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

项目摘要 大脑皮层的功能性激活通过增加血液循环， 流动和代谢，因为神经血管耦合。脑表面温度的变化， 清醒的患者执行运动、感觉或语言任务可用于推断活动的空间模式， 创建功能地图。清醒神经外科用于治疗耐药性癫痫、神经胶质瘤、 和神经血管畸形，以定位癫痫发作和/或生理活动。保护关键 功能区是必要的，以避免术后神经功能缺损。目前，电力 电刺激（DES）是术中手术标测最常用的方法， 功能关键的大脑区域，所以它们不会被切除。然而，DES具有低空间分辨率（~ 1cm）， 可能会引起癫痫发作，而且一次只能检测一个区域。该项目研究了一种新的方法， 基于红外热成像的术中功能标测，具有高分辨率（~100微米） 并同时监测整个暴露的大脑表面而没有癫痫发作的风险。术中 由于肿瘤对神经胶质瘤患者的影响相对静态，因此将开发和测试映射系统。 脑温度与致痫灶和血管畸形的比较。电机和 语言映射病例显示对侧运动皮层的大（~0.5oC）正热激活， 与DES有很强一致性的语言区域。Aim 1将开发一个绘图系统（硬件和 软件），以在清醒开颅手术期间进行实时基于热的脑映射。我们将 在手术工作流程中优化和整合红外记录程序，以最大限度地提高信号质量 同时使治疗干扰最小化。中心部分是一个移动的推车，其中包含一个功能强大的工作站 以及用于将IR摄像机定位在开颅术上方的铰接臂。电脑会提供刺激，监控 并收集行为数据（音频、视频和无线触觉手套），记录IR图像，并显示 实时功能地图DES期间当前使用的患者任务将适用于热成像记录。 目标2将探索热力学响应的时间和空间特性，以优化红外光谱 映射过程。热响应函数（TRF）是血流动力学的热等效值 响应函数（HRF），用于fMRI。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，并使用它来开发一个有效的多任务映射 议定书其结果将是对大脑功能的快速，高效，高分辨率评估，以优化大脑功能。 切除并改善患者预后。目标3将比较函数映射方法（DES和 红外热成像），以确定它们之间的最佳协同作用，从而为 最安全的切除术如果成功，该项目将为术中功能标测创造一种新方法 清醒状态下的神经外科手术最终，我们希望提高术中脑标测的精度， 提高耐药性癫痫、神经胶质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.