Subscribe to RSS
DOI: 10.1055/s-0036-1593959
Predicting Tissue Breaking Strengths in the Epileptic Brain with T2 Relaxometry: Application of Pulsed Water Jet Dissection System for Epilepsy Surgery
Publication History
02 May 2016
14 September 2016
Publication Date:
30 November 2016 (online)
![](https://www.thieme-connect.de/media/jnlsa/201706/lookinside/thumbnails/10-1055-s-0036-1593959_161668oa-1.jpg)
Abstract
Background The piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. Using the ADPJ system in epilepsy surgery requires prediction of the tissue breaking strength of the epileptic brain. The aim of this study was to elucidate whether magnetic resonance imaging T2 relaxometry could predict the breaking strength.
Methods A total of 12 patients with drug-resistant temporal lobe epilepsy who received surgical treatment were included in the study. All the patients qualified for surgery after a comprehensive preoperative evaluation for the treatment of epilepsy. T2 relaxation time, breaking strength of the hippocampus, and an anterior temporal lobe specimen obtained from surgery with dissection depth determined by the ADPJ system were examined.
Results Preoperative T2 relaxation times of the anterior temporal lobe and hippocampus showed mild positive correlation with breaking strength (R2 = 0.60). The hippocampus showed higher T2 relaxation time than the temporal lobe. Hippocampal sclerosis seemed to have higher breaking strength than other pathologies, suggesting the correlation depends on the anatomical location and histopathology. The dissection depth of the extirpated lesion was negatively correlated with the breaking strength at input voltages of 10 V (R2 = − 0.34) and 20 V (R2 = − 0.20).
Conclusions T2 relaxometry may be useful to predict tissue breaking strength in the epileptic brain that allows safe application of the ADPJ system in epilepsy surgery.
-
References
- 1 Delalande O, Bulteau C, Dellatolas G. , et al. Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children. Neurosurgery 2007; 60 (02) (Suppl. 01) ONS19-ONS32; discussion ONS32
- 2 Spencer SS, Schramm J, Wyler A. , et al. Multiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia 2002; 43 (02) 141-145
- 3 Patil AA, Andrews R. Long term follow-up after multiple hippocampal transection (MHT). Seizure 2013; 22 (09) 731-734
- 4 Kawaguchi T, Nakagawa A, Endo T, Fujimura M, Sonoda Y, Tominaga T. Ventricle wall dissection and vascular preservation with the pulsed water jet device: novel tissue dissector for flexible neuroendoscopic surgery. J Neurosurg 2016; 124 (03) 817-822
- 5 Endo T, Takahashi Y, Nakagawa A, Niizuma K, Fujimura M, Tominaga T. Use of actuator-driven pulsed water jet in brain and spinal cord cavernous malformations resection. Neurosurgery 2015; 11 (Suppl. 03) 394-403; discussion 403
- 6 Yamada M, Nakano T, Sato C. , et al. The dissection profile and mechanism of tissue-selective dissection of the piezo actuator-driven pulsed water jet as a surgical instrument: laboratory investigation using swine liver. Eur Surg Res 2014; 53 (1-4): 61-72
- 7 Endo T, Nakagawa A, Fujimura M, Sonoda Y, Shimizu H, Tominaga T. Usefulness of pulsed water jet in dissecting sphenoid ridge meningioma while preserving arteries. [in Japanese]. No Shinkei Geka 2014; 42 (11) 1019-1025
- 8 Jackson GD, Connelly A, Duncan JS, Grünewald RA, Gadian DG. Detection of hippocampal pathology in intractable partial epilepsy: increased sensitivity with quantitative magnetic resonance T2 relaxometry. Neurology 1993; 43 (09) 1793-1799
- 9 Coan AC, Kubota B, Bergo FP, Campos BM, Cendes F. 3T MRI quantification of hippocampal volume and signal in mesial temporal lobe epilepsy improves detection of hippocampal sclerosis. AJNR Am J Neuroradiol 2014; 35 (01) 77-83
- 10 Briellmann RS, Kalnins RM, Berkovic SF, Jackson GD. Hippocampal pathology in refractory temporal lobe epilepsy: T2-weighted signal change reflects dentate gliosis. Neurology 2002; 58 (02) 265-271
- 11 Blümcke I, Thom M, Aronica E. , et al. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia 2013; 54 (07) 1315-1329
- 12 Van Paesschen W, Revesz T, Duncan JS, King MD, Connelly A. Quantitative neuropathology and quantitative magnetic resonance imaging of the hippocampus in temporal lobe epilepsy. Ann Neurol 1997; 42 (05) 756-766
- 13 Oertel J, Gaab MR, Runge U, Schroeder HW, Piek J. Waterjet dissection versus ultrasonic aspiration in epilepsy surgery. Neurosurgery 2005; 56 (1, Suppl) 142-146; discussion 142–146
- 14 Seto T, Yamamoto H, Takayama K, Nakagawa A, Tominaga T. Characteristics of an actuator-driven pulsed water jet generator to dissecting soft tissue. Rev Sci Instrum 2011; 82 (05) 055105