Intraoperative Imaging in Neurosurgery Karanjit Singh Narang, Ajaya Nand Jha
INDEX
Page numbers followed by f refer to figure and t refer to table
A
Adenoid cystic carcinoma 136f, 137f
Adenomatous tissue, removal of 117f
Adenosine triphosphate 89
American College of Radiology 34
Aminolevulinic acid 88, 89, 92
Aneurysm
clips 61
microsurgery 146
Angiography, intraoperative 14
Anisotropy, functional 43
Anterior cranial fossa skull base 133f
Arteriovenous fistula 151f
Arteriovenous malformation 13, 42, 80, 145
microsurgery 148
surgery 173
ruptured 150f
Astrocytoma, low-grade 105f
Automated endoscopic system 173
Axial computed tomography angiography 149f
B
Basal ganglia intracerebral hematoma, deep-seated 152f
Blood
brain barrier 163, 174
oxygen level 97
pressure 32
Bone scan, intraoperative 128
Brain
biopsy 40
deep-seated cavernous malformation of 153f
roentgenography of 3f
shift 40
surgery 70, 72, 158
tumor, primary 41
Brainstem 154
cavernous malformation 155f
Burr hole transducer 80f
C
Cannula placement 172
Capnography 33, 60
Cardiac arrest 61
Carotid artery 111
Catheter placement 72
Cavernous malformation 84t, 153f
microsurgery, deep-seated 154, 154f
Cavernous sinus invasion 111
Central nervous system 88
Cerebellopontine angle 134
Cerebral
artery 147f
atrophy 12
vessels, angiography of 2
Cerebrospinal fluid 12, 39, 53, 85f, 96, 112, 113, 139, 159, 168
Cerebrovascular surgeries 144
Chondrosarcoma 136
low-grade 138f
Chronic neurodegenerative diseases 96
Cochlear implants 61
Computed tomography 26, 57, 63, 169
angiography 144
Convection-enhanced delivery 163, 172
Coproporphyrinogen oxidase 89
Coronal magnetic resonance imaging 140
Corticospinal tracts 159f
Cranial nerve 134
Craniocervical junction 75
Craniomaxillofacial surgery 65
Craniotomy 64, 80f
Cyst, large 85f
D
Deep arteriovenous malformation 149f
Deep brain stimulation 41, 41f, 64, 98, 163, 169, 172
Deep vein thrombosis 123
Delta-aminolevulinic acid 88
Diffusion tensor imaging 4, 9, 12f, 26, 31, 39, 43, 82, 97, 112, 148, 159, 169
Digital subtraction angiography 3f, 63, 144, 170
Dural arteriovenous fistulas 145, 150
E
Electrical cortical stimulation 160
Electrocardiogram 32
monitoring 60
Electrocortical mapping 161
Electrocortical stimulation 161
Electrodes reconstruction image 41f
Electroencephalography 99, 159
Electromyography 129
Endoscopic surgery 114f
Endotracheal tubes 60
Endovascular embolization 132
Enzymes 89f
Epilepsy 96
extratemporal 97
lesional 99
surgery 96
temporal 97
Ethmoidal fistula 151f
External pallidum 41f
F
Facial nerve 134
Fast contrast enhancement 113
Fluid attenuation inversion recovery 37, 92, 19, 105
Fluorescence, principles of 88
Fluoroscopy 63
Focal cortical dysplasia 99
Functional magnetic resonance imaging 26, 39, 96, 112, 159, 169
Functional mapping, invasive methods of 160
G
Gadolinium-contrast agents 61
Ganglioglioma 99
Gauss plot 33f
Glioblastoma 103, 104f
multiforme 17
contrast enhancing 49f
Glioma surgery 47, 102
Glomerular filtration rate 33, 61
Gross total resection 13, 88, 102, 118, 121
H
Haem biosynthetic pathway 89f
Hardy's grade 122t
Hemangioblastomas 14
Hematoma 150f, 151f
High-definition fiber tractography 153
High-field intraoperative magnetic resonance imaging 18, 31
High-grade glioma 82, 83f, 84f, 88, 102, 104
left frontoparietal 43f
resection of 15, 18
photodynamic detection of 90
Huntington's disease 175
Hyperechoic tissue 85f
I
Indocyanine green 42
videoangiography 148
Intracarotid amytal test 160
Intracerebral hematoma, aspiration of 72
Intracerebral hemorrhage
evacuation 150
nontraumatic 150
Intracranial biopsy 7t
Intracranial dural arteriovenous fistulas 150
Intracranial structure 83t
Intracranial vessels, angiography of 2
Intradural neurofibroma 86f
Intraoperative
computed tomography 14, 63, 64, 70, 71, 97, 127, 128
cone-beam computed tomography 8f
diffusion tensor imaging 26
functional magnetic resonance imaging 28
imaging techniques 128
magnetic resonance
imaging 8, 9f, 15, 18, 19, 26, 31, 3335, 41, 49, 49f, 53, 58, 96, 97f, 102, 103, 104f, 105, 105f, 107, 111113, 117, 118, 121, 127, 128, 130f, 162f
spectroscopy 28
neuromonitoring 128
neuronavigation 10, 146, 148
limitations of 12
ultrasound 13, 79, 96, 128
video monitoring 134
Intravenous gadolinium 37
Invasive blood pressure transducers 60
J
Jablonski diagram 88
Juvenile nasopharyngeal angiofibroma 135
K
Kaplan-Meier plot 130f
L
Laryngeal masks 60
Laryngoscopes 60
Laser interstitial thermal ablation therapy 161f
Low-field intraoperative magnetic resonance imaging 15, 31, 47
Low-grade glioma 13, 84, 103, 105
resection of 18
Lumbar discography 2
Lung cancer metastasis 85f
M
Magnetic resonance
angiography 42, 144
imaging 3, 26, 31, 35, 42f, 47, 58, 61, 63, 84t, 118, 138f, 144, 158, 168
scanning 79, 98
spectroscopy 32, 38, 41, 50
therapy 162
venography 42
Magnetic source imaging 20
Magnetoencephalography 35, 99, 159, 169
Matrix-assisted laser desorption ionization 163
Meningioma 82, 85f, 131, 133f
Mesial temporal sclerosis 97f
Metastasis 82
Methyl-l-tryptophan 169
Meyer's loop 98
Minimally invasive
brain surgery 73
spinal instrumentation 75
Mobile computed tomography scanner 71
Modern portable intraoperative ultrasound system 81f
Multicompartment disease 111
Multimodality image-guided neurosurgery 158
Myelography 1
N
Nasal stage 116
National Institutes of Health Stroke Scale Score 152
Near-field techniques 135
Nephrogenic systemic fibrosis 33
Neurosurgery 7, 31
Noninvasive blood pressure cuffs 60
Non-lesional epilepsy 99
Non-radiographic intraoperative imaging techniques 132
O
Obsessive compulsive disorder 169
Oligodendroglioma grade 84
Open neurosurgery 37
Orthopedic prostheses 61
P
Parkinson's disease 172
Pedicle screw 66, 74
Peritumoral edema 160f
Photodynamic therapy 92
Pituitary adenoma 111, 129
transsphenoidal resection of 112
Pituitary surgeries 111
Pneumoencephalography 1
Positron emission tomography 20, 26, 57, 99, 158, 169
Preoperative magnetic resonance imaging 10f, 12f, 97f, 133f, 136f138f, 140f, 162f
Prosthetic heart valves 61
Pulse oximeters 33, 60
R
Radiographic intraoperative imaging techniques 132
Renal failure, chronic severe 33
Rotational three-dimensional angiography 144
S
Sclerosis, hippocampal 98
Sella, reconstruction of 117
Sellar stage 116
Single tensor streamline tractography 160f
Single voxel spectroscopy 38
Sinonasal mass, large 136f, 137f
Skull base 73
surgeries 65, 127
tumors 129
Skull, X-ray 2f
Somatosensory evoked potentials 129
Sphenoid sinus ostium 116
Sphenoidal stage 116
Spinal trauma 66
Spinal vessels, angiography of 2
Spine 66
surgery 42, 69, 74
Stereoelectroencephalography 174
Stereotactic procedures 64
Stimulated Raman spectroscopy 163
Substantia nigra 41f
Subtemporal craniotomy 138f
Subthalamic nucleus 41, 41f
Supratentorial cavernous malformation microsurgery 153
Syringe pumps 60
T
Target resection volume 107
Thalamus, anterior nucleus of 42f
Tractography 169
Transcranial magnetic stimulation 160, 170
Transsphenoidal
resection 140f
surgery 19, 41
Transverse magnetization 36
formation of 36f
Transverse relaxation time 36
Trauma 74
Tumor
benign 111
dimension 107
resection 65, 66, 74, 160
margins 37f
residual 105f
skull base 135
volume resection 122t
Turbo-spectroscopic imaging 38
U
Ultrasonography 63
V
Vascular neurosurgery 42
Vascular surgery 65
Ventricular cannulation 82
Ventriculography 1
Ventriculoperitoneal shunt placement 65
Vertebroplasty 66, 75
Vestibular schwannoma 127, 134
Vestibulocochlear nerve 134
Vomer stage 116
W
Wada testing 160
World Health Organization 18
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fm1INTRAOPERATIVE IMAGING IN NEUROSURGERYfm2
fm3INTRAOPERATIVE IMAGING IN NEUROSURGERY
Editors Karanjit Singh Narang Associate Director (Neurosurgery) Institute of Neurosciences Medanta—The Medicity Gurugram, Haryana, India Ajaya Nand Jha Chairman Institute of Neurosciences Medanta—The Medicity Gurugram, Haryana, India Foreword Michael Schulder
fm4
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Intraoperative Imaging in Neurosurgery
First Edition: 2017
9789386322906
fm5Dedicated to
My loving wife Dr Sherry Narang, my kids Gurneet and Harjas and my caring parents.
Over and above to all my patients whohave taught me and are still teaching me.
—Karanjit Singh Narang
Everyone who has made my life more worthwhile. My wife Dr Urvashi Prasad Jha, who is my greatest motivator; my children Ruchira and Siddharth Jha; son-in-law and daughter-in-law, Dr Ashu Jadhav and Trudy Rebert, and of course, my mother, Mrs Sita Jha.
—Ajaya Nand Jhafm6
fm7Contributors fm9Foreword
Intraoperative Imaging in Neurosurgery is testimony to the rapid pace of change in our world. When I presented preliminary work on the use of a low-field compact intraoperative MRI (iMRI) at the 2000 meeting of the Neurological Society of India (NSI), there were a handful of iMRI units around the world. This was a time of great excitement for us, where our idea of best and most detailed imaging method could be actually incorporated into our operating rooms. The general reaction at the NSI conference was that such luxuries were very nice in the United States or Western Europe, but Indian neurosurgeons would have to make do with much simpler technology at best, may be two-dimensional ultrasound.
How times have changed, for better and for worse. Many Indian neurosurgical centers now use the most sophisticated devices for intraoperative imaging, including iMRI, intraoperative computed tomography, and three-dimensional intraoperative ultrasonography. These have been joined in this work by neurosurgeons elsewhere in Asia and of course around the world. Many institutions have contributed peer-reviewed publications that demonstrate the utility of iMRI and meet the criteria for evidence-based medicine. Intraoperative imaging has been embraced by colleagues around the world.
On the other hand, this complex and expensive technology has been challenged as not being “cost-effective”. Many neurosurgeons reject the extra time and work involved in imaging during surgery. Industrial partners have lost interest as hospital systems shy away from the necessary investment for iMRI implementation. About 45 years ago, the United States made trips to the moon and back routine. Now that expertise has been lost, because of a lack of political will and a collective insistence that we build on the early accomplishments of the Apollo astronauts. Will neurosurgery see the same thing happen with iMRI? Do we lack the political will to insist that we make intraoperative imaging a ubiquitous technology, another step forward in taking the guesswork out of brain surgery of all kinds?
I hope that the book will spur us to continue our efforts to ensure that we keep pushing forward with the development of iMRI and related technologies, so that they become as expected a part of neurosurgical routine as has been the case for diagnostic MRI and surgical navigation. Let us go forward and not backwards.
Michael Schulder MD
Professor and Vice Chairman
Residency Program Director
Director, Brain Tumor Center
Department of Neurosurgery
Hofstra Northwell School of Medicine
Hofstra University
450, Lakeville Road
Lake Success, NY 11042, New York, USA
Vice President, World Society for
Stereotactic and Functional Neurosurgery
AANS Historian
fm11Preface
Our first exposure to neurosurgery during general surgery residency left us with an impression of unconscious patients with shaved heads, and the neurosurgeon drilling burr holes manually with Hudson's brace hoping to hit the spot, having blood under the bone. As general surgery residents, we never understood why they cannot do an exploratory craniotomy such as we used to exploratory laparotomy and look inside. The answer from the Chief of Neurosurgery was a bit snobbish, but very true—neurosurgery requires pin-point precision. We cannot sacrifice a millimeter of brain, unlike people who can get away by removing feet of intestines.
After entering neurosurgical residency, we fully understood the need for precision. From marking the skin incision to reaching the intraparenchymal pathology accurately in neurosurgery, required experience, training and a lot of luck. Post- operative scans would show residual tumor and re-exploration was not uncommon. Things changed when navigation was adopted. Accuracy in marking scalp incisions and reaching target pathology increased significantly.
Only after we started working in an institute with intraoperative MRI, did we realize what we were leaving behind after surgery. It was like a Lie Detector test. You do the surgery, and then think it was a good job done until the MRI picks up the fallacy!
Our strong motivation to compile the book was to spread awareness and education regarding the available technology today, that can help in making neurosurgery more safe and precise.
The book has valuable contributions from authors from all over the world who share their experiences with the specific technologies, they use for intraoperative imaging.
Karanjit Singh Narang
Ajaya Nand Jhafm12
fm13Acknowledgments
We sincerely thank: