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Evaluation of a Fiber-Optic Fluorescence Spectroscopy System to Assist Neurosurgical Tumor Resections
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. (MINT)
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
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2007 (English)In: Novel Optical Instrumentation for Biomedical Applications III (Proceedings Volume) / [ed] Christian D. Depeursinge, Bellingham, Washington, USA: SPIE - International Society for Optical Engineering, 2007, Vol. 6631, 66310W-1-66310W-8 p.Conference paper, Published paper (Other academic)
Abstract [en]

The highly malignant brain tumor, glioblastoma multiforme, is difficult to totally resect without aid due to its infiltrative way of growing and its morphological similarities to surrounding functioning brain under direct vision in the operating field. The need for an inexpensive and robust real-time visualizing system for resection guiding in neurosurgery has been formulated by research groups all over the world. The main goal is to develop a system that helps the neurosurgeon to make decisions during the surgical procedure. A compact fiber optic system using fluorescence spectroscopy has been developed for guiding neurosurgical resections. The system is based on a high power light emitting diode at 395 nm and a spectrometer. A fiber bundle arrangement is used to guide the excitation light and fluorescence light between the instrument and the tissue target. The system is controlled through a computer interface and software package especially developed for the application. This robust and simple instrument has been evaluated in vivo both on healthy skin but also during a neurosurgical resection procedure. Before surgery the patient received orally a low dose of 5-aminolevulinic acid, converted to the fluorescence tumor marker protoporphyrin IX in the malignant cells. Preliminary results indicate that PpIX fluorescence and brain tissue autofluorescence can be recorded with the help of the developed system intraoperatively during resection of glioblastoma multiforme.

Place, publisher, year, edition, pages
Bellingham, Washington, USA: SPIE - International Society for Optical Engineering, 2007. Vol. 6631, 66310W-1-66310W-8 p.
Series
Proceedings of SPIE - International Society for Optical Engineering, ISSN 0277-786X ; Vol. 6631
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-38407DOI: 10.1117/12.728546Local ID: 44225ISBN: 9780819467751 (print)OAI: oai:DiVA.org:liu-38407DiVA: diva2:259256
Conference
Novel optical instrumentation for biomedical applications III : 17-19 June 2007, Munich, Germany
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-08-16Bibliographically approved
In thesis
1. Fluorescence Guided Resection of Brain Tumors: Evaluation of a Hand-held Spectroscopic Probe
Open this publication in new window or tab >>Fluorescence Guided Resection of Brain Tumors: Evaluation of a Hand-held Spectroscopic Probe
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Malignant gliomas grow infiltrative in the brain and can therefore not be completely removed by neurosurgical means. However, for an optimized oncological treatment it has proven useful to resect as much as possible of tumor. The identification of the tumor in the marginal zone is difficult but crucial. Studies have shown that visualization of the specific enhancement of 5-aminolevulinic acid(5-ALA) in the tumor can help to maximize the resection. The Department of Biomedical Engineering, Linköping University, has developed an optical hand-held probe (HHP) to identify tumor tissue with a high sensitivity by means of fluorescence spectroscopy.

The technical design and the optical properties of the probe were gradually developed in a standard neurosurgical setting during resection of malignant gliomas. The device could easily be implemented in the operating room, meeting all requirements in terms of sterile handling and without interference of any kind with other equipment. The integration of the device in a navigation system and its use in combination with a blue light surgical microscope were simple. Measurements in 27 operations during resection of malignant gliomas were compared to results from biopsies from the same tumor locations. The equipment was tested as a stand-alone device (n = 180), integrated in a navigation system or in combination with the blue light microscope (n = 190). A ratiocal culated from the measurements enabled objective and comparable values for different tissue types, in correspondence with the findings from the histopathological examinations and in accordance with the navigation system as well as with the surgical microscope.The marginal zone was explored and tumor fluorescence could be identified beyond the fluorescence as seen through the microscope. A higher sensitivity of the HHP was confirmed; the specificity was lower.

The combined use of the HHP with a navigation system and with asurgical microscope was beneficial.

Abstract [sv]

Maligna hjärntumörer växer infiltrerande i hjärnan och kan därförinte helt avlägsnas genom kirurgiska operationer. För en optimerad behandling har det emellertid visat sig vara av värde att avlägsna såmycket som möjligt av tumörvävnaden. Identifiering av tumören i gränszonen är mycket svårt, men avgörande. Studier har visat att visualisering av den specifika laddningen av 5-aminolevulinsyra (5-ALA) i tumören kan bidra till att maximera resektionen. Institutionen för Medicinsk Teknik (IMT) på Linköpings universitet,har utvecklat en liten handhållen optisk prob (HHP) för att identifiera tumörvävnad med hög känslighet med hjälp avfluorescens-spektroskopi.

Den tekniska konstruktionen och de optiska egenskaperna hos proben utvecklades stegvis genom testning i flera neurokirurgiska operationer för resektion av maligna gliom. Utrustningen uppfyllde alla krav när det gällde steril hantering i operationssalen och kunde användas utan störningar av något slag med annan operationsutrustning. Integreringen i ett navigerings-system och användningen i kombination med ett kirurgiskt mikroskop för fluorescens-styrd kirurgi var oproblematiska. Mätningar under 27 operationer vid resektion av maligna gliom jämfördes med resultat från biopsier från samma tumörtagningsställen. Utrustningen testades såväl som en fristående enhet (n = 180) och som integrerad i ett navigationssystem eller i kombination med mikroskopet (n =190). En särskild kvot beräknad ur mätningarna möjliggjorde objektiva och jämförbara värden för olika vävnader, i överensstämmelse med resultaten från de vävnadspatologiska undersökningarna och i överensstämmelse med navigationssystemet såväl som med det kirurgiska mikroskopet.

Tumörernas gränszon undersöktes och tumörfluorescens kunde identifieras bortom fluorescensen som mikroskopet visade. En högre känslighet hos HHP bekräftades; specificiteten var lägre. Den kombinerade användningen av HHP med ett navigationssystem och med ett kirurgiskt mikroskop visade sig vara fördelaktig.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 77 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1581
National Category
Surgery Neurosciences Medical Laboratory and Measurements Technologies Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-139793 (URN)10.3384/diss.diva-139793 (DOI)978-91-7685-475-4 (ISBN)
Public defence
2017-09-01, Hugo Theorell, ingång 7, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2017-08-21Bibliographically approved

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Ilias, MichailRichter, JohanWestermark, FridaBrantmark, MartinWårdell, Karin

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