Robotic Assisted MRI-Guided Interventional Interstitial MR-Guided Focused Ultrasound Ablation in a Swine Model

MacDonell, Jacquelyn; Patel, Niravkumar; Fischer, Gregory S.; Burdette, Everette C.; Jiang, Qian; Chumbalkar, Vaibhav; Ghoshal, Goutam; Heffter, Tamas; Williams, Emery; Gounis, Matthew J.; King, R; Thibodeau, Juliette; Bogdanov, G.S.; Brooks, Olivia W.; Langan, Erin; Hwang, Roy; Pilitsis, Julie G.

doi:10.1093/neuros/nyy266

Cited by 21 publications

(15 citation statements)

References 28 publications

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“…Alongside surgical advances in conventional epilepsy surgery, stereotactic lesioning has emerged as an alternative when surgery is not an option. Several stereotactic approaches have been developed, including radiosurgery [6], Laser Interstitial Thermotherapy (LiTT) [7][8][9][10][11][12][13][14][15], High Intensity Focal Ultrasound (HIFU) [16,17], and SEEG-guided Radiofrequency Thermo-Coagulation (SEEG-guided RF-TC) [18][19][20][21][22][23][24][25][26][27]. The present review focuses on the latter, which aims at coupling SEEG investigation with RF-TC stereotactic lesioning directly through the recording electrodes.…”

Section: Introductionmentioning

confidence: 99%

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Bourdillon

Rheims

Catenoix

et al. 2020

Seizure

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Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC) consists of coupling SEEG investigation with RF-TC stereotactic lesioning directly through the recording electrodes. In this systematic review the surgical technique, indications, and outcomes are described. Maximum accuracy is reached when a frame-based procedure with a robotic assistance and a per-operative vascular X-ray imaging are performed. Monitoring of the lesioning procedure based on the impedance, a sharp modification of which indicates that the thermocoagulation has reached its maximum volume, allows the optimization of the lesion size. The first indication concerns patients in whom a SEEG is required to determine whether surgery is feasible and in whom resection is indeed possible. Even if surgery is performed owing to insufficient efficacy of SEEG-guided RF-TC, the procedure remains interesting owing to its high positive predictive value for good outcome after surgery. The second indication concerns patients in whom phase I non-invasive investigations have concluded to surgical contraindication and who may still undergo SEEG in a purely therapeutic perspective (small deep zones inaccessible to surgery and network nodes of large epileptic networks). Lastly, SEEG-guided RF-TC can be considered as a first-line treatment for periventricular nodular heterotopia (PNH). Independently of indication, the overall seizure-free rate is 23% and the responder rate is 58%. The best results are obtained for PNH (38% seizure-free and 81% responders), while the worst results have been reported for temporal lobe-epilepsy in a dedicated study. The overall complication rate is 2.5%. More evidence is needed to help determine the exact place of SEEG-guided RF-TC in the surgical management algorithm.

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Section: Introductionmentioning

confidence: 99%

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Bourdillon

Rheims

Catenoix

et al. 2020

Seizure

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“…There are a number of ultrasound‐based ablative techniques that could be used to make therapeutic brain lesions (reviewed in ref. [ 1 ] ) including cavitation enhanced ablation, [ 2 ] histotripsy, [ 3 ] interstitial ablation, [ 4 ] and thermal based focused ultrasound ablation. Most clinical experience to date with cranial ultrasound surgery, has been performed with magnetic resonance imaging guidance thermal based focused ultrasound (MRgFUS) ablation.…”

Section: Ultrasound Surgerymentioning

confidence: 99%

Transcranial Ultrasound Innovations Ready for Broad Clinical Application

Beisteiner

Lozano

2020

Advanced Science

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Brain diseases are one of the most important problems in our rapidly ageing society. Currently, there are not many effective medications and surgical options are limited due to invasiveness and non-invasive brain stimulation techniques cannot be well targeted and cannot access deep brain areas. A novel therapy is transcranial ultrasound which allows a variety of treatments without opening of the skull. Recent technological developments generated three revolutionary options including 1) targeted non-invasive surgery, 2) highly targeted drug, antibody, or gene therapy via local opening of the blood-brain barrier, and 3) highly targeted brain stimulation to improve pathological brain functions. This progress report summarizes the current state of the art for clinical application and the results of recent patient investigations.

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“…Fractional anisotropy (FA) maps obtained by DTI analysis showed loss of WM integrity in the ipsilateral hemisphere (in the internal capsule and corpus callosum) [ 16 , 240 ] in a pig model of stroke. In addition, a stem cell vesicle-based treatment was found to preserve the integrity and functionality of WM [ 103 , 104 ].When focusing on the effects of hemorrhagic stroke, leakage of blood into the brain parenchyma of swine has been mostly measured using CT [ 180 , 206 , 208 , 214 ] or MRI FLAIR images or in T2*-weighted images [ 165 , 173 , 174 , 178 , 187 , 213 , 214 , 241 ]. To overcome possible artefacts, the iron from hemoglobin can be indirectly measured using the rate of transverse magnetization relaxation, R2*(1/T2*).…”

Section: Evaluation Of Stroke Damage In Swine By Neuroimagingmentioning

confidence: 99%

Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation

Melià-Sorolla

Castaño

DeGregorio-Rocasolano

et al. 2020

IJMS

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In the search of animal stroke models providing translational advantages for biomedical research, pigs are large mammals with interesting brain characteristics and wide social acceptance. Compared to rodents, pigs have human-like highly gyrencephalic brains. In addition, increasingly through phylogeny, animals have more sophisticated white matter connectivity; thus, ratios of white-to-gray matter in humans and pigs are higher than in rodents. Swine models provide the opportunity to study the effect of stroke with emphasis on white matter damage and neuroanatomical changes in connectivity, and their pathophysiological correlate. In addition, the subarachnoid space surrounding the swine brain resembles that of humans. This allows the accumulation of blood and clots in subarachnoid hemorrhage models mimicking the clinical condition. The clot accumulation has been reported to mediate pathological mechanisms known to contribute to infarct progression and final damage in stroke patients. Importantly, swine allows trustworthy tracking of brain damage evolution using the same non-invasive multimodal imaging sequences used in the clinical practice. Moreover, several models of comorbidities and pathologies usually found in stroke patients have recently been established in swine. We review here ischemic and hemorrhagic stroke models reported so far in pigs. The advantages and limitations of each model are also discussed.

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Robotic Assisted MRI-Guided Interventional Interstitial MR-Guided Focused Ultrasound Ablation in a Swine Model

Cited by 21 publications

References 28 publications

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

Transcranial Ultrasound Innovations Ready for Broad Clinical Application

Relevance of Porcine Stroke Models to Bridge the Gap from Pre-Clinical Findings to Clinical Implementation

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