National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, 100084, China.
Departments of Neurosurgery, Peking Union Medical College Hospital (East), Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China.
Biomech Model Mechanobiol. 2022 Aug;21(4):1133-1144. doi: 10.1007/s10237-022-01580-7. Epub 2022 Apr 27.
Tumor treating fields (TTFields) are a breakthrough in treating glioblastoma (GBM), whereas the intensity cannot be further enhanced, due to the limitation of scalp lesions. Skull remodeling (SR) surgery can elevate the treatment dose of TTFields in the intracranial foci. This study was aimed at exploring the characteristics of the skull modulated strategies toward TTFields augmentation. The simplified multiple-tissue-layer model (MTL) and realistic head (RH) model were reconstructed through finite element methods (FEM), to simulate the remodeling of the skull, which included skull drilling, thinning, and cranioplasty with PEEK, titanium, cerebrospinal fluid (CSF), connective tissue and autologous bone. Skull thinning could enhance the intensity of TTFields in the brain tumor, with a 10% of increase in average peritumoral intensity (API) by every 1 cm decrease in skull thickness. Cranioplasty with titanium accompanied the most enhancement of TTFields in the MTL model, but CSF was superior in TTFields enhancement when simulated in the RH model. Besides, API increased nonlinearly with the expansion of drilled burr holes. In comparison with the single drill replaced by titanium, nine burr holes could reach 96.98% of enhancement in API, but it could only reach 63.08% of enhancement under craniectomy of nine times skull defect area. Skull thinning and drilling could enhance API, which was correlated with the number and area of skull drilling. Cranioplasty with highly conductive material could also augment API, but might not provide clinical benefits as expected.
肿瘤治疗电场（TTFields）是治疗胶质母细胞瘤（GBM）的一项突破，然而由于头皮病变的限制，强度无法进一步提高。颅骨重塑（SR）手术可以提高颅内病灶 TTFields 的治疗剂量。本研究旨在探讨颅骨调制策略对 TTFields 增强的特点。通过有限元方法（FEM）重建简化的多层组织层模型（MTL）和真实头模型（RH），以模拟颅骨重塑，包括颅骨钻孔、颅骨变薄和用聚醚醚酮（PEEK）、钛、脑脊液（CSF）、结缔组织和自体骨进行颅骨修补。颅骨变薄可以增强脑肿瘤内 TTFields 的强度，颅骨厚度每减少 1cm，平均肿瘤周围强度（API）增加 10%。在 MTL 模型中，钛颅骨修补可增强 TTFields 的强度，但在 RH 模型中，CSF 增强 TTFields 的效果更好。此外，API 随钻头钻孔面积的扩大呈非线性增加。与单个钛钻头相比，九个钻头可使 API 增强 96.98%，但在九倍颅骨缺损面积的颅骨切除术下，仅能增强 63.08%。颅骨变薄和钻孔可以增强 API，这与颅骨钻孔的数量和面积有关。使用高导电性材料进行颅骨修补也可以增强 API，但可能不会像预期的那样提供临床益处。
