Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Barkley, Ariana; McGrath, Lynn B.; Hofstetter, Christoph P.

doi:10.3171/case2083

Cited by 6 publications

(8 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, the Dutch medical-ethical committee explicitly restricted the use of our experimental technique for surgical decision-making at this point of the study. Until now, the resolution we could achieve while imaging the spinal cord with µDoppler was not available intra-operatively using ultrasound, with only CEUS coming somewhat close ( 20 , 21 , 26 ). Therefore, this current report aims to create scientific awareness of the availability and image quality of µDoppler, hoping to inspire others working on hemangioblastoma to join in studying its surgical potential.…”

Section: Discussionmentioning

confidence: 99%

“…Literature reports recommendations on improving surgical safety and efficacy during hemangioblastoma resection by focusing on vascular details specifically ( 12 ). Compared to currently available ultrasound-based techniques such as CEUS which aim to image these vascular details ( 20 , 21 , 26 ), µDoppler-imaging would be able to achieve the same if not better resolution images without the need for a contrast agent ( 32 ). This means that µDoppler-imaging is continuous in nature, whereas CEUS is contrast bolus-dependent ( 20 , 21 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

“…Compared to currently available ultrasound-based techniques such as CEUS which aim to image these vascular details ( 20 , 21 , 26 ), µDoppler-imaging would be able to achieve the same if not better resolution images without the need for a contrast agent ( 32 ). This means that µDoppler-imaging is continuous in nature, whereas CEUS is contrast bolus-dependent ( 20 , 21 , 26 ). Similarly, compared to conventional Doppler, µDoppler-imaging is able to reach far superior resolutions (in the range of 100–500 µm, depending on the transducer frequency) ( 40 ).…”

Section: Introductionmentioning

confidence: 99%

“…Intra-operatively, ultrasound and its submodalities (e.g., Doppler, Contrast Enhanced Ultrasound (CEUS)) have become a more common practice during spinal procedures given their many benefits including ease of use of the techniques, mobility, and availability of real-time feedback during surgical resection (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). For example, several reports in literature on CEUS demonstrate how the technique could provide new insights on localization (20,21,26), diagnosis (21) and surgical boundaries (20, 26) during intra-operative resection of spinal cord tumors.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma

et al. 2023

View full text Add to dashboard Cite

Surgical resection of spinal cord hemangioblastomas remains a challenging endeavor: the neurosurgeon’s aim to reach total tumor resections directly endangers their aim to minimize post-operative neurological deficits. The currently available tools to guide the neurosurgeon’s intra-operative decision-making consist mostly of pre-operative imaging techniques such as MRI or MRA, which cannot cater to intra-operative changes in field of view. For a while now, spinal cord surgeons have adopted ultrasound and its submodalities such as Doppler and CEUS as intra-operative techniques, given their many benefits such as real-time feedback, mobility and ease of use. However, for highly vascularized lesions such as hemangioblastomas, which contain up to capillary-level microvasculature, having access to higher-resolution intra-operative vascular imaging could potentially be highly beneficial. µDoppler-imaging is a new imaging modality especially fit for high-resolution hemodynamic imaging. Over the last decade, µDoppler-imaging has emerged as a high-resolution, contrast-free sonography-based technique which relies on High-Frame-Rate (HFR)-ultrasound and subsequent Doppler processing. In contrast to conventional millimeter-scale (Doppler) ultrasound, the µDoppler technique has a higher sensitivity to detect slow flow in the entire field-of-view which allows for unprecedented visualization of blood flow down to sub-millimeter resolution. In contrast to CEUS, µDoppler is able to image high-resolution details continuously, without being contrast bolus-dependent. Previously, our team has demonstrated the use of this technique in the context of functional brain mapping during awake brain tumor resections and surgical resections of cerebral arteriovenous malformations (AVM). However, the application of µDoppler-imaging in the context of the spinal cord has remained restricted to a handful of mostly pre-clinical animal studies. Here we describe the first application of µDoppler-imaging in the case of a patient with two thoracic spinal hemangioblastomas. We demonstrate how µDoppler is able to identify intra-operatively and with high-resolution, hemodynamic features of the lesion. In contrast to pre-operative MRA, µDoppler could identify intralesional vascular details, in real-time during the surgical procedure. Additionally, we show highly detailed post-resection images of physiological human spinal cord anatomy. Finally, we discuss the necessary future steps to push µDoppler to reach actual clinical maturity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The contrast consists of microbubbles that can illustrate the tumor vascular network, and outline the tumor to a greater extent than B-mode imaging. In addition, contrast administration after resection can help confirm the resection extent ( 56 ). Augmented reality operating microscopes have been reported to help visualize tumor outline and assist with resection using principles similar to intracranial augmented reality-based applications ( 57 ).…”

Section: Managementmentioning

confidence: 99%

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

2022

View full text Add to dashboard Cite

Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.

show abstract

Prognostic factors for surgically managed intramedullary spinal cord tumours: a single-centre case series

et al. 2022

View full text Add to dashboard Cite

Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Cited by 6 publications

References 37 publications

Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma

Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

Prognostic factors for surgically managed intramedullary spinal cord tumours: a single-centre case series

Contact Info

Product

Resources

About