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Optical Touch Pointer for Fluorescence Guided Glioblastoma Resection Using 5-Aminolevulinic Acid
Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. (MINT)ORCID iD: 0000-0002-0555-8877
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL. Linköping University, The Institute of Technology. (MINT)
Linköping University, The Institute of Technology. (Department of Physics, Lund University)
Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology. (MINT)ORCID iD: 0000-0002-0012-7867
2010 (English)In: Lasers in Surgery and Medicine, ISSN 0196-8092, E-ISSN 1096-9101, Vol. 42, no 1, 9-14 p.Article in journal (Refereed) Published
Abstract [en]

Background and Objective

Total tumor resection in patients with glioblastoma multiforme (GBM) is difficult to achieve due to the tumor's infiltrative way of growing and morphological similarity to the surrounding functioning brain tissue. The diagnosis is usually subjectively performed using a surgical microscope. The objective of this study was to develop and evaluate a hand-held optical touch pointer using a fluorescence spectroscopy system to quantitatively distinguish healthy from malignant brain tissue intraoperatively.

Study Design/Materials and Methods

A fluorescence spectroscopy system with pulsed modulation was designed considering optimum energy delivery to the tissue, minimal photobleaching of PpIX and omission of the ambient light background in the operating room (OR). 5-Aminolevulinic acid (5-ALA) of 5 mg/kg body weight was given to the patients with a presumed GBM prior to surgery. During the surgery a laser pulse at 405 nm was delivered to the tissue. PpIX in glioblastoma tumor cells assigned with peaks at 635 and 704 nm was detected using a fiber optical probe.

Results/Conclusion

By using the pulsed fluorescence spectroscopy, PpIX fluorescence is quantitatively detected in the GBM. An effective suppression of low power lamp background from the recorded spectra in addition to a significant reduction of high power surgical lights is achieved.

Place, publisher, year, edition, pages
Wiley-Blackwell , 2010. Vol. 42, no 1, 9-14 p.
Keyword [en]
background light suppression • fluorescence spectroscopy • glioblastoma multiforme • intraoperative
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-53946DOI: 10.1002/lsm.20868OAI: oai:DiVA.org:liu-53946DiVA: diva2:293891
Available from: 2010-02-15 Created: 2010-02-15 Last updated: 2017-12-12Bibliographically 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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Haj-Hosseini, NedaRichter, JohanWårdell, Karin

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