Ishikawa Mami, Ota Yasushi, Nagai Mutsumi, Kusaka Gen, Tanaka Yuichi, Naritaka Heiji
Department of Neurosurgery, Edogawa Hospital, Tokyo, Japan; Department of Neurosurgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of ENT Surgery, Sakura Hospital, Toho Medical Center, Chiba, Japan.
World Neurosurg. 2017 Jan;97:749.e11-749.e20. doi: 10.1016/j.wneu.2016.10.111. Epub 2016 Oct 27.
Neuronavigation based on preoperative magnetic resonance imaging has been developed as a useful tool to improve visibility of the surgical site in the operative field. Ultrasonography (US) monitoring has also been used as a reliable imaging technique, providing real-time information during neurosurgical operations. We combined the latest innovative imaging technique for detecting very low-flow components, Superb Microvascular Imaging (SMI), with US monitoring during brain tumor surgery.
Fifteen patients diagnosed with brain tumor (8 malignant and 7 benign) underwent neurosurgery with US monitoring using an Aplio 400/500 US system with the new SMI technique (imaging frequency, 10-12 MHz; frame rate, 28-31 Hz). Features of the SMI images in the gray scale mode include 1) visualization of low-velocity flow with minimal motion artifact, 2) high resolution of images, and 3) high frame rates. The tumors, tumor vessels, compressed and shifted healthy vessels, and cistern were clearly visualized on the SMI images in the gray scale mode, detailing the characteristics of healthy brain tissue (vertically penetrating, fine, straight vessels), glioblastoma (rounding, dilating, and bending vessels), low-grade glioma (fine and straight vessels), meningioma (many large and branching vessels), and lymphoma (less vascular, low echoic tumor) and demonstrating the tumor-defined border. We also performed biopsies under US monitoring with SMI.
We combined SMI technique with US monitoring during brain tumor surgery and observed healthy and tumor vessels. Further research is important for the development of a more precise and reliable neurosurgery.
基于术前磁共振成像的神经导航技术已发展成为一种有用的工具，可提高手术视野中手术部位的可视性。超声（US）监测也已被用作一种可靠的成像技术，在神经外科手术期间提供实时信息。我们在脑肿瘤手术中将用于检测极低血流成分的最新创新成像技术——超微血管成像（SMI）与US监测相结合。
15例被诊断为脑肿瘤的患者（8例恶性和7例良性）使用配备新SMI技术（成像频率，10 - 12 MHz；帧率，28 - 31 Hz）的Aplio 400/500 US系统在US监测下接受了神经外科手术。SMI图像在灰阶模式下的特征包括：1）以最小的运动伪影显示低速血流；2）图像具有高分辨率；3）高帧率。肿瘤、肿瘤血管、受压和移位的健康血管以及脑池在灰阶模式的SMI图像上清晰可见，详细显示了健康脑组织（垂直穿透、细小、笔直的血管）、胶质母细胞瘤（圆形、扩张和弯曲的血管）、低级别胶质瘤（细小和笔直的血管）、脑膜瘤（许多粗大且分支的血管）以及淋巴瘤（血管较少、低回声肿瘤）的特征，并显示了肿瘤界定边界。我们还在US监测下使用SMI进行了活检。
我们在脑肿瘤手术中将SMI技术与US监测相结合，观察了健康血管和肿瘤血管。进一步的研究对于开发更精确和可靠的神经外科手术很重要。
