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Intraoperative image-directed dye marking of tumor margins
1Department of Neurosurgery, Rikshospitalet, University of Oslo, Norway.
Abstract:
The incorporation of interactive image guidance during intracranial tumor surgery offers the possibilities of reduced operative trauma, shorter operation time, greater precision, and an increased understanding of complex anatomy and pathology. A basic weakness with these systems though is that they cannot account for movement of target points due to brain shift by draining of CSF or removal of pathology during the operative procedure. We have developed a stereotactic (frameless) guided injector probe for marking the tumor boundary with dye injection in conjunction with a neuronavigation system. The device consisted of a rigid blunt hollow probe (2 mm dia.) with 4 small side holes at the tip. The catheter is mounted in a holder equipped with 3 LEDs supplying guidance information for the neuronavigation system. A small manual aliquoting pump delivers a measured amount of dye in each track. Isotonic methylene blue was injected in 6 to 8 tracks around the periphery of the tumor as determined by the contract ring in MR scans. The dye was injected using image-directed guidance before resection of the tumor was started (often with the dura intact). Tumor tissue could then be resected until the dye became visible at the tumor boundary. Identification of the dye in the tissue was enhanced with the use of the operating microscope. The 3-dimensional position of the dye track could be determined at the end of tumor resection and compared with its initial position giving a good estimate of local brain shift. The method has proved especially helpful for the resection of large gliomas allowing for a more radical operative result.
Insights
This study introduces a novel image-guided injector probe for intracranial tumor surgery. The system effectively marks tumor boundaries with dye, improving resection accuracy and addressing brain shift challenges.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Technology
Background:
- Interactive image guidance in intracranial tumor surgery offers benefits like reduced trauma and increased precision.
- A key limitation of current systems is their inability to compensate for brain shift caused by cerebrospinal fluid drainage or tumor removal.
- Brain shift can lead to inaccurate targeting and suboptimal tumor resection.
Purpose of the Study:
- To develop and evaluate a stereotactic (frameless) guided injector probe for marking intracranial tumor boundaries.
- To integrate this probe with a neuronavigation system for enhanced surgical precision.
- To assess the system's ability to account for brain shift during tumor resection.
Main Methods:
- A rigid, blunt, hollow probe (2 mm diameter) with side holes was developed.
- The probe was equipped with LEDs for neuronavigation system guidance and connected to a manual pump for dye injection.
- Isotonic methylene blue was injected into 6-8 tracks around the tumor periphery, guided by MR imaging, before resection.
Main Results:
- The dye injection system, used with neuronavigation, allowed for precise tumor boundary marking.
- Resection proceeded until the dye became visible, with identification enhanced by the operating microscope.
- The 3D position of dye tracks was compared pre- and post-resection, providing an estimate of local brain shift.
- The method proved particularly beneficial for resecting large gliomas, enabling more radical tumor removal.
Conclusions:
- The developed stereotactic guided injector probe effectively marks tumor boundaries during intracranial surgery.
- This technique addresses the challenge of brain shift, improving surgical precision and enabling more complete tumor resection.
- The system shows significant promise for enhancing outcomes in the surgical treatment of large gliomas.
