Intraoperative Identification of Cranial Nerves in Skull Base Surgery Using Polarization Sensitive Optical Coherence Tomography

项目摘要/摘要 颅底手术中颅神经的识别是避免医源性损伤的关键。即使是那些 这些神经中任何一条的轻微损伤都可能极大地影响患者的预后。尽管重要的是 在脑神经识别方面，术前影像很难提供所需信息。在.期间 在外科手术中，电刺激技术经常被用来提供基于点的分析 神经及其功能的能力，但他们仍然无法描绘整个领域。事实上，有 目前还没有临床工具能够标测神经纤维并将其位置显示回外科医生 实时的。在这个项目中，我们建议开发一种成像工具，以填补当前这一明显的空白 并将其直接送到颅底外科医生手中。该工具将基于偏振 敏感的光学相干层析成像(OCT)，一种显示精致对比度的光学成像方式 用来治疗有髓神经。激光技术的最新进展(称为圆周测距，由 Mentor Dr.Vakoc)已经将OCT激光应用到了与运动兼容的程度 由标准手术流程诱导。这个两个目标的项目旨在将循环范围引入 颅底手术中的手术区，并评估其增强脑神经可视化的能力， 独一无二地结合了外科和技术专业知识。这项工作将在两个NIH之间进行- 资助的P41-持有机构：马萨诸塞州综合医院的Wellman光医学中心 (MGH)，生物医学OCT研究中心(CBORT)和布里格姆妇女医院 (BWH)，国家影像引导治疗中心(NCIGT)的总部，那里的资源 先进的多模式图像引导操作套件(AMIGO)，无论是在设备方面还是在 经验，将为进行这样的研究提供完美的环境。这一奖项的候选人是 丹妮尔·J·哈珀博士，麻省理工学院和哈佛医学院博士后研究员。哈珀医生一直在 在生物光子学领域训练有素。她的专业领域是OCT及其功能扩展，包括 偏振映射和深度分辨光谱分析。她的长期职业目标是升学 独立并领导一个专注于术中光学神经成像的研究小组。去帮助她 实现这一目标，哈珀博士建立了一支强大的团队，在研究和职业生涯的各个方面指导她 发展。MGH/HMS的光学成像专家本杰明·J·瓦科克博士将担任主要 门托。BWH的神经外科医生Alexandra J.Golby博士和Michael Mooney博士将提供指导， 在所有临床方面提供指导和协助。波士顿大学的田雷博士将提供监督 和该项目深度学习方面的指导，MGH/HMS的Tayyaba Hasan博士将 提供一般的职业发展建议。在这个团队的支持下，这个职业发展奖将 为哈珀博士提供她过渡到完全独立所需的剩余技能和培训。

Project summary/abstract Identification of cranial nerves during skull base surgery is critical to avoid iatrogenic injury. Even the slightest damage to any one of these nerves can hugely affect patient outcomes. Despite the importance of cranial nerve identification, preoperative imaging struggles to provide the needed information. During the surgical procedure, electrostimulation techniques are often utilized to provide a point-based analysis of a nerve and its functional capability, but they remain unable to picture the whole field. In fact, there is no current clinical tool capable of mapping nerve fibers and displaying their location back to the surgeon in real time. In this project, we propose to develop an imaging tool that can fill this obvious gap in current technology and place it directly into the hands of skull base surgeons. This tool will be based on polarization sensitive optical coherence tomography (OCT), an optical imaging modality that shows exquisite contrast for myelinated nerves. Recent advances in laser technology (known as circular ranging, invented by Mentor Dr. Vakoc) have brought OCT lasers to a point where their use is compatible with the motion induced by standard surgical workflow. This two-aim project seeks to bring circular ranging into the operating theater during skull base surgery and assess its capability to enhance cranial nerve visualization, uniquely combining both surgical and technical expertise. This work will take place between two NIH- funded P41-holding institutions: the Wellman Center for Photomedicine at Massachusetts General Hospital (MGH), home to the Center for Biomedical OCT Research (CBORT), and Brigham and Women’s Hospital (BWH), home of the National Center for Image-Guided Therapy (NCIGT) where the resources of the Advanced Multi-modality Image Guided Operating suite (AMIGO), both in terms of equipment and experience, will provide the perfect environment to conduct such a study. The candidate for this award is Dr. Danielle J. Harper, a postdoctoral fellow at MGH and Harvard Medical School. Dr. Harper has been well trained in the field of biophotonics. Her area of expertise is OCT and its functional extensions, including polarization mapping and depth-resolved spectroscopy. Her long-term career goal is to reach academic independence and lead a research group focused on intraoperative optical neuroimaging. To help her achieve this, Dr. Harper has built a strong team to guide her in all aspects of research and career development. Dr. Benjamin J. Vakoc at MGH/HMS, an expert in optical imaging, will serve as the primary mentor. Neurosurgeons Dr. Alexandra J. Golby and Dr. Michael Mooney at BWH will provide mentoring, guidance, and assistance with all clinical aspects. Dr. Lei Tian of Boston University will provide supervision and guidance for the deep learning aspects of the project, and Dr. Tayyaba Hasan at MGH/HMS will provide general career development advice. Supported by this team, this career development award will give Dr. Harper the remaining skills and training she requires to make the transition to full independence.