Continuous Compensation of Brain Shift during Neurosurgery

神经外科手术期间脑转移的持续补偿

• 批准号: 10178011
• 负责人: SARAH FRISKEN
• 金额: $ 39.47万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10178011
• 关键词: 3-Dimensional; 3D ultrasound; Address; Adoption; Algorithms; Biopsy; Brain; Brain Neoplasms; Breast; Cessation of life; Clinical; Clinical Research; Complex; Computer Graphics; Computer software; Consumption; Craniotomy; Custom; Data; Devices; Evolution; Excision; Feedback; Financial compensation; Freedom; Functional Imaging; Glioma; Goals; Head; Hospitals; Image; Image-Guided Surgery; Knowledge; Life Expectancy; Liquid substance; Literature; Liver; Location; Lung; Magnetic Resonance Imaging; Manuals; Mathematics; Measurement; Measures; Medical Imaging; Methods; Modeling; Modernization; Monitor; Neurologic Deficit; Neuronavigation; Neurosurgeon; Operative Surgical Procedures; Patients; Primary Brain Neoplasms; Property; Prostate; Quality of life; Reporting; Research; Risk; Sampling; Seizures; Side; Speed; Structure; Surgeon; Surgical Instruments; Surgically-Created Resection Cavity; System; Testing; Time; Tissues; Translations; Tumor Tissue; Ultrasonography; United States; Update; Visualization; anatomic imaging; brain shape; brain surgery; brain tissue; clinical practice; curve fitting; design; feature detection; image registration; imaging facilities; improved; neurosurgery; novel; physical model; pressure; prevent; prototype; reduce symptoms; soft tissue; software systems; systems research; tool; tumor

Project Summary / Abstract There are nearly 700,000 people living with primary brain tumors in the United States, with nearly 80,000 new cases and 11,000 deaths expected in 2018. Surgical removal is the first defense against brain tumors because it relieves symptoms, decreases seizure risks and increases life expectancy. Recent studies have shown that extent of tumor resection is strongly correlated with both freedom from progression and survival. However, tumors are often situated in and around critical brain structures and damaging these structures can cause loss of brain function. Thus, the primary goal in brain surgery is to maximize the extent of tumor resection while minimizing damage to surrounding brain tissue. Commercial neuronavigation systems present pre-operative image data to the surgeon during surgery that can help them visualize the location of their surgical instruments relative to these critical structures. Unfortunately, commercial systems do not compensate for progressive deformation of the brain during surgery, known as brain shift, which can be as large as 1-2 centimeters so the accuracy of neuronavigation systems decreases progressively during surgery. What is needed is a way to measure and compensate for brain shift continuously during surgery so that surgeons have timely, up-to-date information about what tissue has been removed, what tissue remains, and where nearby critical brain structures are. Such a system would enable neurosurgeons to make timely decisions that increase life expectancy and improve quality-of-life. While there is promising research in modeling brain deformation during surgery and a few end-to- end research systems that provide brain shift compensation, current approaches have a number of limitations. In particular, they rely on intraoperative data that is only available at a few time-points during surgery and they require many minutes of computation before model updates can be presented to the surgeon. This proposal addresses the three bottlenecks in state-of-the-art brain shift compensation research that prevent its adoption in clinical practice: 1) current method for modeling brain shift do not directly measure what has been removed during tumor resection so they tend to be inaccurate at the resection boundary, which is precisely where accuracy is most needed; 2) algorithms for modeling brain shift require significant preprocessing, computational power, and are too slow to provide timely feedback to the surgeon; and 3) intraoperative image acquisition is disruptive, time consuming and expensive so updates are infrequent. In this proposal we will address these bottlenecks by applying algorithms developed for real-time computer graphics to model the resection cavity and brain shift, and a new device and surgical workflow that will allow us to collect 3D ultrasound without disrupting surgery so we can monitor brain shift at frequent intervals. This project will address these bottlenecks with the following specific aims: Aim 1. Investigate the use of Adaptively Sampled Distance Fields for modeling of tumor resection Aim 2. Extend and investigate the use of 3D Chainmail for real-time brain shift modeling from intraoperative ultrasound Aim 3. Demonstrate continuous brain shift monitoring with a new surgical workflow and a prototype intraoperative ultrasound device

项目概要/摘要 美国有近 70 万人患有原发性脑肿瘤，新增病例近 8 万例， 预计 2018 年将有 11,000 人死亡。手术切除是预防脑肿瘤的第一道防线，因为它可以缓解症状， 降低癫痫发作风险并延长预期寿命。最近的研究表明，肿瘤切除的程度对 与无进展和生存相关。然而，肿瘤通常位于关键部位及其周围 大脑结构和损坏这些结构会导致大脑功能丧失。因此，脑部手术的首要目标是 最大限度地切除肿瘤，同时最大限度地减少对周围脑组织的损伤。商业的 神经导航系统在手术过程中向外科医生提供术前图像数据，帮助他们可视化手术过程 他们的手术器械相对于这些关键结构的位置。不幸的是，商业系统不 补偿手术期间大脑的逐渐变形，称为脑移位，可大至 1-2 厘米，因此神经导航系统的准确性在手术过程中逐渐降低。 我们需要一种在手术过程中连续测量和补偿大脑移位的方法，以便外科医生能够 及时、最新的信息，了解哪些组织已被移除、哪些组织剩余以及关键大脑附近的位置 结构是。这样的系统将使神经外科医生能够及时做出决定，从而延长预期寿命和 提高生活质量。虽然在手术期间模拟大脑变形方面有一些有前景的研究，并且有一些最终结果 尽管最终研究系统提供了大脑转移补偿，但目前的方法存在许多局限性。在 特别是，它们依赖于仅在手术期间的几个时间点可用的术中数据，并且需要大量数据 在将模型更新呈现给外科医生之前需要几分钟的计算时间。 该提案解决了最先进的脑转移补偿研究中阻碍其实现的三个瓶颈 临床实践中的采用：1）当前的大脑转移建模方法不能直接测量被移除的内容 在肿瘤切除过程中，因此它们在切除边界处往往不准确，而这正是准确度最高的地方 需要； 2）大脑转移建模算法需要大量的预处理和计算能力，而且速度太慢 及时向外科医生提供反馈； 3) 术中图像采集具有破坏性、耗时且 价格昂贵，所以更新不频繁。在本提案中，我们将通过应用开发的算法来解决这些瓶颈 用于实时计算机图形来模拟切除腔和脑移位，以及新的设备和手术流程 将使我们能够在不中断手术的情况下收集 3D 超声波，这样我们就可以频繁地监测大脑的变化。这 项目将解决这些瓶颈，具体目标如下： 目标 1. 研究自适应采样距离场在肿瘤切除建模中的应用 目标 2. 扩展并研究 3D Chainmail 在术中超声实时脑转移建模中的应用 目标 3. 通过新的手术工作流程和术中原型演示连续脑转移监测 超声波装置