Case report: High-resolution, intra-operative µDoppler-imaging of spinal cord hemangioblastoma

Frontiers in Surgery

Surgery

Pieter Kruizinga¹  Bastian S. Generowicz¹  Luuk Verhoef¹  Sebastiaan K. E. Koekkoek¹  Sadaf Soloukey²  Chris I. De Zeeuw³  Clemens M. F. Dirven⁴  Arnaud J. P. E. Vincent⁴  Biswadjiet S. Harhangi⁵ 

[1] Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands;Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands;Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands;Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands;Royal Dutch Academy for Arts and Sciences, Netherlands Institute for Neuroscience, Amsterdam, Netherlands;Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands;Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands;Department of Neurosurgery, Park MC, Rotterdam, Netherlands;

关键词: µDoppler;    hemangioblastoma;    intramedullary tumor;    functional ultrasound;    spinal cord;    case report;   

DOI  :  10.3389/fsurg.2023.1153605

 received in 2023-01-29, accepted in 2023-05-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

Surgical resection of spinal cord hemangioblastomas remains a challenging endeavor: the neurosurgeon’s aim to reach total tumor resections directly endangers their aim to minimize post-operative neurological deficits. The currently available tools to guide the neurosurgeon’s intra-operative decision-making consist mostly of pre-operative imaging techniques such as MRI or MRA, which cannot cater to intra-operative changes in field of view. For a while now, spinal cord surgeons have adopted ultrasound and its submodalities such as Doppler and CEUS as intra-operative techniques, given their many benefits such as real-time feedback, mobility and ease of use. However, for highly vascularized lesions such as hemangioblastomas, which contain up to capillary-level microvasculature, having access to higher-resolution intra-operative vascular imaging could potentially be highly beneficial. µDoppler-imaging is a new imaging modality especially fit for high-resolution hemodynamic imaging. Over the last decade, µDoppler-imaging has emerged as a high-resolution, contrast-free sonography-based technique which relies on High-Frame-Rate (HFR)-ultrasound and subsequent Doppler processing. In contrast to conventional millimeter-scale (Doppler) ultrasound, the µDoppler technique has a higher sensitivity to detect slow flow in the entire field-of-view which allows for unprecedented visualization of blood flow down to sub-millimeter resolution. In contrast to CEUS, µDoppler is able to image high-resolution details continuously, without being contrast bolus-dependent. Previously, our team has demonstrated the use of this technique in the context of functional brain mapping during awake brain tumor resections and surgical resections of cerebral arteriovenous malformations (AVM). However, the application of µDoppler-imaging in the context of the spinal cord has remained restricted to a handful of mostly pre-clinical animal studies. Here we describe the first application of µDoppler-imaging in the case of a patient with two thoracic spinal hemangioblastomas. We demonstrate how µDoppler is able to identify intra-operatively and with high-resolution, hemodynamic features of the lesion. In contrast to pre-operative MRA, µDoppler could identify intralesional vascular details, in real-time during the surgical procedure. Additionally, we show highly detailed post-resection images of physiological human spinal cord anatomy. Finally, we discuss the necessary future steps to push µDoppler to reach actual clinical maturity.

【 授权许可】

Unknown   
© 2023 Soloukey, Verhoef, Generowicz, De Zeeuw, Koekkoek, Vincent, Dirven, Harhangi and Kruizinga.