Real-Time Stereotactic Mass Spectrometry Tissue Analysis for Intraoperative Neuro

描述(由申请人提供) 摘要：实时立体定向质谱仪组织分析对术中神经外科指导临床和翻译研究摘要脑胶质瘤占颅内肿瘤的40%，其中近70%为间变性或更高级别。他们最恶性的形式，多形性胶质母细胞瘤仍然抵制精心设计的治疗策略，中位生存期为12-15个月，间变性胶质瘤为2-5年。直到今天，手术仍然是大多数脑肿瘤最重要的，通常也是第一种治疗方式。大体肿瘤全切除的好处包括减轻肿块效应、降低癫痫风险、延长进展时间和延长生存时间。现在公认的是，术后残留肿瘤体积越小，患者的预后就越好。因此，神经外科干预的主要挑战和目标是最大限度地切除肿瘤，同时通过保留关键组织来最大限度地减少神经功能缺陷的可能性。神经外科医生必须有能力在手术中以最高的确定性识别病变组织和关键脑组织。该项目旨在将一个组合的质谱学和神经导航平台集成到临床环境中，用于体内测量肿瘤边界。质谱学获得的信号将对照标准组织病理学进行验证，并与术前和/或术中的放射成像相关联。分子信息最终可能被用来指导手术室的临床决策。另一个目标是创造便携的工具，可以在没有高度专业化的中心可用的术中成像水平的中心使用。将一种新的质谱学方法与手术探头相结合，将允许同时进行手术切除组织和体内分子分析。该项目将专注于胶质瘤边缘的实时识别，并与多模式成像平台相结合，以提高肿瘤边界检测的特异性，为个性化神经外科治疗的实践奠定基础。 公共卫生相关性：在脑癌的神经外科干预中，主要的挑战和目标是最大限度地切除肿瘤，同时通过保留关键组织来最大限度地减少神经功能缺陷的可能性。该项目旨在开发一种使用质谱学结合放射成像对危险组织进行实时分子分析，以指导神经外科手术。为这种复杂系统开发的平台可以进一步适用于需要高度特异性指导的其他外科干预措施。

DESCRIPTION (Provided by the applicant) Abstract: Real-Time Stereotactic Mass Spectrometry Tissue Analysis for Intraoperative Neurosurgical Guidance Clinical and Translational Research Abstract Gliomas account for 40% of intracranial tumors, with close to 70% of them being of anaplastic grade or higher. Their most malignant form, glioblastoma multiforme still resists elaborate treatment strategies with a median survival of 12-15 months, and 2 to 5 years for anaplastic gliomas. To this day, surgery remains the most important, and usually first treatment modality for the majority of brain tumors. The benefits of gross total tumor resection include relief of mass effect, decrease in risk for epilepsy, increase of time to progression, and increase survival time. It is now well accepted that a smaller volume of postoperative residual tumor is associated with an improved prognosis for the patient. The principal challenge and objective of neurosurgical intervention is therefore to maximize the resection of tumor, while minimizing the potential for neurological deficit by preserving critical tissue. Neurosurgeons must then have the capability during surgery to identify diseased tissue as well as critical brain tissue with the highest level of certitude. This project aims to integrate a combined mass spectrometry and neuronavigation platform into the clinical environment for in vivo measurement of tumor boundaries. Mass spectrometry derived signatures will be validated against standard histopathology and correlated to pre- and/or intra- operative radiology imaging. The molecular information could eventually be used to guide clinical decisions in the operating room. A further goal is to create portable tools that may be used in centers without the level of intraoperative imaging available in highly specialized centers. Combination of a novel mass spectrometry approach with a surgical probe will allow simultaneous surgical removal of tissue and in vivo molecular analysis. The proposed project will focus on glioma margin identification in real-time and integrate with a multimodality imaging platform to increase specificity in tumor boundaries detection, for the practice of personalized neurosurgical treatment. Public Health Relevance: In neurosurgical interventions for brain cancers, the principal challenge and objective is to maximize the resection of tumor, while minimizing the potential for neurological deficit by preserving critical tissue. This project aims to develop a real-time molecular analysis of the tissue at stake using mass spectrometry in combination with radiology imaging to guide neurosurgery. The platform being developed for such a complex system can be further adapted to other surgical interventions t in need of highly specific guidance.