High-resolution Infrared Thermal Imaging (ITI) for Simultaneous Functional Mapping of the Entire Craniotomy in Awake Patients

项目总结 大脑皮层的功能激活通过增加血液使局部体温显著升高 神经血管耦合导致的流动和新陈代谢。体表脑温的变化 清醒患者执行运动、感觉或语言任务可以用来推断活动的空间模式 创建功能图。清醒神经外科被用于治疗抗药性癫痫，神经胶质瘤， 和神经血管畸形，以定位癫痫和/或生理活动。密钥的保护 功能区是避免术后神经功能障碍的关键。目前，直流电 刺激(DES)是术中最常用的手术标测方法，它可以识别 大脑的关键功能区域，因此它们不会被切除。然而，DES的空间分辨率较低(~1厘米)， 可能会引发癫痫发作，一次只能测试一个区域。这个项目研究了一种新的方法 基于高分辨率(~100微米)红外热像的术中功能标测 同时监测整个暴露的大脑表面，而不会有癫痫发作的风险。术中手术 将开发测绘系统并在胶质瘤患者身上进行测试，因为肿瘤对 脑温与致痫灶和血管畸形的比较。电机和电机的初步数据 语言测绘病例显示对侧运动皮质大量(~0.5oC)正向热激活， 与DES有很强一致性的语言区域。AIM 1将开发一个测绘系统(硬件和 软件)，以便在清醒开颅手术期间进行基于温度的实时脑成像。我们会 在手术流程中优化和集成红外线记录程序，以最大限度地提高信号质量 同时将治疗干扰降至最低。中心部分是一辆装有强大工作站的移动手推车 和一个关节臂，用来定位开颅手术上方的红外摄像机。计算机将传递刺激、监控 并收集行为数据(音频、视频和无线触觉手套)，记录红外图像，并显示 实时功能图。目前在DES期间使用的患者任务将被调整为热像仪记录。 目标2将探索热力学响应的时间和空间特性，以优化红外 测绘程序。热响应函数(TRF)是血液动力学的热等效值 功能磁共振成像中使用的响应函数(HRF)。通过建模和高分辨率(空间和时间)IR 数据，我们将估计热脉冲响应，并使用它来开发有效的多任务映射 协议。其结果将是快速、高效、高分辨率的脑功能评估，以优化 切除和改善患者的预后。目标3将比较功能映射方法(DES和 红外热成像)，以确定它们之间的最佳协同作用，从而为 最安全的切除。如果成功，该项目将创造一种新的术中功能标测方法 在清醒的神经外科手术中。最终，我们希望提高术中脑图的精确度，同时 提高耐药癫痫、脑胶质瘤和脑膜瘤患者手术的安全性和有效性 神经血管畸形。

PROJECT SUMMARY Functional activation of the cerebral cortex creates a robust increase in local temperature by increasing blood flow and metabolism because of neurovascular coupling. Changes in surface brain temperature while an awake patient performs a motor, sensory, or language task can be used to infer spatial patterns of activity to create functional maps. Awake neurosurgery is used in the management of drug-resistant epilepsy, glioma, and neurovascular malformation, in order to localize seizure and/or physiologic activity. Protection of key functional areas is imperative to avoiding postoperative neurologic deficits. Currently, direct electrical stimulation (DES) is the most commonly used method of intraoperative surgical mapping, which identifies functionally critical brain regions so they are not resected. However, DES has low spatial resolution (~1 cm), may provoke seizures, and can only test one area at a time. This project investigates a new method of intraoperative functional mapping based on infrared thermography, which has high resolution (~100 micron) and simultaneously monitors the entire exposed brain surface without risk for seizures. The Intraoperative Mapping System will be developed and tested on glioma patients, as tumors have relatively static impact on brain temperature compared to epileptogenic foci and vascular malformations. Preliminary data in motor and language mapping cases shows large (~0.5oC) positive thermal activation of contralateral motor cortex and language regions that have strong agreement with DES. Aim 1 will develop a mapping system (hardware and software) required to conduct real-time thermal-based brain mapping during awake craniotomy. We will optimize and integrate the infrared recording procedure within the surgical workflow, to maximize signal quality while minimizing treatment interference. The central piece is a mobile cart containing a powerful workstation and an articulating arm to locate the IR camera over the craniotomy. The computer will deliver stimuli, monitor and collect behavioral data (audio, video, and a wireless haptic glove), record the IR images, and display the real-time functional map. Patient tasks currently used during DES will be adapted for thermographic recording. Aim 2 will explore the temporal and spatial properties of the thermodynamic response to optimize the infrared mapping procedure. The thermal response function (TRF) is the thermal equivalent of the hemodynamic response function (HRF) that is used in fMRI. Through modeling and high resolution (spatial and temporal) IR data, we will estimate the thermal impulse response and use it to develop an efficient multi-task mapping protocol. The result will be a rapid, efficient, high resolution assessment of brain function to optimize the resection and improve patient outcomes. Aim 3 will compare the functional mapping methods (DES and infrared thermal imaging) to determine optimal synergy between them to provide the best information for the safest resection. If successful, this project will create a new method for intraoperative functional mapping during awake neurosurgery. Ultimately, we hope to improve the precision of intraoperative brain mapping while increasing the safety and efficacy of surgery for patients with drug-resistant epilepsy, glioma, and neurovascular malformations.