Simulations and human cadaver head studies to identify optimal acoustic receiver locations for minimally invasive photoacoustic-guided neurosurgery
Simulations and human cadaver head studies to identify optimal acoustic receiver locations for minimally invasive photoacoustic-guided neurosurgery
复制标题
模拟和人体尸体头部研究，以确定微创光声引导神经外科手术的最佳声学接收器位置
DOI：
10.1016/j.pacs.2020.100183
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发表时间：
2020
期刊：
影响因子：
7.9
通讯作者：
Lediju Bell, Muyinatu A.
中科院分区：
文献类型：
--
作者：
Graham, Michelle T.;Huang, Jiaqi;Creighton, Francis X.;Lediju Bell, Muyinatu A.
微创神经外科手术过程中的实时术中指导（例如，鼻内经蝶手术）通常限于内窥镜检查和CT引导的图像导航，这在定位下面的血管和神经方面可能是次优的。对这些关键结构的意外损坏可能会导致严重的手术并发症，包括患者失明和死亡。光声图像引导先前被提出作为防止意外伤害的方法。虽然所提出的技术仍然很有前途，但该技术的原始光传输和声音接收组件需要改变，以使该技术适合患者使用。本文介绍了模拟和实验研究进行了一个完整的人类头骨（这是从组织附件清洁）和一个完整的人的尸体头部（内容物和周围组织完好），以调查最佳位置的超声探头放置在光声成像过程中，并测试的可行性修改的光传输设计。人体颅骨的体积X射线CT图像用于创建该颅骨环境内声波传播的k波模拟。使用同一颅骨进行颈内动脉（伊卡）的光声成像。将发射750 nm光的光纤插入鼻腔中用于伊卡照明。将超声探头放置在通过模拟识别的三个最佳区域上：（1）鼻腔，（2）眼部区域，和（3）Imm厚的颞骨（在模拟中，其分别接收初始光声压的9.2%、4.7%和3.8%）。对于这三个探头位置，伊卡在比较实验光声图像中的对比度分别为27 dB、19 dB和12 dB，分别具有3 mJ、5 mJ和4.2 mJ的延迟求和（DAS）波束成形和激光脉冲能量。短滞后空间相干（SLSC）波束形成将这些DAS图像的对比度提高了15 dB，使单个图像中的多个横截面伊卡视图可视化，并使低激光能量的使用成为可能。空颅骨和厚度大于1 mm的颞骨的模拟和实验结果表明，眼部和鼻部区域是比颞部超声探头位置更佳的探头位置。来自填充有羊脑和眼睛的相同头骨以及人类尸体头部的结果验证了眼部区域作为我们当前系统设置的最佳声学窗口，产生高对比度（即，高达35dB）DAS和SLSC光声图像，其在独立于手术工具的新颖、紧凑的光传输系统设计的激光安全极限内（即，具有6.8mm外径、2mm直径光学孔径以及蝶骨和光纤尖端之间的气隙间隔的光纤束）。这些结果对于识别、量化和克服主要的系统设计障碍以继续进行未来的患者测试是有希望的。
Real-time intraoperative guidance during minimally invasive neurosurgical procedures (e.g., endonasal transsphenoidal surgery) is often limited to endoscopy and CT-guided image navigation, which can be suboptimal at locating underlying blood vessels and nerves. Accidental damage to these critical structures can have severe surgical complications, including patient blindness and death. Photoacoustic image guidance was previously proposed as a method to prevent accidental injury. While the proposed technique remains promising, the original light delivery and sound reception components of this technology require alterations to make the technique suitable for patient use. This paper presents simulation and experimental studies performed with both an intact human skull (which was cleaned from tissue attachments) and a complete human cadaver head (with contents and surrounding tissue intact) in order to investigate optimal locations for ultrasound probe placement during photoacoustic imaging and to test the feasibility of a modified light delivery design. Volumetric x-ray CT images of the human skull were used to create k-Wave simulations of acoustic wave propagation within this cranial environment. Photoacoustic imaging of the internal carotid artery (ICA) was performed with this same skull. Optical fibers emitting 750 nm light were inserted into the nasal cavity for ICA illumination. The ultrasound probe was placed on three optimal regions identified by simulations: (1) nasal cavity, (2) ocular region, and (3) 1 mm-thick temporal bone (which received 9.2%, 4.7%, and 3.8% of the initial photoacoustic pressure, respectively, in simulations). For these three probe locations, the contrast of the ICA in comparative experimental photoacoustic images was 27 dB, 19 dB, and 12 dB, respectively, with delay-and-sum (DAS) beamforming and laser pulse energies of 3 mJ, 5 mJ, and 4.2 mJ, respectively. Short-lag spatial coherence (SLSC) beamforming improved the contrast of these DAS images by up to 15 dB, enabled visualization of multiple cross-sectional ICA views in a single image, and enabled the use of lower laser energies. Combined simulation and experimental results with the emptied skull and >1 mm-thick temporal bone indicated that the ocular and nasal regions were more optimal probe locations than the temporal ultrasound probe location. Results from both the same skull filled with ovine brains and eyes and the human cadaver head validate the ocular region as an optimal acoustic window for our current system setup, producing high-contrast (i.e., up to 35 dB) DAS and SLSC photoacoustic images within the laser safety limits of a novel, compact light delivery system design that is independent of surgical tools (i.e., a fiber bundle with 6.8 mm outer diameter, 2 mm-diameter optical aperture, and an air gap spacing between the sphenoid bone and fiber tips). These results are promising toward identifying, quantifying, and overcoming major system design barriers to proceed with future patient testing.
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