Category Archives: Industry

INSIGHTEC’S EXABLATE NEURO NAMED BEST MEDICAL TECHNOLOGY AT ESTEEMED PRIX GALIEN AWARDS 2017

INSIGHTEC, the leader in MR-guided Focused Ultrasound (MRgFUS), has been awarded Best Medical Technology for Exablate Neuro by The Galien Foundation.  Exablate Neuro is an innovative medical technology that uses focused ultrasound coupled with MR imaging (MRgFUS), to precisely target and treat areas deep within the brain through an intact skull.

The prestigious Prix Galien awards recognize excellence in scientific innovations that improve the state of human health. The Best Medical Technology award confirms INSIGHTEC’s vision of transformative healthcare and the company’s determination to improve the daily lives of patients living with essential tremor.

“It’s a great honor to receive this award, which recognizes our dedication to researching and developing a non-invasive medical treatment,” said INSIGHTEC’s CEO and Chairman of the Board, Maurice R. Ferré MD. “Our pursuit of innovation is not only driven by our founder Kobi Vortman, but also by the leading neurosurgery centers which have adopted the Exablate Neuro around the world. This is an exciting time for INSIGHTEC and spurs on our commitment to supporting healthcare professionals, deliver treatments which truly improve the lives of people worldwide.”

Having accepted the award at The American Museum of Natural History in New York City, INSIGHTEC’s Vice President of Marketing, Xen Mendelsohn Aderka added “To be seen as an innovator whilst in the presence of so many renowned figures in the pharmaceutical, biomedical and medical technology industry, is a great accolade. We thank the judges for acknowledging the hard work and dedication of our team.”

The U.S. Food and Drug Administration (FDA) approved Exablate Neuro in July 2016 for the non-invasive treatment of patients with essential tremor who had not responded to medication. Essential tremor is the most common movement disorder, affecting more than 5 million people in the United States, and millions more worldwide. Hand tremor is the most common symptom and for these patients, performing everyday tasks can seem nearly impossible and greatly impacts on their quality of life.

Update: PulseRider Aneurysm Neck Reconstruction Device

PulseRider

http://www.pulsarvascular.com/

see Video

The PulseRider Aneurysm Neck Reconstruction Device is intended for use with embolic coils in the treatment of intracranial aneurysms originating on or near a vessel bifurcation.

In the early 1990’s, endovascular treatment using embolic coils for the treatment of intracranial aneurysms was established. Since then, there has been a significant body of peer-reviewed literature written by medical experts regarding the use, safety, and efficacy of these detachable embolic coils. With the publishing of the ISAT (Intracranial Subarachnoid Aneurysm Trial) trial data in 2005, which compared clinical outcomes of neurosurgical clipping and endovascular coiling, embolic coiling became the preferred method for treatment of the majority of unruptured intracranial aneurysms [ISAT 2003, Molyneux et al. 2005].

Since then, there has been a revolution in interventional neuroradiology which includes a shift toward catheter based procedures. Unfortunately, for a variety of reasons there are not always endovascular treatment options available to some patients with intracranial aneurysms, especially if the neck of the aneurysm is wide. Additionally there is a range of concerns relating to patient comorbidities, aneurysm geometry or the location of the lesion. Consequently there are many challenges, even today, when treating patients with such lesions. Hence there has been significant research in this arena to develop adjunctive devices to be used with embolic coils as well as sole therapy devices.


The PulseRider has an open cell frame. The unique frame configuration opens to conform to the vessel walls. The PulseRider is specifically designed to resolve the shortcomings of current endovascular devices by preserving luminal patency and hemodynamic flow through the parent vessel bifurcation, while minimizing exposed metal in order to encourage early endothelialization while securely retaining embolic agents within the aneurysm sac. The PulseRider is delivered through commercially available microcatheters using standard endovascular techniques. The implant is retrievable and may be repositioned by retracting it into the microcatheter at any time during or after deployment (prior to detachment). The implant is designed with an open frame to maintain luminal patency. It is deployed at the parent vessel bifurcation and across the aneurysm neck to provide a support framework, bridging the aneurysm neck while retaining embolic agents within the aneurysm. The PulseRider is electrolytically detached from the delivery wire.


In the early experience with the Pulse Rider device its use was safe and effective as an adjunct in the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus 1).


The safety and probable benefit of the PulseRider (Pulsar Vascular, Los Gatos, California) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, nonrandomized, single arm clinical trial-the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction (ANSWER) Trial.

Aneurysms treated with the PulseRider device among sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study.

Thirty-four patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3-11.6 mm). In all patients, the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at 6-month follow-up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months.

The results from the ANSWER trial demonstrate that the PulseRider device is safe and offers probable benefit as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist 2).

1)

Spiotta AM, Chaudry MI, Turk AS, Turner RD. Initial experience with the PulseRider for the treatment of bifurcation aneurysms: report of first three cases in the USA. J Neurointerv Surg. 2016 Feb;8(2):186-9. doi: 10.1136/neurintsurg-2014-011531. Epub 2015 Jan 5. PubMed PMID: 25561583.
2)

Spiotta AM, Derdeyn CP, Tateshima S, Mocco J, Crowley RW, Liu KC, Jensen L, Ebersole K, Reeves A, Lopes DK, Hanel RA, Sauvageau E, Duckwiler G, Siddiqui A, Levy E, Puri A, Pride L, Novakovic R, Chaudry MI, Turner RD, Turk AS. Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-Necked, Bifurcation Aneurysms. Neurosurgery. 2017 Apr 25. doi: 10.1093/neuros/nyx085. [Epub ahead of print] PubMed PMID: 28449126.

Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis.

Implementation of intraoperative magnetic resonance imaging (iMRI) has been shown to optimize the extent of resection and safety of brain tumor surgery. In addition, iMRI can help account for the phenomenon of brain shift and can help to detect complications earlier than routine postoperative imaging, which can potentially improve patient outcome.

Intraoperative MRI is considered the gold standard among all intraoperative imaging technologies currently available. Its main indication is in the intraoperative detection of residual disease during tumour resections.

It allows real-time image-guided excision of brain tumors, especially gliomas and pituitary adenomas.

Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures.

Jiménez et al present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon’s intraoperative assessment by iMRI.

Noise of unknown origin

Low magnetic field iMRI devices may produce low-quality images due to nonideal imaging conditions in the operating room and additional noise of unknown origin.

Unbiased nonlocal means filter for iMRI de-noising proved very useful for image quality enhancement and assistance in the interpretation of iMR images 1).

The higher signal-to-noise ratio offered by 3 Tesla (T) iMRI compared with lower field strength systems is particularly advantageous.

To maximize efficiency, iMRI sequences can be tailored to particular types of tumors and procedures, including nonenhancing brain tumor surgery, enhancing brain tumor surgery, transsphenoidal pituitary tumor surgery, and laser ablation. Unique imaging findings on iMRI include the presence of surgically induced enhancement, which can be a potential confounder for residual enhancing tumor, and hyperacute hemorrhage, which tends to have intermediate signal on T1-weighted sequences and high signal on T2-weighted sequences due to the presence of oxyhemoglobin. MR compatibility and radiofrequency shielding pose particularly stringent technical constraints at 3T and influence the design and usage of the surgical suite with iMRI 2).

Language

Intraoperative magnetic resonance imaging (iMRI) and functional neuronavigation may help maximize tumor resection, minimize language deficits in patients with gliomas involving language areas, and improve survival time for patients with glioblastomas 3).

Metaanalysis

The Medline, PubMed, Cochrane, Google Scholar databases were searched until September 26th, 2015 Randomized controlled trials (RCTs), two-arm prospective studies, retrospective studies in patients with glioblastoma/glioma who had received surgical treatment were included.

The primary outcome measures were the extent of tumor resection and tumor size reduction for using iMRI-guided or conventional neuronavigation-guided neurosurgery. Secondary outcomes included impact of surgery on the 6-month progression-free survival (PFS) and 12-month overall survival (OS) rates and surgical duration were also studied.

They found that iMRI was associated with greater rate of gross total resection (rGTR) compared with conventional neuronavigation procedures (3.16, 95% confidence interval [CI] 2.07-4.83, P < 0.001). We found no difference between the two neuronavigation approaches in extent of resection (EOR), tumor size reduction, or time required for surgery (P values ≥0.065). Intraoperative MRI was associated with a higher rate of progression-free survival (PFS) compared with conventional neuronavigation (odds ratio, 1.84; 95% CI of 1.15 to 2.95; P = 0.012), but the rate of overall survival (OS) between groups was similar (P = 0.799). Limitations of the study included the fact that data from non-RCTs were used, the small study population, and heterogeneity of outcomes across studies.

The findings indicate that iMRI more frequently resulted in more complete resections leading to improved PFS in patients with malignant gliomas 4).

Case series

2015

In 300 consecutive patients, three sequential groups (groups A, B, C; n=100 each) were compared with respect to time management, complications and technical difficulties to assess improvement in these parameters with experience.

Raheja et al observed a reduction in the number of technical difficulties (p<0.001), time to induction (p<0.001) and total anesthesia time (p=0.007) in sequential groups. IOMRI was performed for neuronavigation guidance (n=252) and intraoperative validation of extent of resection (EOR; n=67). Performing IOMRI increased the EOR over and beyond the primary surgical attempt in 20.5% (29/141) and 18% (11/61) of patients undergoing glioma and pituitary surgery, respectively. Overall, EOR improved in 59.7% of patients undergoing IOMRI (40/67). Intraoperative tractography and real time navigation using re-uploaded IOMRI images (accounting for brain shift) helps in intraoperative planning to reduce complications. IOMRI is an asset to neurosurgeons, helping to augment the EOR, especially in glioma and pituitary surgery, with no significant increase in morbidity to the patient 5).

2013

Brell et al. retrospectively reviewed the first 21 patients operated on the aid of this technology. Maximal safe resection was the surgical goal in all cases. Surgeries were performed using conventional instrumentation and the required assistance in each case.

The mean number of intraoperative studies was 2.3 per procedure (range: 2 to 4). Intraoperative studies proved that the surgical goal had been achieved in 15 patients (71.4%), and detected residual tumour in 6 cases (28.5%). After comparing the last intraoperative image and the postoperative study, 2 cases (9.5%) were considered as “false negatives”.

Intraoperative MRI is a safe, reliable and useful tool for guided resection of brain tumours. Low-field devices provide images of sufficient quality at a lower cost; therefore their universalisation seems feasible 6).

Case reports

Giordano et al. describe two explicative cases including the setup, positioning, and the complete workflow of the surgical approach with intraoperative imaging. Even if the configuration of iopMRI equipment was originally designed for cranial surgery, they have demonstrated the feasibility of cervical intramedullary glioma resection with the aid of high-field iopMRI. This tool was extremely useful to evaluate the extent of tumor removal and to obtain a higher resection rate, but still need some enhancement in the configuration of the headrest coil and surgical table to allow better patient positioning 7).


1) Mizukuchi T, Fujii M, Hayashi Y, Tsuzaka M. Usability of unbiased nonlocal means for de-noising intraoperative magnetic resonance images in neurosurgery. Int J Comput Assist Radiol Surg. 2014 Jan 7. [Epub ahead of print] PubMed PMID: 24395699.
2) Ginat DT, Swearingen B, Curry W, Cahill D, Madsen J, Schaefer PW. 3 Tesla intraoperative MRI for brain tumor surgery. J Magn Reson Imaging. 2014 Jun;39(6):1357-65. PubMed PMID: 24921066.
3) Zhang J, Chen X, Zhao Y, Wang F, Li F, Xu B. Impact of intraoperative magnetic resonance imaging and functional neuronavigation on surgical outcome in patients with gliomas involving language areas. Neurosurg Rev. 2015 Apr;38(2):319-30. doi: 10.1007/s10143-014-0585-z. Epub 2014 Dec 19. PubMed PMID: 25519766.
4) Li P, Qian R, Niu C, Fu X. Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis. Curr Med Res Opin. 2016 Dec 23:1-28. doi: 10.1080/03007995.2016.1275935. [Epub ahead of print] PubMed PMID: 28008781.
5) Raheja A, Tandon V, Suri A, Sarat Chandra P, Kale SS, Garg A, Pandey RM, Kalaivani M, Mahapatra AK, Sharma BS. Initial experience of using high field strength intraoperative MRI for neurosurgical procedures. J Clin Neurosci. 2015 Aug;22(8):1326-31. doi: 10.1016/j.jocn.2015.02.027. Epub 2015 Jun 12. PubMed PMID: 26077939.
6) Brell M, Roldán P, González E, Llinàs P, Ibáñez J. [First intraoperative magnetic resonance imaging in a Spanish hospital of the public healthcare system: initial experience, feasibility and difficulties in our environment]. Neurocirugia (Astur). 2013 Jan-Feb;24(1):11-21. doi: 10.1016/j.neucir.2012.07.003. Epub 2012 Nov 13. Spanish. PubMed PMID: 23154131.
7) Giordano M, Gerganov VM, Metwali H, Fahlbusch R, Samii A, Samii M, Bertalanffy H. Feasibility of cervical intramedullary diffuse glioma resection using intraoperative magnetic resonance imaging. Neurosurg Rev. 2013 Nov 15. [Epub ahead of print] PubMed PMID: 24233260.

Intrinsic optical imaging

Intrinsic signal optical imaging is a functional imaging modality where the reflectance of red light indicates active portions of cortex, as developed by Grinvald et al. is a powerful technique for monitoring neural function in the in vivo central nervous system. The advent of this dye-free imaging has also enabled us to monitor human brain function during neurosurgical operations.


It offers advantages for studying functional organization in the cat or monkey visual cortex and the rodent somatosensory (whisker barrel) cortex.

In intrinsic optical signals, it is indicated that there are at least three components.

The first component originates from activity-dependent changes in the oxygen saturation level of hemoglobin. The second component originates from changes in blood volume that are probably due to dilation of venules in an area containing electrically active neurons. The third component arises from light-scattering changes that accompany cortical activation caused by ion and water movement, expansion and contraction of extracellular spaces, capillary expansion or neurotransmitter release.

The intrinsic optical imaging technique was also applied to the human brain during neurosurgery. Haglund et al. first demonstrated the usefulness of this technique for functional localization in the human brain. They obtained maps during stimulation-evoked epileptiform afterdischarges and cognitively evoked functional activity. Functional images induced by language tasks were also shown by Cannestra et al. and Pouratian et al. they detected neuronal responses from the Broca’s and Wernicke’s areas in awake patients.

There are a few reports of intrinsic optical imaging from the human somatosensory cortex in response to median/ulnar nerve stimulation or digit stimulation. Although these reports showed neural responses in the primary somatosensory cortex, they did not separate optical responses among the Brodmann’s subdivisions.


Intrinsic optical signal (IOS) imaging, laser speckle flowmetry (LSF) and electrocorticography were performed in different configurations in three groups of in total 18 swine. SDs were elicited by topical application of KCl or occurred spontaneously after middle cerebral artery occlusion. Movement artefacts in IOS were compensated by an elastic registration algorithm during post-processing. Using movement-compensated IOS, we were able to differentiate between four components of optical changes, corresponding closely with haemodynamic variations measured by LSF. Compared with ECoG and LSF, our setup provides higher spatial and temporal resolution, as well as a better signal-to-noise ratio. Using IOS alone, we could identify the different zones of infarction in a large gyrencephalic middle cerebral artery occlusion pig model. We strongly suggest movement-compensated IOS for the investigation of the role of haemodynamic responses to SDs during the development of secondary brain damage and in particular to examine the effect of potential therapeutic interventions in gyrencephalic brains 1).


In a study, using intraoperative optical imaging of intrinsic signals (iOIS) recording techniques, detailed cortical activations within the auditory cortex in response to auditory and somatosensory stimulation were recorded from three intraoperative anesthetized patients with brain tumor located at superior temporal gyrus.

At both green-light (545±13 nm) and red-light (610±10 nm) illumination, the primary and secondary auditory cortices showed to be respond significantly to the somatosensory stimulation. As induced by the somatosensory stimulus, the average overlapping rate of the activated region was 74.51% ± 0.15%, and the peak responding time occurred at post-stimulus 7-8 seconds. In addition, there was no significant difference of the peak responding time between auditory and somatosensory stimuli (P<0.01, paired t-test).

These findings provide novel evidence for multisensory interplay within human auditory cortex at early stage of cortical processing, which extends the understandings of multisensory mechanism of human brain functions 2)

Usefulness of Intraoperative Intrinsic Optical Imaging for Neurosurgery

Intraoperative optical imaging (IOI) is an experimental technique used for visualizing functional brain areas after surgical exposure of the cerebral cortex. This technique identifies areas of local changes in blood volume and oxygenation caused by stimulation of specific brain functions.


Sato et al briefly describe his own experience in functional mapping of the human somatosensory cortex, carried out using intraoperative optical imaging. The maps obtained demonstrate new additional evidence of a hierarchy for sensory response patterns in the human primary somatosensory cortex 3).

They performed intrinsic optical imaging of neuronal activity induced by peripheral stimulation from the human primary somatosensory cortex during brain tumor surgery for 11 patients. After craniotomy and dura reflection, the cortical surface was illuminated with a xenon light through an operating microscope. The reflected light passed through a bandpass filter, and they acquired functional images using an intrinsic optical imaging system. Electrical stimulation of the median nerve, or the first and fifth digits, induced biphasic intrinsic optical signals which consisted of a decrease in light reflectance followed by an increase. The decrease in light reflectance was imaged, and we identified a neural response area within the crown of the postcentral gyrus. In experiments on first and fifth digit stimulation, we identified optical responses in separated areas within the crown of the postcentral gyrus, i.e. near the central sulcus and near the postcentral sulcus. In the former response area, separate representations of the two fingers were observed, whereas in the latter response area, the two fingers were represented in the same region. A similar somatotopic representation was observed with electrical stimulation of the first and third branches of the trigeminal nerve. These results seem to support the hypothesis of hierarchical organization in the human primary somatosensory cortex 4).


In 14 patients with tumors adjacent to or within the sensorimotor cortex, intrinsic optical signals in response to somatosensory stimuli were recorded by illuminating the brain surface with Xe white light and imaging the reflected light passing through a bandpass filter (605 nm). Results were compared with intraoperative recordings of sensory evoked potentials in all 14 patients and with noninvasive mapping modalities such as magnetoencephalography and positron emission tomography in selected patients. In all but two patients, the somatosensory optical signals were recorded on the primary sensory cortex. Optical signals elicited by stimulation of the first and fifth digits and the three branches of the trigeminal nerve were recorded at different locations on the sensory strip. This somatotopic information was useful in determining the resection border in patients with glioma located in the sensorimotor cortex. 5).


Meyer et al implement an easy-to-use and robust imaging setup that can be used in clinical routine with standard hardware equipment (surgical microscope, high-resolution camera, stimulator for peripheral nerve stimulation) and custom-made software for intraoperative and postoperative data analysis. Evaluation of different light sources (halogen, xenon) showed a sufficient temporal behavior of xenon light without using a stabilized power supply. Spatial binning (2×2) of the camera reduces temporal variations in the images by preserving a high spatial resolution. The setup was tested in eight patients. Images were acquired continuously for 9 min with alternating 30-s rest and 30-s stimulation conditions. Intraoperative measurement and visualization of high-resolution two-dimensional activity maps could be achieved in <15 min. The detected functional regions corresponded with anatomical and electrophysiological validation. The integration of optical imaging in clinical routine could successfully be achieved using standard hardware, which improves guidance for the surgeon during interventions near the eloquent areas of the brain 6).


In 41 patients with tumor lesions adjacent to the postcentral gyrus, lesions were surgically removed by using IOI during stimulation of the contralateral median nerve. Optical properties of the cortical tissue were measured with a sensitive camera system connected to a surgical microscope. Imaging was performed by using 9 cycles of alternating prolonged stimulation and rest periods of 30 seconds. Intraoperative optical imaging was based on blood volume changes detected by using a filter at an isosbestic wavelength (λ = 568 nm). A spectral analysis algorithm was used to improve computation of the activity maps. Movement artifacts were compensated for by an elastic registration algorithm. For validation, intraoperative conduction of the phase reversal over the central sulcus and postoperative evaluation of the craniotomy site were used.

The new method and analysis enabled significant differentiation (p < 0.005) between functional and nonfunctional tissue. The identification and visualization of functionally intact somatosensory cortex was highly reliable; sensitivity was 94.4% and specificity was almost 100%. The surgeon was provided with a 2D high-resolution activity map within 12 minutes. No method-related side effects occurred in any of the 41 patients.

Sobottka et al., approach makes IOI a contact-free and label-free optical technique that can be used safely in a routine clinical setup. Intraoperative optical imaging can be used as an alternative to other methods for the identification of sensory cortex areas and offers the added benefit of a high-resolution map of functional activity. It has great potential for visualizing and monitoring additional specific functional brain areas such as the visual, motor, and speech cortex. A prospective national multicenter clinical trial is currently being planned 7).


Complete removal of epileptogenic cortex while preserving eloquent areas is crucial in patients undergoing epilepsy surgery. In this manuscript, the feasibility was explored of developing a new methodology based on dynamic intrinsic optical signal imaging (DIOSI) to intraoperatively detect and differentiate epileptogenic from eloquent cortices in pediatric patients with focal epilepsy. From 11 pediatric patients undergoing epilepsy surgery, negatively-correlated hemodynamic low-frequency oscillations (LFOs, ~ 0.02-0.1 Hz) were observed from the exposed epileptogenic and eloquent cortical areas, as defined by electrocorticography (ECoG), using a DIOSI system. These LFOs were classified into multiple groups in accordance with their unique temporal profiles. Causal relationships within these groups were investigated using the Granger causality method, and 83% of the ECoG-defined epileptogenic cortical areas were found to have a directed influence on one or more cortical areas showing LFOs within the field of view of the imaging system. To understand the physiological origins of LFOs, blood vessel density was compared between epileptogenic and normal cortical areas and a statistically-significant difference (p < 0.05) was detected. The differences in blood-volume and blood-oxygenation dynamics between eloquent and epileptogenic cortices were also uncovered using a stochastic modeling approach. This, in turn, yielded a means by which to separate epileptogenic from eloquent cortex using hemodynamic LFOs. The proposed methodology detects epileptogenic cortices by exploiting the effective connectivity that exists within cortical regions displaying LFOs and the biophysical features contributed by the altered vessel networks within the epileptogenic cortex. It could be used in conjunction with existing technologies for epileptogenic/eloquent cortex localization and thereby facilitate clinical decision-making 8).


1) Schöll MJ, Santos E, Sanchez-Porras R, Kentar M, Gramer M, Silos H, Zheng Z, Gang Y, Strong AJ, Graf R, Unterberg A, Sakowitz OW, Dickhaus H. Large field-of-view movement-compensated intrinsic optical signal imaging for the characterization of the haemodynamic response to spreading depolarizations in large gyrencephalic brains. J Cereb Blood Flow Metab. 2016 Sep 27. pii: 0271678×16668988. [Epub ahead of print] PubMed PMID: 27677673.
2) Zhou Q, Wang Y, Yi L, Tan Z, Jiang Y. Multisensory interplay within human auditory cortex: new evidence from intraoperative optical imaging of intrinsic signal. World Neurosurg. 2016 Oct 26. pii: S1878-8750(16)31089-0. doi: 10.1016/j.wneu.2016.10.100. [Epub ahead of print] PubMed PMID: 27794511.
3) Sato K, Nariai T, Momose-Sato Y, Kamino K. Intraoperative intrinsic optical imaging of human somatosensory cortex during neurosurgical operations. Neurophotonics. 2017 Jul;4(3):031205. doi: 10.1117/1.NPh.4.3.031205. Review. PubMed PMID: 28018935.
4) Sato K, Nariai T, Sasaki S, Yazawa I, Mochida H, Miyakawa N, Momose-Sato Y, Kamino K, Ohta Y, Hirakawa K, Ohno K. Intraoperative intrinsic optical imaging of neuronal activity from subdivisions of the human primary somatosensory cortex. Cereb Cortex. 2002 Mar;12(3):269-80. PubMed PMID: 11839601.
5) Nariai T, Sato K, Hirakawa K, Ohta Y, Tanaka Y, Ishiwata K, Ishii K, Kamino K, Ohno K. Imaging of somatotopic representation of sensory cortex with intrinsic optical signals as guides for brain tumor surgery. J Neurosurg. 2005 Sep;103(3):414-23. PubMed PMID: 16235671.
6) Meyer T, Sobottka SB, Kirsch M, Schackert G, Steinmeier R, Koch E, Morgenstern U. Intraoperative optical imaging of functional brain areas for improved image-guided surgery. Biomed Tech (Berl). 2013 Jun;58(3):225-36. doi: 10.1515/bmt-2012-0072. PubMed PMID: 23729529.
7) Sobottka SB, Meyer T, Kirsch M, Koch E, Steinmeier R, Morgenstern U, Schackert G. Intraoperative optical imaging of intrinsic signals: a reliable method for visualizing stimulated functional brain areas during surgery. J Neurosurg. 2013 Oct;119(4):853-63. doi: 10.3171/2013.5.JNS122155. PubMed PMID: 23790114.
8) Song Y, Riera JJ, Bhatia S, Ragheb J, Garcia C, Weil AG, Jayakar P, Lin WC. Intraoperative optical mapping of epileptogenic cortices during non-ictal periods in pediatric patients. Neuroimage Clin. 2016 Feb 26;11:423-34. doi: 10.1016/j.nicl.2016.02.015. PubMed PMID: 27104137; PubMed Central PMCID: PMC4827725.

Neurosurgical Focus October 2016

http://thejns.org/toc/foc/41/4

Laser interstitial thermotherapy (LITT), sometimes referred to as stereotactic laser ablation or SLA, is a minimally invasive surgery approach that uses thermal energy delivered by a laser to ablate tissue.

Advances in technology and near real-time thermography have generated renewed interest in this technology for the treatment of diseases of the brain and spine.

Several authors report technical adjuncts for improving the precision and speed of LITT using customized 3D printed frame as well as robot-assisted guidance for LITT.

Other groups have focused on assessing the safety of LITT procedures performed in a conventional operating room compared to the intraoperative MRI suite, and utilizing diffusion tensor imaging of the corticospinal tract to predict postoperative motor deficits.

Clinically oriented series include reports of LITT for rare lesions such as hypothalamic harmartomas, subependymal giant cell astrocytomas, and hypothalamic and intraventricular lesions often associated with epilepsy.

A multicenter review of LITT for brain metastases that recur after stereotactic radiosurgery and a comparison of LITT for newly diagnosed and recurrent glioblastomas (GBMs) are also presented.

Two groups describe the outcomes after efforts to minimize complications associated with post-LITT cerebral edema of large GBMs by combining LITT with minimally invasive craniotomies 1).

Barnett GH, Chen CC, Gross RE, Sloan AE. Introduction: Laser ablation techniques. Neurosurg Focus. 2016 Oct;41(4):E1. PubMed PMID: 27690650.

 

 

Hospital Quirón Barcelona incorpora el primer escáner intraoperatorio O-arm® 2 en España

hospital quiroacuten

Disminuye un 50% la dosis de radiación utilizada y mejora la calidad de las imágenes aportadas. Al mismo tiempo, ofrece una cirugía menos invasiva y más precisa.

Hospital Quirón Barcelona, de la mano del Instituto Clavel, acaba de incorporar el primer escáner intraoperatorio de última generación O-arm® 2 y de navegación intraoperatoria  stealth station S7  en España. Este nuevo sistema, de la marca Medtronic, se utilizará para lasintervenciones de neurocirugía y columna vertebral del equipo dirigido por el doctor Pablo Clavel. Este pionero sistema permite navegar con datos de alta precisión, imágenes bidimensionales y tridimensionales durante las intervenciones en quirófano y en tiempo real, incrementando la seguridad del paciente, así como los rendimientos y eficiencia de la actividad quirúrgica.

Con el equipo de nueva generación O-arm® 2, primero de sus características que se instala en España y noveno en Europa, el equipo médico del Instituto Clavel gana en precisión en cada cirugía, mejora la eficacia mecánica de los implantes utilizados en el tratamiento de la patología vertebral, evita reintervenciones y pruebas radiológicas postoperatorias. Durante cada intervención, los cirujanos disponen de imágenes instantáneas multi-dimensionales e imágenes fluoroscópicas que les permiten ver la anatomía del paciente en la posición operativa, supervisar el estado de la cirugía  y verificar los cambios quirúrgicos con una imagen volumétrica 3D antes de que el paciente salga del quirófano. Con este sistema revolucionario, utilizado para pacientes de neurocirugía de Hospital Quirón Barcelona, los pacientes se benefician de una cirugía menos invasiva, una operación más corta, una recuperación más rápida y un mejor resultado final.

Este nuevo modelo de alta tecnología reduce a la mitad la dosis de radiación en la toma de las imágenes y permite adquirir un volumen tridimensional mucho mayor. El equipo instalado en Hospital Quirón Barcelona cuenta con un pórtico similar al de un TAC pero con apertura y cierre alrededor del paciente de modo que se mantiene estéril dentro del campo quirúrgico, siendo más seguro.

Con la incorporación de esta tecnología de última generación, el Instituto Clavel -fundado por el Dr. Pablo Clavel, neurocirujano especialista en cirugía de columna-  se consolida como centro de referencia en técnicas de neurocirugía no invasiva.