Mapping Resection Progress by Tool-Tip Tracking during Brain Tumor Surgery for Real-Time Estimation of Residual Tumor
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Preoperative Planning
2.3. Neuronavigation and Instrument Tracking
2.4. Data Collection and Visualization of Resection Progress
2.5. Intraoperative Imaging
2.6. Postoperative Data Analysis
2.7. Additional Clinical Descriptors and Metadata
3. Results
3.1. Distribution of Clinical and Surgical Descriptors
3.2. Qualitative Results
3.2.1. Case 7
3.2.2. Case 31
3.3. Quantitative Results
4. Discussion
4.1. System Compatibility and Generalizability
4.2. Line-of-Sight
4.3. Choice of Tracked Surgical Instrument
4.4. Instrument Tracking Arrays
4.5. User Interface
4.6. Brain Shift
4.7. Extrapolation to Other Pathologies and Subspecialties
4.8. Neurosurgical Education
4.9. Alternative to iMRI
4.10. Advancements from Prior Studies
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Case ID | Preoperative Tumor Volume (cm3) | Residual Tumor Volume (cm3) | Tumor Resected Based on iMRI (%) | Tumor Resected Based on Tool-Tip Tracking (%) | False Positive Tracking (%) |
---|---|---|---|---|---|
1 | 33.5 | 14.7 | 56.1 | 46.5 | 3.5 |
2 | 36.8 | 3.1 | 91.6 | 60.1 | 16.6 |
3 | 13.0 | 4.4 | 65.7 | 63.7 | 6.25 |
4 | 38.1 | 0.3 | 99.3 | 57.6 | 3.1 |
5 | 6.3 | 2.5 | 60.0 | 50.1 | 14.6 |
6 | 6.5 | 3.7 | 42.6 | 46.2 | 5.8 |
7 | 35.3 | 12.3 | 65.1 | 50.8 | 7.3 |
8 | 1.8 | 0.0 | 100.0 | 40.25 | 0 |
9 | 4.9 | 0.0 | 100.0 | 15.22 | 0 |
10 | 8.6 | 5.1 | 40.2 | 66.5 | 6.3 |
11 | 6.3 | 0.2 | 97.3 | 72.5 | 4.4 |
12 | 28.9 | 3.8 | 86.7 | 55.4 | 12.6 |
13 | 8.7 | 2.5 | 71.1 | 52.1 | 1.5 |
14 | 28.9 | 2.9 | 89.9 | 41.5 | 10.3 |
15 | 16.4 | 2.8 | 82.8 | 62.3 | 30.4 |
16 | 48.1 | 8.6 | 82.1 | 60.4 | 7.7 |
17 | 9.4 | 3.2 | 66.3 | 83.5 | 47.9 |
18 | 86.2 | 2.4 | 97.2 | 72.8 | 42.9 |
19 | 10.5 | 0.4 | 96.1 | 69.5 | 10.1 |
20 | 38.0 | 4.5 | 88.1 | 64.2 | 33.2 |
21 | 11.9 | 6.0 | 50.0 | 68.6 | 37.9 |
22 | 0.8 | 0.0 | 100.0 | 99.7 | 0 |
23 | 0.8 | 0.0 | 100.0 | 44.7 | 0 |
24 | 0.1 | 0.0 | 100.0 | 98 | 0 |
25 | 35.5 | 0.0 | 100.0 | 78.4 | 0 |
26 | 19.7 | 0.0 | 100.0 | 85.3 | 0 |
27 | 30.3 | 0.6 | 97.9 | 67.7 | 17.5 |
28 | 16.4 | 9.4 | 42.9 | 56.3 | 6.8 |
29 | 7.7 | 0.3 | 96.0 | 55.6 | 38.7 |
30 | 40.9 | 6.4 | 84.4 | 50.3 | 10.9 |
31 | 14.7 | 3.7 | 75.1 | 75.2 | 3.9 |
32 | 57.9 | 2.0 | 96.5 | 69 | 40.4 |
33 | 20.4 | 9.7 | 52.6 | 58.3 | 13.5 |
34 | 4.7 | 0.0 | 100.0 | 69.8 | 0 |
35 | 37.0 | 1.1 | 97.0 | 41.3 | 1.5 |
36 | 18.4 | 10.1 | 45.0 | 56.5 | 13.5 |
37 | 9.9 | 0.0 | 100.0 | 71.2 | 0 |
38 | 19.8 | 18.2 | 7.7 | 45.7 | 7 |
39 | 17.5 | 5.3 | 69.9 | 78 | 14.8 |
40 | 8.2 | 0.0 | 100.0 | 53.1 | 0 |
41 | 11.8 | 5.3 | 55.0 | 76.4 | 29 |
42 | 23.5 | 7.5 | 68.1 | 84.5 | 13 |
43 | 27.2 | 4.5 | 83.6 | 64.4 | 21.1 |
44 | 42.8 | 0.0 | 100.0 | 44.7 | 0 |
Case ID | Age/Sex | Race | Laterality, Anatomic Compartments | Eloquence | Cystic | Enhancing | Non-enhancing | Ventricle Opened? | Cistern Opened? | Brain Shift | GTR | Residual Location | Pathology | WHO Grade | MIB-1 Index | MGMT Promoter | IDH Mutation | 1p/19q Status | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 43/F | White | R | Temporal, Mesial Temporal, Thalamic | Yes | No | No | Yes | Yes | Yes | Yes | No | Thalamus | Glioblastoma | 4 | 5.46% | Methylated | - | Retained |
2 | 26/M | White | L | Frontal, Insular, Temporal | Yes | No | No | Yes | No | No | Yes | No | Superior, Frontal | Anaplastic Astrocytoma | 3 | 5% | Partially Methylated | + | Retained |
3 | 38/M | White | R | Insular | No | No | No | Yes | No | Yes | Yes | No | Anterior, Posterior | Diffuse Astrocytoma | 2 | 2% | Unmethylated | + | Retained |
4 | 62/M | White | R | Frontal, Insular, Temporal | Yes | Yes | Yes | No | No | Yes | Yes | Yes | None | Glioblastoma | 4 | Unmethylated | - | Retained | |
5 | 42/M | White | R | Frontal, Insular, Temporal | Yes | No | No | Yes | No | No | No | No | Medial, Anterior, Superior | Oligodendroglioma | 2 | 1% | Methylated | + | Co-deleted |
6 | 52/F | White | L | Frontal, SMA | Yes | No | No | Yes | No | No | No | No | Anterior, Lateral, Inferior, Posterior | Glioblastoma | 4 | >80% | Unmethylated | - | Pending |
7 | 28/M | White | L | Mesial Temporal | Yes | No | No | Yes | Yes | No | No | No | Superior, Posterior, Medial, Anterior | Anaplastic Astrocytoma | 3 | 10% | Methylated | + | Retained |
8 | 45/F | White | R | Frontal, Parietal | Yes | Yes | No | Yes | No | No | Yes | Yes | None | Oligodendroglioma | 2 | 0.68% | Methylated | + | Co-deleted |
9 | 58/M | White | B | Multifocal (Frontal, Parietal, Occipital) | Yes | Yes | Yes | No | No | No | Yes | No | Right Basal Frontal, Right Frontal, Right Occipital | Metastatic Carcinoma from Lung Primary | |||||
10 | 49/F | White | B | Frontal | No | Yes | Yes | No | Yes | No | Yes | No | Anterior, Medial | Anaplastic Oligodendroglioma | 3 | 3.70% | Unknown | + | Co-deleted |
11 | 33/F | White | L | Parietal | No | Yes | Yes | Yes | Yes | No | Yes | Yes | None | Low-grade Glioma | 7% | Methylated | - | Retained | |
12 | 59/F | White | L | Temporal, Mesial Temporal, Thalamic | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Medial, Posterior | Glioblastoma | 4 | Unmethylated | - | Retained | |
13 | 61/F | White | L | Temporal, Mesial Temporal, Capsular | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Temporal, Internal Capsule | Glioblastoma | 4 | 30% | Unmethylated | - | Retained |
14 | 24/M | White | L | Temporal, Insular | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Medial, Lateral, Posterior, Inferior | Low-grade Glioma/Glioneural Tumor | 2 | 10% | - | Retained | |
15 | 64/F | White | R | Frontal, Parietal | Yes | Yes | No | Yes | No | No | Yes | No | Anterior, Medial, Inferior | Anaplastic Oligodendroglioma | 3 | 30% | Methylated | + | Co-deleted |
16 | 25/M | White | R | Frontal, Insular, Temporal | Yes | No | Yes | Yes | Yes | Yes | Yes | No | Insula, Amygdala, Frontal | Glioblastoma | 4 | 15% | Unmethylated | + | Retained |
17 | 53/F | White | L | Frontal, SMA | Yes | No | No | Yes | No | No | No | No | Posterior, Lateral, Inferior, Anterior | Glioblastoma | 4 | >80% | Unmethylated | - | Retained |
18 | 51/M | White | L | Frontal, Temporal | Yes | No | Yes | Yes | No | Yes | Yes | No | Frontal Operculum | Anaplastic Oligodendroglioma | 3 | Methylated | + | Co-deleted | |
19 | 30/M | Asian | L | Temporal | Yes | No | No | Yes | No | No | Yes | Yes | None | Oligodendroglioma | 2 | 10% | Methylated | + | Co-deleted |
20 | 52/F | White | R | Frontal, Temporal | Yes | Yes | Yes | No | Yes | Yes | No | Yes | None | Metastatic Breast Carcinoma | |||||
21 | 36/F | White | R | Occipital | Yes | No | No | Yes | No | No | No | No | Lateral | Oligodendroglioma | 2 | 4% | Methylated | + | Co-deleted |
22 | 61/M | White | R | Frontal, SMA | Yes | No | Yes | Yes | No | No | No | No | Lateral | Anaplastic Oligodendroglioma | 3 | <2% | Methylated | + | Co-deleted |
23 | 40/M | White | L | Frontal | No | No | Yes | Yes | No | No | No | Yes | None | Astrocytoma | 4 | <3% | Methylated | + | Retained |
24 | 43/F | White | R | Temporal | No | No | Yes | No | No | No | No | No | Medial | Abnormally Thickened Blood Vessels and Chronic Inflammatory Infiltrate | |||||
25, 26 | 72/M | White | R | Temporal | No | No | Yes | Yes | No | No | No | No | Anterior | Glioblastoma | 4 | Methylated | - | Retained | |
27 | 63/F | White | R | Frontal | Yes | Yes | Yes | Yes | No | No | Yes | No | Posterior, Medial | Anaplastic Oligodendroglioma | 3 | 16% | Methylated | + | Co-deleted |
28 | 50/M | White | L | Temporal, Mesial Temporal, Insular | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Insula | Glioblastoma | 4 | Unmethylated | - | Retained | |
29 | 70/M | White | L | Frontal | No | No | Yes | No | No | No | Yes | No | Posterior | Metastatic Melanoma | |||||
30 | 46/F | White | R | Thalamus, Caudate | Yes | No | No | Yes | Yes | No | Yes | No | Inferolateral Thalamus | Glioblastoma | 4 | 5% | Methylated | - | |
31 | 45/M | White | L | Frontal, Insular, Temporal, Mesial Temporal | Yes | No | No | Yes | Yes | Yes | Yes | No | Temporal, Insula | Astrocytoma | 3 | 2% | Unmethylated | + | Retained |
32 | 24/F | Asian | R | Frontal, SMA | Yes | Yes | Yes | Yes | No | No | Yes | No | Posterior, Inferior | Astrocytoma | 4 | Methylated | + | Retained | |
33 | 26/F | Declined | R | Temporal, Insular | Yes | Yes | No | Yes | Yes | No | Yes | No | Insula, Temporal | Oligodendroglioma | 2 | 2% | Partially Methylated | + | Co-deleted |
34 | 31/F | White | L | Frontal | No | No | No | Yes | No | No | No | No | Left Frontal Medial and Inferior | Astrocytoma | 3 | 15% | Partially Methylated | + | Retained |
35 | 66/F | White | L | Frontal, Temporal | No | No | Yes | No | Yes | No | Yes | Yes | None | Metastatic Poorly Differentiated Carcinoma | |||||
36 | 62/M | White | L | Temporal, Mesial Temporal | Yes | No | No | Yes | Yes | Yes | Yes | No | Temporal, Amygdala, Hippocampus, Insula | Diffuse Glioma | >2 | 2-3% | Partially Methylated | - | Retained |
37 | 32/F | African American | L | Parietal | Yes | No | No | Yes | No | No | No | Yes | None | Astrocytoma | 2 | 2% | Methylated | + | Retained |
38 | 69/M | White | L | Frontal, Insular, Mesial Temporal | Yes | No | Yes | Yes | No | Yes | Yes | No | Amygdala, Anterior and Posterior insula | Glioblastoma | 4 | Methylated | - | Retained | |
39 | 66/F | White | R | Frontal, SMA | Yes | No | Yes | No | No | No | No | No | Anterior, Medial, Posterior, Inferior | Glioblastoma | 4 | >50% | Unmethylated | - | Retained |
40 | 43/M | Asian | R | Frontal, Insular, Temporal | Yes | No | No | Yes | No | No | No | Yes | None | Astrocytoma | 2 | 3% | Methylated | + | Retained |
41 | 60/M | White | L | Frontal | No | Yes | Yes | No | No | No | Yes | Yes | None | Metastatic Melanoma | |||||
42 | 30/M | White | R | Temporal, Insular | Yes | No | Yes | Yes | Yes | Yes | No | No | Posterior, Anterior | Astrocytoma | 2 | 5-10% | Unmethylated | + | Retained |
43 | 42/F | White | L | Frontal, Insular, Temporal | Yes | No | No | Yes | Yes | Yes | Yes | No | Small Segment of Anterior Superior Insular Gyrus, Segment of the Posterior Insula and the Posterior Superior Temporal Segment of the tumor | Oligodendroglioma | 2 | 5% | Methylated | + | |
44 | 70/M | White | L | Parietal, Temporal | Yes | Yes | Yes | No | No | No | Yes | No | Posterior, Inferior | Metastatic Gastrointestinal Stromal Tumor |
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Variables | Median [IQR], Mean ± SD, % (n) |
---|---|
Demographics | |
Age | 46 [31–61] |
Sex | |
Female | 47.6% (20) |
Male | 52.4% (22) |
Race | |
White | 88.1% (37) |
Asian | 7.1% (3) |
African American | 2.4% (1) |
Pathology | |
Gliomas | 84% (35) |
Glioblastoma | 26.4% (11) |
Astrocytoma | 19.2% (8) |
Oligodendroglioma | 14.4% (6) |
Anaplastic Oligodendroglioma | 12.0% (5) |
Anaplastic Astrocytoma | 4.8% (2) |
Others | 7.2% (3) |
Metastases | 14.4% (6) |
Other | 2.4% (1) |
Variables | Median [IQR], Mean ± SD, % (n) |
---|---|
Preoperative MRI | |
Laterality | |
Left | 50.0% (22) |
Right | 45.5% (20) |
Bilateral | 4.5% (2) |
Previous cranial surgery | |
Yes | 65.9% (29) |
No | 34.1% (15) |
Resection cavity | |
Yes | 40.9% (18) |
No | 59.1% (26) |
Anatomic compartments | |
Frontal | 56.8% (25) |
Temporal | 52.3% (23) |
Insular | 27.3% (12) |
Limbic | 20.5% (9) |
Parietal | 13.6% (6) |
Occipital | 4.5% (2) |
Basal ganglia | 4.5% (2) |
Components | |
Cystic | 36.4% (16) |
Enhancing | 56.8% (25) |
Non-enhancing | 77.3% (34) |
Eloquence | |
Yes | 63.6% (28) |
No | 36.4% (16) |
Intraoperative findings and iMRI | |
Opening of ventricle | |
Yes | 38.6% (17) |
No | 61.4% (27) |
Opening of basal cisterns | |
Yes | 34.1% (15) |
No | 65.9% (29) |
Brain shift | |
Yes | 63.6% (28) |
No | 36.4% (16) |
Gross total resection | |
Yes | 22.7% (10) |
No | 77.3% (34) |
Preoperative Tumor Volume (cm3) | Residual Tumor Volume (cm3) | Tumor Resected Based on iMRI (%) | Tumor Resected Based on Tool-Tip Tracking (%) | False Positive Tracking (%) | |
---|---|---|---|---|---|
Mean | 21.1 | 3.9 | 79.1 | 61.5 | 16.2 |
Median | 16.4 | 2.9 | 86.7 | 60.4 | 12.6 |
Minimum | 0.1 | 0.0 | 7.7 | 15.2 | 1.5 |
Maximum | 86.2 | 18.2 | 100.0 | 99.7 | 47.9 |
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Share and Cite
Juvekar, P.; Torio, E.; Bi, W.L.; Bastos, D.C.D.A.; Golby, A.J.; Frisken, S.F. Mapping Resection Progress by Tool-Tip Tracking during Brain Tumor Surgery for Real-Time Estimation of Residual Tumor. Cancers 2023, 15, 825. https://doi.org/10.3390/cancers15030825
Juvekar P, Torio E, Bi WL, Bastos DCDA, Golby AJ, Frisken SF. Mapping Resection Progress by Tool-Tip Tracking during Brain Tumor Surgery for Real-Time Estimation of Residual Tumor. Cancers. 2023; 15(3):825. https://doi.org/10.3390/cancers15030825
Chicago/Turabian StyleJuvekar, Parikshit, Erickson Torio, Wenya Linda Bi, Dhiego Chaves De Almeida Bastos, Alexandra J. Golby, and Sarah F. Frisken. 2023. "Mapping Resection Progress by Tool-Tip Tracking during Brain Tumor Surgery for Real-Time Estimation of Residual Tumor" Cancers 15, no. 3: 825. https://doi.org/10.3390/cancers15030825