use of non-invasive optical analysis in neurosurgery

Conditions: Brain Tumour; Glioma; Meningioma; Brain Metastases; Schwannoma

Summary: the present study aims to investigate the potential application of multispectral analysis, hyperspectral imaging, and fluorescence during neuro-oncological procedures, specifically during brain tumour debulking / resection. these optics techniques are entirely non-invasive and consist in camera with a filter to be linked to the standard microsurgical and endoscopic instruments used in theatre. the research procedure consists of images acquisition and data processing, with virtually no additional invasive procedures to be performed on patients.

surgical resection of brain tumours remains a challenge. while the center of a tumour is easily resectable, its margins are often fading into normal brain, and therefore quite difficult to identify. moreover, there is now extensive literature proving that tumour cells extend way beyond visible margins of a tumour, following white matter tracts in the brain. as opposite to different organs (such as liver or kidney), resection of brain tumours beyond the visible margins is limited by the presence of eloquent/functional areas. damages or resection of these areas will inevitably cause a permanent disability, which can be incredibly serious and impact on further treatment: a paralyzed or unconscious patient is not capable of tolerating chemotherapy or radiotherapy after surgery, both crucial complementary forms of treatment to contain the disease, in combination with surgery. because of these premises, the concept of "functional margins of resection" is now established in the neurosurgical community: a tumour is resected and the resection is pushed up to 1-2 cms beyond the margins or only up to the point where a functional/eloquent area is found. if the latter is the case, the functional area is obviously preserved and tumour resection is stopped. identifying these areas is the main challenge in brain tumour surgery. the aim of this study and its scientific justification is to refine a new, potentially more practical and quick technique to identify functional brain areas in real time. this study can serve as a benchmark study to both improve surgery of brain tumours and increase our knowledge about brain tumours and eloquent brain vascular supply. this technique can also potentially be implemented to obtain a novel technology to assess brain perfusion during neurosurgical procedures. maintaining blood supply to healthy brain tissue is a key component of successful neuro-oncological surgery. multispectral/hyperspectral analysis can be evaluated as a complementary tool to assess brain perfusion in real-time and prevent post-operative devastating neurological complications, such as strokes, or significantly reduce the secondary damage would these complications occurr. the present project consists of a pilot observational study on patients diagnosed with brain tumours candidate for a neurosurgical operation. from a practical point of view, participation in the study will only imply that some images will be acquired during surgery and processed at a later stage. the study won't impact on patients' care at any stage, nor will produce results that will be relevant for future medical records of patients enrolled. patients will be approached about this study at the time of their first neuro-oncology clinic consultation. a member of the research team will be present at the time of the consultation and will explain in details what are the purposes and the methods of the present study.

Eligibility criteria:
inclusion criteria: * candidates for surgery due to a confirmed clinical and radiological diagnosis of cranial intrinsic or extrinsic tumour - any histological diagnosis confirming neuro-oncological disease, including primary and secondary disease * agreed to take part to the present research protocol and signed proper informed consent form exclusion criteria: * suspected differential diagnosis of pathological condition affecting central nervous system other than neuro-oncological disease - including demyelinating diseases, infections, brain traumas / haematomas, vascular or auto-immune diseases * patients not capable to give consent - not in condition of understanding, processing and retaining information

Keywords: gliomas multispectral analysis hyperspectral analysis fluorescence brain tumours