scholarly journals Improving the accuracy of brain tumor surgery via Raman-based technology

2016 ◽  
Vol 40 (3) ◽  
pp. E9 ◽  
Author(s):  
Todd Hollon ◽  
Spencer Lewis ◽  
Christian W. Freudiger ◽  
X. Sunney Xie ◽  
Daniel A. Orringer
Keyword(s):  
Raman Spectroscopy ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Real Time ◽  
Surgical Management ◽  
Residual Tumor ◽  
Normal Brain ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Perfect Agreement

Despite advances in the surgical management of brain tumors, achieving optimal surgical results and identification of tumor remains a challenge. Raman spectroscopy, a laser-based technique that can be used to nondestructively differentiate molecules based on the inelastic scattering of light, is being applied toward improving the accuracy of brain tumor surgery. Here, the authors systematically review the application of Raman spectroscopy for guidance during brain tumor surgery. Raman spectroscopy can differentiate normal brain from necrotic and vital glioma tissue in human specimens based on chemical differences, and has recently been shown to differentiate tumor-infiltrated tissues from noninfiltrated tissues during surgery. Raman spectroscopy also forms the basis for coherent Raman scattering (CRS) microscopy, a technique that amplifies spontaneous Raman signals by 10,000-fold, enabling real-time histological imaging without the need for tissue processing, sectioning, or staining. The authors review the relevant basic and translational studies on CRS microscopy as a means of providing real-time intraoperative guidance. Recent studies have demonstrated how CRS can be used to differentiate tumor-infiltrated tissues from noninfiltrated tissues and that it has excellent agreement with traditional histology. Under simulated operative conditions, CRS has been shown to identify tumor margins that would be undetectable using standard bright-field microscopy. In addition, CRS microscopy has been shown to detect tumor in human surgical specimens with near-perfect agreement to standard H & E microscopy. The authors suggest that as the intraoperative application and instrumentation for Raman spectroscopy and imaging matures, it will become an essential component in the neurosurgical armamentarium for identifying residual tumor and improving the surgical management of brain tumors.

scholarly journals Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

2021 ◽  
Author(s):  
Da-wei Zhao ◽  
Xu-yang Zhang ◽  
Kai-yan Wei ◽  
Yi-bin Jiang ◽  
Dan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Operation Time ◽  
Postoperative Pneumonia ◽  
Tumor Surgery ◽  
Regression Analyses ◽  
Brain Tumor Surgery ◽  
The Impact ◽  
Preoperative Albumin

Abstract Hypoalbuminemia is associatied with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pneumonia had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pneumonia were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and is associated with postoperative pneumonia in patients undergoing brain tumor surgery.

scholarly journals Effect of hemostasis and electrosurgery on the development and evolution of brain tumor surgery in the late 19th and early 20th centuries

2005 ◽  
Vol 18 (4) ◽  
pp. 1-7 ◽  
Author(s):  
John R. Vender ◽  
Jason Miller ◽  
Andy Rekito ◽  
Dennis E. McDonnell
Keyword(s):  
Brain Tumor ◽  
Brain Tissue ◽  
Surgical Management ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
The Impact ◽  
Neurological Surgeon ◽  
The Brain ◽  
Development And Evolution ◽  
Type Of Surgery

Hemostatic options available to the surgeon in the late 19th and early 20th centuries were limited. The surgical ligature was limited in value to the neurological surgeon because of the unique structural composition of brain tissue as well as the approaches and operating angles used in this type of surgery. In this manuscript the authors review the options available and the evolution of surgical hemostatic techniques and electrosurgery in the late 19th and early 20th centuries and the impact of these methods on the surgical management of tumors of the brain and its coverings.

scholarly journals New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review

2018 ◽  
Vol 8 (11) ◽  
pp. 202 ◽  
Author(s):  
Maria Pino ◽  
Alessia Imperato ◽  
Irene Musca ◽  
Rosario Maugeri ◽  
Giuseppe Giammalva ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Low Cost ◽  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Pubmed Database

Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.

387 Ischemic Preconditioning Reduces the Incidence of Postoperative Ischemic Lesions in Patients Undergoing Surgical Resection of Brain Tumors: A Single Center, Randomized, Double-blind, Controlled Trial

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 292-293
Author(s):  
Arthur H A Sales ◽  
Melanie Barz ◽  
Stefanie Bette ◽  
Benedikt Wiestler ◽  
Yu-Mi Ryang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Ischemic Preconditioning ◽  
Control Group ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Blood Pressure Cuff ◽  
Pressure Cuff ◽  
Ischemic Tissue

Abstract INTRODUCTION Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Previous clinical and experimental studies have shown that the application of a brief ischemic stimulus not only in the target organ but also in a remote tissue can prevent ischemia. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences. METHODS Sixty patients were randomly assigned to two groups, with 1:1 allocation, stratified after tumor type (glioma or metastasis) and previous treatment with radiotherapy. Remote ischemic preconditioning was induced by inflating a blood pressure cuff placed on the upper arm three times for 5 minutes at 200 mmHg in the treatment group after induction of anesthesia. Between the cycles, the blood pressure cuff was released to allow reperfusion. In the control group no preconditioning was performed. Early postoperative MR images were evaluated blinded to randomization for the presence of ischemia and its volume. RESULTS >Fifty-eight of the 60 patients were assessed for occurrence of postoperative ischemia. Of these 58 patients, 44 (75.9%) had new postoperative ischemic lesions. The incidence of new postoperative ischemic lesions was significantly higher in the control group (87.1%) (27/31) than in the rIPC group (63.0%) (17/27) (P = 0.03). The median infarct volume was 0.36 cm3 (IR: 0.0- 2.35) in the rIPC group compared with 1.30 cm3 (IR: 0.29- 3.66) in the control group (P = 0.09). CONCLUSION Application of rIPC significantly reduced the incidence of postoperative ischemic tissue damage in patients undergoing elective brain tumor surgery. This is the first study indicating a benefit of rIPC in brain tumor surgery.

scholarly journals Brain tumor surgery in the elderly: a single institution experience of short-term outcome—a retrospective case study

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Mostafa F. Tantawy ◽  
Wael M. Nazim
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Elderly Patients ◽  
Elderly People ◽  
The Elderly ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Single Institution ◽  
Short Term ◽  
The Mean

Abstract Background There is an evolving concern in the management of brain tumors in the elderly. The number of elderly people (aged 65 years or more) increases progressively, and there is a considerable percent of brain tumors affecting this age group. Elderly people may have one or more chronic illnesses that may render cranial surgery of high risk for mortality and morbidity. This study was carried out to evaluate the short-term (30 days) outcome of brain tumor surgery in elderly patients. Results This is a single-institution retrospective study of elderly patients harboring brain tumors who were managed by surgery. The study included 31 patients between 2014 and 2019. Elective and emergency cases were included. The mean age for the study population was 68.29 years. The mean functional status using the Karnofsky Performance Scale (KPS) changed from 58.06 before surgery to 70 after surgery. Meningioma grade I and glioblastoma multiforme (GBM) were the most common neoplasms, 41.9 and 29%, respectively. There was a statistically significant relationship between the mortality and GBM (P value < 0.05) while there was no correlation with concomitant diseases, KPS, or extent of resection (P value > 0.05). Preoperative concomitant diseases were found in 16 patients. Mortality occurred in 11 cases (35.4%). Conclusions Old age by itself should not be a risk factor alone for increasing mortality or morbidity in cranial surgery for patients with brain tumors. Glioblastoma in old patients with poor KPS carries a significant risk for mortality. Further studies with a larger number of patients and inclusion of more variables are required.

scholarly journals Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Da-wei Zhao ◽  
Feng-chun Zhao ◽  
Xu-yang Zhang ◽  
Kai-yan Wei ◽  
Yi-bin Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Operation Time ◽  
Tumor Surgery ◽  
Regression Analyses ◽  
Brain Tumor Surgery ◽  
Pulmonary Imaging ◽  
The Impact ◽  
Preoperative Albumin

AbstractHypoalbuminemia is associated with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pulmonary imaging abnormalities had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pulmonary imaging abnormalities were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Pulmonary imaging abnormalities [OR 19.862 (95% CI 2.546–154.936, P = 0.004)] was a novel independent predictors of postoperative pneumonia. Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and may be associated with postoperative complications in patients undergoing brain tumor surgery.

Epilepsy surgery following brain tumor resection in children

2011 ◽  
Vol 7 (3) ◽  
pp. 229-234 ◽  
Author(s):  
Ashley G. Tian ◽  
Michael S. B. Edwards ◽  
Nicole J. Williams ◽  
Donald M. Olson
Keyword(s):  
Brain Tumor ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Choroid Plexus Papilloma ◽  
Intractable Epilepsy ◽  
Residual Tumor ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Imaging Results

Object Intractable epilepsy following successful brain tumor surgery in children may have several underlying causes such as residual tumor, cortical dysplasia, and gliosis. The authors reviewed the cases of children who had previously undergone resection of a brain tumor only to have medically refractory seizures postoperatively. Methods The authors performed a retrospective case review of 9 children who underwent brain tumor surgery 2–13 years before undergoing a second surgery to try and control their seizures. Results Eight of 9 children had seizures at the time of tumor presentation. Tumor types included ganglioglioma, dysembryoplastic neuroepithelial tumor, pilocytic astrocytoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. All patients achieved a seizure-free interval before intractable seizures recurred. After the second operation, 3 children were seizure free, 1 only had auras, 2 had rare complex partial seizures, and 3 continued to have relatively frequent seizures, although the frequency and severity were reduced. Seven of 9 patients had pathology showing residual tumor. Conclusions Epilepsy surgery following earlier brain tumor surgery can provide substantial benefit with reduced seizure number and severity. Despite reassuring brain imaging results, residual tumor was present more often than expected in pathological specimens.

scholarly journals Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection

2021 ◽  
Vol 11 ◽  
Author(s):  
Huan Wee Chan ◽  
Christopher Uff ◽  
Aabir Chakraborty ◽  
Neil Dorward ◽  
Jeffrey Colin Bamber
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Shear Wave Elastography ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Normal Brain ◽  
Mri Scan ◽  
Significant Difference ◽  
Brain Tumor Resection

BackgroundThe clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported.AimsTo determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”.MethodsThirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan.ResultsThe YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p &lt; 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p &lt; 0.001, respectively).ConclusionsSWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.

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