Massimiliano Del Bene1,2, Luca Raspagliesi3, Giovanni Carone3, Paola Gaviani4, Antonio Silvani4, Luigi Solbiati5,6, Francesco Prada3,7,8, Francesco DiMeco3,9,10. 1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. massimiliano.delbene@istituto-besta.it. 2. Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy. massimiliano.delbene@istituto-besta.it. 3. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. 4. Neuro-Oncological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 5. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. 6. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. 7. Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA. 8. Focused Ultrasound Foundation, Charlottesville, VA, USA. 9. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. 10. Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA.
Abstract
INTRODUCTION: Ultrasound (US) is a versatile technology, able to provide a real-time and multiparametric intraoperative imaging, and a promising way to treat neuro-oncological patients outside the operating room. Anyhow, its potential is limited both in imaging and therapeutic purposes by the existence of the bone shielding. To enhance the spectrum of uses, our group has designed a dedicated US-translucent cranial prosthesis. Herein, we provide the proof of concept of a long-term US-based follow-up and a potential bedside therapeutic exploitation of US. METHODS: The prosthesis was first implanted in a cadaveric specimen to record any issue related to the cranioplasty procedure. Hence, the device was implanted in a patient undergoing surgery for a multi-recurrent anaplastic oligodendroglioma. US multiparametric scans through the device were acquired at 3, 6, 9, and 30 months after the procedure. RESULTS: The prosthesis could be modeled and implanted through ordinary instruments, with no concerns over safety and feasibility. Trans-prosthesis multiparametric US imaging was feasible, with image quality comparable to intraoperative US. Long-term follow-up in an outpatient setting was possible with no adverse events. Trans-prosthesis mechanical interaction with microbubbles was also feasible during follow-up. CONCLUSIONS: This report provides the first proof of concept for a potential breakthrough in the management of neuro-oncological patients. Indeed, through the implantation of an artificial acoustic window, the road is set to employ US both for a more dynamic long-term follow-up, and for US-guided therapeutic applications.
INTRODUCTION: Ultrasound (US) is a versatile technology, able to provide a real-time and multiparametric intraoperative imaging, and a promising way to treat neuro-oncological patients outside the operating room. Anyhow, its potential is limited both in imaging and therapeutic purposes by the existence of the bone shielding. To enhance the spectrum of uses, our group has designed a dedicated US-translucent cranial prosthesis. Herein, we provide the proof of concept of a long-term US-based follow-up and a potential bedside therapeutic exploitation of US. METHODS: The prosthesis was first implanted in a cadaveric specimen to record any issue related to the cranioplasty procedure. Hence, the device was implanted in a patient undergoing surgery for a multi-recurrent anaplastic oligodendroglioma. US multiparametric scans through the device were acquired at 3, 6, 9, and 30 months after the procedure. RESULTS: The prosthesis could be modeled and implanted through ordinary instruments, with no concerns over safety and feasibility. Trans-prosthesis multiparametric US imaging was feasible, with image quality comparable to intraoperative US. Long-term follow-up in an outpatient setting was possible with no adverse events. Trans-prosthesis mechanical interaction with microbubbles was also feasible during follow-up. CONCLUSIONS: This report provides the first proof of concept for a potential breakthrough in the management of neuro-oncological patients. Indeed, through the implantation of an artificial acoustic window, the road is set to employ US both for a more dynamic long-term follow-up, and for US-guided therapeutic applications.
Authors: Jan Coburger; Angelika Scheuerle; Thomas Kapapa; Jens Engelke; Dietmar Rudolf Thal; Christian R Wirtz; Ralph König Journal: Neurosurg Rev Date: 2015-04-10 Impact factor: 3.042
Authors: Jan Coburger; Ralph W König; Angelika Scheuerle; Jens Engelke; Michal Hlavac; Dietmar R Thal; Christian Rainer Wirtz Journal: World Neurosurg Date: 2014-05-27 Impact factor: 2.104
Authors: Francesco Prada; Massimiliano Del Bene; Alessandro Moiraghi; Cecilia Casali; Federico Giuseppe Legnani; Andrea Saladino; Alessandro Perin; Ignazio Gaspare Vetrano; Luca Mattei; Carla Richetta; Marco Saini; Francesco DiMeco Journal: Biomed Res Int Date: 2015-05-25 Impact factor: 3.411