBMs located in close vicinity to or within the eloquent brain areas were retrospectively analyzed...
January 22, 2018: Neurosurgical Review
Michael D Jenkinson, Damiano Giuseppe Barone, Andrew Bryant, Luke Vale, Helen Bulbeck, Theresa A Lawrie, Michael G Hart, Colin Watts
BACKGROUND: Extent of resection is considered to be a prognostic factor in neuro-oncology. Intraoperative imaging technologies are designed to help achieve this goal. It is not clear whether any of these sometimes very expensive tools (or their combination) should be recommended as standard care for people with brain tumours. We set out to determine if intraoperative imaging technology offers any advantage in terms of extent of resection over standard surgery and if any one technology was more effective than another...
January 22, 2018: Cochrane Database of Systematic Reviews
Ryan B Kochanski, Sepehr Sani
Advancements in neuroimaging have led to a trend toward direct, image-based targeting under general anesthesia without the use of microelectrode recording (MER) or intraoperative test stimulation, also referred to as "asleep" deep brain stimulation (DBS) surgery. Asleep DBS, utilizing imaging in the form of intraoperative computed tomography (iCT) or magnetic resonance imaging (iMRI), has demonstrated reliable targeting accuracy of DBS leads implanted within the globus pallidus and subthalamic nucleus while also improving clinical outcomes in patients with Parkinson's disease...
January 19, 2018: Brain Sciences
Young Goo Kim, Eun Jung Kweon, Won Seok Chang, Hyun Ho Jung, Jin Woo Chang
Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) surgery has recently gained favor as a novel, noninvasive alternative to conventional neurosurgery. In contrast to traditional ablative interventions, transcranial MRgFUS surgery is entirely imaging-guided and uses continuous temperature measurements at the target and surrounding tissue taken in real-time. Unlike Gamma Knife radiosurgery, MRgFUS surgery can make a lesion immediately and does not use ionizing radiation. Moreover, since no metallic device is implanted, MR imaging-based diagnosis is not restricted throughout life...
2018: Progress in Neurological Surgery
L Dade Lunsford, Ajay Niranjan
The first surgical procedures for abnormal movement disorders began in the 1930s, when surgeons first proposed ablative techniques of the caudate nucleus or transection of motor (pyramidal) pathways to reduce involuntary movements in patients with Parkinson's related tremor. During the 50-year interval between 1945 and 1995, the development of precise intracranial guiding devices, brain maps, and advanced imaging led to the refinement of appropriate deep brain targets affecting extrapyramidal pathways. Lesional surgery and subsequent neuroaugmentation using deep brain stimulation extended the role of deep brain surgery for a wider group of patients with tremor, rigidity, dyskinesia, and other involuntary movement disorders...
2018: Progress in Neurological Surgery
Sebastian R Schreglmann, Stefan Hägele-Link, Beat Werner, Ernst Martin, Georg Kägi
BACKGROUND: The development of high-intensity magnetic resonance imaging (MRI)-guided focused ultrasound (MRIgFUS) ablation has widened the spectrum of interventional techniques for stereotactic functional neurosurgery of lesions. This has resulted in novel incisionless intervention approaches for the therapy of tremor disorders. The safety and efficacy is documented by recent study data. OBJECTIVES: This article encompasses a description of the technological basis and typical course of MRIgFUS interventions, a comparison to alternative open or incisionless surgical techniques as well as a review of the current evidence base for MRIgFUS ablation in the context of lesional interventions to treat tremor...
January 11, 2018: Der Nervenarzt
Amir Nikouei, Pooya Torkian, Tohid Emami Meybodi, Arash Javad Mousavi, Amir Saied Seddighi
OBJECTIVE: Deep Brain Stimulation (DBS) is an effective surgical approach for treatment of Parkinson's disease (PD), dystonia and essential tremor (ET). Traditionally, DBS is performed using frame-based stereotactic technique. Recently, image guided surgery (IGS) using neuronavigation has gained popularity in neurosurgical procedures. We aim to investigate whether DBS using neuronavigation is capable of improving patient's outcome and minimize its complications. SUBJECT AND METHODS: From February 2011 to October 2016, 20 patients with PD and 6 patients with ET were enrolled in the study...
September 2017: Hellenic Journal of Nuclear Medicine
Montserrat Lara-Velazquez, Rawan Al-Kharboosh, Stephanie Jeanneret, Carla Vazquez-Ramos, Deependra Mahato, Daryoush Tavanaiepour, Gazanfar Rahmathulla, Alfredo Quinones-Hinojosa
Glioblastoma (GBM) is the most common primary intracranial neoplasia, and is characterized by its extremely poor prognosis. Despite maximum surgery, chemotherapy, and radiation, the histological heterogeneity of GBM makes total eradication impossible, due to residual cancer cells invading the parenchyma, which is not otherwise seen in radiographic images. Even with gross total resection, the heterogeneity and the dormant nature of brain tumor initiating cells allow for therapeutic evasion, contributing to its recurrence and malignant progression, and severely impacting survival...
December 20, 2017: Brain Sciences
Raul Martínez-Fernández, Rafael Rodríguez-Rojas, Marta Del Álamo, Frida Hernández-Fernández, Jose A Pineda-Pardo, Michele Dileone, Fernando Alonso-Frech, Guglielmo Foffani, Ignacio Obeso, Carmen Gasca-Salas, Esther de Luis-Pastor, Lydia Vela, José A Obeso
BACKGROUND: Ablative neurosurgery has been used to treat Parkinson's disease for many decades. MRI-guided focused ultrasound allows focal lesions to be made in deep brain structures without skull incision. We investigated the safety and preliminary efficacy of unilateral subthalamotomy by focused ultrasound in Parkinson's disease. METHODS: This prospective, open-label pilot study was done at CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur in Madrid, Spain...
January 2018: Lancet Neurology
Toshihiro Takami, Kentaro Naito, Toru Yamagata, Nobuyuki Shimokawa, Kenji Ohata
BACKGROUND: Intraoperative image guidance using near-infrared indocyanine green videoangiography (ICG-VA) has been used to provide real-time angiographic images during vascular or brain tumor surgery, and it is also being used for spine surgery. OBJECTIVE: To further investigate the benefits and limitations of ICG-VA image-guided surgery for spinal intramedullary tumors through retrospective study. METHODS: ICG-VA was used in 48 cases that were treated surgically over the past 5 yr...
December 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Joseph Plazak, Simon Drouin, Louis Collins, Marta Kersten-Oertel
Image-guided neurosurgery, or neuronavigation, has been used to visualise the location of a surgical probe by mapping the probe location to pre-operative models of a patient's anatomy. One common limitation of this approach is that it requires the surgeon to divert their attention away from the patient and towards the neuronavigation system. In order to improve this type of application, the authors designed a system that sonifies (i.e. provides audible feedback of) distance information between a surgical probe and the location of the anatomy of interest...
October 2017: Healthcare Technology Letters
Nancy Wang, Mia S Bertalan, Priscilla K Brastianos
Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging, with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits, such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, magnetic resonance imaging of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid. Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the cerebral spinal fluid...
January 1, 2018: Cancer
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