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Article ; Online: Optical technologies for intraoperative neurosurgical guidance.

Valdés, Pablo A / Roberts, David W / Lu, Fa-Ke / Golby, Alexandra

2016 Volume 40, Issue 3, Page(s) E8

Abstract: ... of optical technologies as intraoperative guidance tools in neurosurgery. ... additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy ... in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors ...

Abstract	Biomedical optics is a broadly interdisciplinary field at the interface of optical engineering, biophysics, computer science, medicine, biology, and chemistry, helping us understand light-tissue interactions to create applications with diagnostic and therapeutic value in medicine. Implementation of biomedical optics tools and principles has had a notable scientific and clinical resurgence in recent years in the neurosurgical community. This is in great part due to work in fluorescence-guided surgery of brain tumors leading to reports of significant improvement in maximizing the rates of gross-total resection. Multiple additional optical technologies have been implemented clinically, including diffuse reflectance spectroscopy and imaging, optical coherence tomography, Raman spectroscopy and imaging, and advanced quantitative methods, including quantitative fluorescence and lifetime imaging. Here we present a clinically relevant and technologically informed overview and discussion of some of the major clinical implementations of optical technologies as intraoperative guidance tools in neurosurgery.
MeSH term(s)	Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Humans ; Monitoring, Intraoperative/methods ; Neurosurgical Procedures/methods ; Spectrum Analysis, Raman/methods ; Tomography, Optical Coherence/methods
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2015.12.FOCUS15550
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Article ; Online: Theranostic applications of optical coherence tomography in neurosurgery?

Hartmann, Karl / Stein, Klaus-Peter / Neyazi, Belal / Sandalcioglu, I Erol

Neurosurgical review

2021 Volume 45, Issue 1, Page(s) 421–427

Abstract: ... optical coherence tomography as a neurosurgical guidance tool. The Results demonstrate that OCT is the first imaging technique ... near" future applications of optical coherence tomography (OCT) as an intraoperative neurosurgical ... as an imaging technique in the field of neurosurgery or neurosurgical research. n = 7 articles documented ...

Abstract	In light of our own experiences, we value the existing literature to critically point out possible "near" future applications of optical coherence tomography (OCT) as an intraoperative neurosurgical guidance tool. "Pub Med", "Cochrane Library", "Crossref Metadata Search", and "IEEE Xplore" databases as well as the search engine "Google Scholar" were screened for "optical coherence tomography + neurosurgery", "optical coherence tomography + intraoperative imaging + neurosurgery", and "microscope integrated optical coherence tomography + neurosurgery". n = 51 articles related to the use of OCT as an imaging technique in the field of neurosurgery or neurosurgical research. n = 7 articles documented the intraoperative use of OCT in patients. n = 4 articles documented the use of microscope-integrated optical coherence tomography as a neurosurgical guidance tool. The Results demonstrate that OCT is the first imaging technique to study microanatomy in vivo. Postoperative analysis of intraoperative scans holds promise to enrich our physiological and pathophysiological understanding of the human brain. No data exists to prove that OCT-guided surgery minimizes perioperative morbidity or extends tumor resection. But results suggest that regular use of microscope-integrated OCT could increase security during certain critical microsurgical steps like, e.g., dural dissection at cavernous sinus, transtentorial approaches, or aneurysm clip placement. Endoscopy integration could aid surgery in regions which are not yet accessible to real-time imaging modalities like the ventricles or hypophysis. Theranostic instruments which combine OCT with laser ablation might gain importance in the emerging field of minimal invasive tumor surgery. OCT depicts vessel wall layers and its pathologies uniquely. Doppler OCT could further visualize blood flow in parallel. These abilities shed light on promising future applications in the field of vascular neurosurgery.
MeSH term(s)	Humans ; Microscopy ; Neurosurgery ; Neurosurgical Procedures ; Precision Medicine ; Tomography, Optical Coherence
Language	English
Publishing date	2021-08-16
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-021-01599-x
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Article: Intraoperative Imaging and Optical Visualization Techniques for Brain Tumor Resection: A Narrative Review.

Bin-Alamer, Othman / Abou-Al-Shaar, Hussam / Gersey, Zachary C / Huq, Sakibul / Kallos, Justiss A / McCarthy, David J / Head, Jeffery R / Andrews, Edward / Zhang, Xiaoran / Hadjipanayis, Constantinos G

Cancers

2023 Volume 15, Issue 19

Abstract: ... of neurosurgical procedures. Despite their substantial benefits, these technologies share common challenges, including ... This comprehensive review intricately describes the evolution of conventional and emerging technologies ... and virtual reality technologies. This rapidly evolving landscape represents fertile ground for future ...

Abstract	Advancements in intraoperative visualization and imaging techniques are increasingly central to the success and safety of brain tumor surgery, leading to transformative improvements in patient outcomes. This comprehensive review intricately describes the evolution of conventional and emerging technologies for intraoperative imaging, encompassing the surgical microscope, exoscope, Raman spectroscopy, confocal microscopy, fluorescence-guided surgery, intraoperative ultrasound, magnetic resonance imaging, and computed tomography. We detail how each of these imaging modalities contributes uniquely to the precision, safety, and efficacy of neurosurgical procedures. Despite their substantial benefits, these technologies share common challenges, including difficulties in image interpretation and steep learning curves. Looking forward, innovations in this field are poised to incorporate artificial intelligence, integrated multimodal imaging approaches, and augmented and virtual reality technologies. This rapidly evolving landscape represents fertile ground for future research and technological development, aiming to further elevate surgical precision, safety, and, most critically, patient outcomes in the management of brain tumors.
Language	English
Publishing date	2023-10-09
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15194890
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Article ; Online: Dual-modality optical biopsy of glioblastomas multiforme with diffuse reflectance and fluorescence: ex vivo retrieval of optical properties.

Du Le, Vinh Nguyen / Provias, John / Murty, Naresh / Patterson, Michael S / Nie, Zhaojun / Hayward, Joseph E / Farrell, Thomas J / McMillan, William / Zhang, Wenbin / Fang, Qiyin

Journal of biomedical optics

2017 Volume 22, Issue 2, Page(s) 27002

Abstract: ... resection of glioma and, thus, improving intraoperative tumor identification for guiding surgical ... Therefore, the current technique might be a promising tool for aiding neurosurgeons in determining the extent of surgical ... methods for improving the accuracy of brain tissue resection. Optical properties were retrieved using ...

Abstract	Glioma itself accounts for 80% of all malignant primary brain tumors, and glioblastoma multiforme (GBM) accounts for 55% of such tumors. Diffuse reflectance and fluorescence spectroscopy have the potential to discriminate healthy tissues from abnormal tissues and therefore are promising noninvasive methods for improving the accuracy of brain tissue resection. Optical properties were retrieved using an experimentally evaluated inverse solution. On average, the scattering coefficient is 2.4 times higher in GBM than in low grade glioma (LGG), and the absorption coefficient is 48% higher. In addition, the ratio of fluorescence to diffuse reflectance at the emission peak of 460 nm is 2.6 times higher for LGG while reflectance at 650 nm is 2.7 times higher for GBM. The results reported also show that the combination of diffuse reflectance and fluorescence spectroscopy could achieve sensitivity of 100% and specificity of 90% in discriminating GBM from LGG during ex vivo measurements of 22 sites from seven glioma specimens. Therefore, the current technique might be a promising tool for aiding neurosurgeons in determining the extent of surgical resection of glioma and, thus, improving intraoperative tumor identification for guiding surgical intervention.
MeSH term(s)	Biopsy ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Glioblastoma/diagnostic imaging ; Glioblastoma/surgery ; Humans ; Spectrometry, Fluorescence
Language	English
Publishing date	2017-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1309154-2
ISSN	1560-2281 ; 1083-3668
ISSN (online)	1560-2281
ISSN	1083-3668
DOI	10.1117/1.JBO.22.2.027002
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Article ; Online: Optical Principles of Fluorescence-Guided Brain Tumor Surgery: A Practical Primer for the Neurosurgeon.

Zhang, Daniel Y / Singhal, Sunil / Lee, John Y K

Neurosurgery

2018 Volume 85, Issue 3, Page(s) 312–324

Abstract: ... innovations in surgical oncology in the past decade. These intraoperative imaging technologies provide ... of the various advantages and limitations of the most commonly used intraoperative imaging agents, including 5 ... currently undergoing or will soon enter clinical trials for the intraoperative imaging of brain tumors. ...

Abstract	Fluorescence-guided surgery is a rapidly growing field that has produced some of the most important innovations in surgical oncology in the past decade. These intraoperative imaging technologies provide information distinguishing tumor tissue from normal tissue in real time as the surgery proceeds and without disruption of the workflow. Many of these fluorescent tracers target unique molecular or cellular features of tumors, which offers the opportunity for identifying pathology with high precision to help surgeons achieve their primary objective of a maximal safe resection. As novel fluorophores and fluorescent probes emerge from preclinical development, a practical understanding of the principles of fluorescence remains critical for evaluating the clinical utility of these agents and identifying opportunities for further innovation. In this review, we provide an "in-text glossary" of the fundamental principles of fluorescence with examples of direct applications to fluorescence-guided brain surgery. We offer a detailed discussion of the various advantages and limitations of the most commonly used intraoperative imaging agents, including 5-aminolevulinic acid, indocyanine green, and fluorescein, with a particular focus on the photophysical properties of these specific agents as they provide a framework through which to understand the new agents that are entering clinical trials. To this end, we conclude with a survey of the fluorescent properties of novel agents that are currently undergoing or will soon enter clinical trials for the intraoperative imaging of brain tumors.
MeSH term(s)	Brain Neoplasms/surgery ; Fluorescent Dyes ; Humans ; Neuroimaging/methods ; Neurosurgeons ; Neurosurgical Procedures/methods ; Optical Imaging/methods ; Surgery, Computer-Assisted/methods
Chemical Substances	Fluorescent Dyes
Language	English
Publishing date	2018-08-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1093/neuros/nyy315
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Article ; Online: Advances in intraoperative optical coherence tomography for surgical guidance

El-Haddad, Mohamed T. / Tao, Yuankai K.

Current Opinion in Biomedical Engineering. 2017,

2017

Abstract: Translation of optical coherence tomography (OCT) technologies for intraoperative visualization ... directions of the technology. ... decision-making. Over the last decade, intraoperative OCT has evolved from two-dimensional imaging using handheld ...

Abstract	Translation of optical coherence tomography (OCT) technologies for intraoperative visualization enables in vivo micron-resolution imaging of subsurface tissue structures and image-guided clinical decision-making. Over the last decade, intraoperative OCT has evolved from two-dimensional imaging using handheld probes to include biopsy-needles for minimally invasive deep-tissue imaging, surgical instrumentation using optical feedback for tremor dampening and stabilization, and stereomicroscope integrated systems that provide real-time three- and four-dimensional visualization of surgical maneuvers. In addition, several preliminary studies have demonstrated the feasibility and utility of combining intraoperative OCT imaging with novel image-processing and display methods to implement augmented/virtual reality and robotic surgical guidance platforms. While research and commercialization of these innovations have been largely driven by needs in ophthalmology, OCT is finding new clinical applications in surgical oncology and neurosurgery. In this paper, we review recent developments in intraoperative OCT and discuss current trends and future directions of the technology.
Keywords	OCT ; FD-OCT ; PS-OCT ; FF-OCT ; MEMS ; HUD ; ROI ; FOV ; GPU ; MH ; ERM ; DALK
Language	English
Publishing place	Elsevier Inc.
Document type	Article ; Online
Note	Pre-press version
ISSN	2468-4511
DOI	10.1016/j.cobme.2017.09.007
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: A miniature optical neuronavigation system for CT-guided stereotaxy.

von Jako, Christopher R / Perlaki, Gabor / Orsi, Gergely / Schwarcz, Attila / Dóczi, Tamás

Stereotactic and functional neurosurgery

2014 Volume 92, Issue 1, Page(s) 1–7

Abstract: ... indicated its potential usefulness for common neurosurgical applications. Furthermore, this small-footprint ... tracking technology does not experience the traditional environmentally induced issues or the requirement ... these markers to the anatomy and a user-selected target. A computer displays the cannula guidance information ...

Abstract	Background and objective: Neuronavigation devices have progressed over the past 2 decades, but logistical limitations remain for many stereotactic procedures. We describe our technique and accuracy for a novel miniature optical tracking system which overcomes these limitations. Method: The minioptical tracking system uses a miniature video camera mounted on a rigid cannula to determine cannula location and orientation relative to a patient-attached sticker containing reference markers. A CT scan is used to register these markers to the anatomy and a user-selected target. A computer displays the cannula guidance information to the target. Bench testing was performed on 225 targets in a custom test phantom and additional testing was performed on 20 small targets in an anthropomorphic head phantom to determine the practical accuracy and workflow. Results: The phantom study demonstrated that 3-D navigation accuracy is 1.41 ± 0.53 mm. There was a 100% head phantom study success rate for the 20 small targets. Conclusions: The resulting accuracy data demonstrated good correlation with the CT data, and the clinical simulation workflow indicated its potential usefulness for common neurosurgical applications. Furthermore, this small-footprint tracking technology does not experience the traditional environmentally induced issues or the requirement of pin-based head fixation, allowing for use in the neurointensive care unit and the emergency department.
MeSH term(s)	Equipment Design ; Humans ; Monitoring, Intraoperative ; Neuronavigation/instrumentation ; Neuronavigation/methods ; Neurosurgery/instrumentation ; Optical Imaging/instrumentation ; Optical Imaging/methods ; Reproducibility of Results ; Stereotaxic Techniques/instrumentation ; Surgery, Computer-Assisted/instrumentation ; Surgery, Computer-Assisted/methods ; Tomography, X-Ray Computed/instrumentation ; Tomography, X-Ray Computed/methods ; Video-Assisted Surgery/instrumentation ; Video-Assisted Surgery/methods
Language	English
Publishing date	2014
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000354819
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Article: Review of the potential of optical technologies for cancer diagnosis in neurosurgery: a step toward intraoperative neurophotonics.

Vasefi, Fartash / MacKinnon, Nicholas / Farkas, Daniel L / Kateb, Babak

Neurophotonics

2016 Volume 4, Issue 1, Page(s) 11010

Abstract: ... spectroscopy, highlighting the importance of these technologies in live intraoperative tissue mapping during ... technologies including Raman spectroscopy, thermal imaging, optical coherence tomography, and fluorescence ... neurosurgery. While these technologies need further validation in larger clinical trials, they show remarkable ...

Abstract	Advances in image-guided therapy enable physicians to obtain real-time information on neurological disorders such as brain tumors to improve resection accuracy. Image guidance data include the location, size, shape, type, and extent of tumors. Recent technological advances in neurophotonic engineering have enabled the development of techniques for minimally invasive neurosurgery. Incorporation of these methods in intraoperative imaging decreases surgical procedure time and allows neurosurgeons to find remaining or hidden tumor or epileptic lesions. This facilitates more complete resection and improved topology information for postsurgical therapy (i.e., radiation). We review the clinical application of recent advances in neurophotonic technologies including Raman spectroscopy, thermal imaging, optical coherence tomography, and fluorescence spectroscopy, highlighting the importance of these technologies in live intraoperative tissue mapping during neurosurgery. While these technologies need further validation in larger clinical trials, they show remarkable promise in their ability to help surgeons to better visualize the areas of abnormality and enable safe and successful removal of malignancies.
Language	English
Publishing date	2016-12-26
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2781943-7
ISSN	2329-4248 ; 2329-423X
ISSN (online)	2329-4248
ISSN	2329-423X
DOI	10.1117/1.NPh.4.1.011010
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Article ; Online: Use of optical fluorescence agents during surgery for pituitary adenomas: current state of the field.

Chang, Stephanie W / Donoho, Daniel A / Zada, Gabriel

Journal of neuro-oncology

2018 Volume 141, Issue 3, Page(s) 585–593

Abstract: ... challenge despite improvements in optical visualization technology for pituitary adenoma (PA) surgery ... During neurosurgical procedures for other tumor types, 5-aminolevulinic acid (5-ALA) has become a focus ... neurosurgical endoscopic/microscopic approaches. 5-ALA photodynamic therapy was evaluated in two in-vitro models ...

Abstract	Introduction: Differentiation of normal pituitary from abnormal tumor tissue remains a surgical challenge despite improvements in optical visualization technology for pituitary adenoma (PA) surgery. During neurosurgical procedures for other tumor types, 5-aminolevulinic acid (5-ALA) has become a focus of investigation based on its high specificity in differentiating tumor tissue. However, the role of 5-ALA and other optical fluorescent agents in PA surgery remains less clear. Objective: To perform a systematic review on the use of various optical fluorescent agents in PA surgery. Method: Using PRISMA guidelines, a systematic literature review to identify reports describing 5-ALA and other optical agents for fluorescence-guided surgery for PA was performed. Eleven research studies met inclusion criteria and were reviewed. Results: In two studies, 5-ALA was not shown to be effective in aiding PA resection using standard neurosurgical endoscopic/microscopic approaches. 5-ALA photodynamic therapy was evaluated in two in-vitro models with inconsistent results. Intraoperative use of indocyanine green (ICG) concluded with varying results, but showed a tendency towards improved differentiation of functional PA. OTL38 showed potential for intraoperative identification of nonfunctioning PA, particularly in tumors with high folate receptor expression. One study reported clinically useful fluorescence following sodium fluorescein administration. Conclusion: We conclude that selected optical fluorescent agents, including ICG and folate receptors, are most likely to hold promise for clinical use in differentiating PA from normal tissue.
MeSH term(s)	Adenoma/diagnostic imaging ; Adenoma/surgery ; Aminolevulinic Acid ; Fluorescent Dyes ; Humans ; Optical Imaging/methods ; Pituitary Neoplasms/diagnostic imaging ; Pituitary Neoplasms/surgery ; Surgery, Computer-Assisted
Chemical Substances	Fluorescent Dyes ; Aminolevulinic Acid (88755TAZ87)
Language	English
Publishing date	2018-12-06
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	604875-4
ISSN	1573-7373 ; 0167-594X
ISSN (online)	1573-7373
ISSN	0167-594X
DOI	10.1007/s11060-018-03062-2
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Article ; Online: Intraoperative optical imaging of metabolic changes after direct cortical stimulation - a clinical tool for guidance during tumor resection?

Oelschlägel, Martin / Meyer, Tobias / Schackert, Gabriele / Kirsch, Matthias / Sobottka, Stephan B / Morgenstern, Ute

Biomedizinische Technik. Biomedical engineering

2018 Volume 63, Issue 5, Page(s) 587–594

Abstract: ... intraoperative conditions. Measurements with an optical imaging setup were performed as a proof of concept ... possible, and the technique might be a useful clinical tool in the future. ... a novel approach, the use of optical imaging in connection with direct electrical cortical stimulation ...

Abstract	Brain tumor resection is even today one of the most challenging disciplines in neurosurgery. The current state of the art for the identification of tumor tissue during the surgical procedure comprises a wide variety of different tools, each with its own limitations and drawbacks. In this paper, we present a novel approach, the use of optical imaging in connection with direct electrical cortical stimulation (DCS), for identification of impaired tumor tissue and functional intact normal brain tissue under intraoperative conditions. Measurements with an optical imaging setup were performed as a proof of concept on three patients who underwent tumor resection of superficial gliomas. Direct electrical stimulations were applied on tumor tissue and surrounding brain tissue in each patient and characteristic features from the observed changes in the optical properties were compared between the different groups. The results reveal that in all patients a differentiation between non-functional tumor tissue and functional intact brain tissue was possible, and the technique might be a useful clinical tool in the future.
MeSH term(s)	Brain/surgery ; Brain Neoplasms/pathology ; Electric Stimulation/methods ; Glioma ; Humans ; Neurosurgical Procedures/methods
Language	English
Publishing date	2018-02-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	120817-2
ISSN	1862-278X ; 0013-5585
ISSN (online)	1862-278X
ISSN	0013-5585
DOI	10.1515/bmt-2017-0156
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