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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Intraoperative in-situ raman spectroscopy for brain tumour delineation

Intraoperative in-situ Raman Spektroskopie zur Abgrenzung von Hirntumoren

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  • presenting/speaker Sven Richter - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Jonathan Ziegler - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Tareq Juratli - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Stephan B. Sobottka - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Roberta Galli - Carl Gustav Carus Universitätsklinikum, TU Dresden, Abteilung Klinisches Sensoring und Monitoring, Klinik für Anästhesie und Intensivtherapie, Dresden, Deutschland
  • Gerald Steiner - Carl Gustav Carus Universitätsklinikum, TU Dresden, Abteilung Klinisches Sensoring und Monitoring, Klinik für Anästhesie und Intensivtherapie, Dresden, Deutschland
  • Matthias Kirsch - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland; Asklepios Kliniken Schildautal, Klinik für Neurochirurgie, Seesen, Deutschland
  • Gabriele Schackert - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Ortrud Uckermann - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV270

doi: 10.3205/22dgnc262, urn:nbn:de:0183-22dgnc2626

Published: May 25, 2022

© 2022 Richter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Maximal safe tumor resection (MTR) is one of the biggest challenges in Neurosurgery. Raman spectroscopy could be utilized to achieve MTR, since it is a label-free technique to acquire a biochemical fingerprint of tissue within seconds. However, clinical translation to intraoperative settings remains demanding. Hence, we performed in-situ Raman spectroscopy during brain tumor surgery with an easy-to-use handheld Raman probe to prove feasibility during neurosurgical procedures and investigate Raman-based biomarkers for intraoperative tumor delineation.

Methods: Intraoperative Raman spectroscopy was performed in 30 patients with primary and secondary brain tumors (10 glioblastoma WHO IV, 6 glioma WHO II-III, 3 meningioma WHO I-II, 11 metastases). A commercially available fiber-optic Raman probe was used with an excitation wavelength of 785 nm and acquisition time of 2 s per spectrum. Between 5-15 spectra of tumor-, and adjacent tissue were acquired per patient at different loci. Reference histopathology was performed at measurement positions. Both, Near-Infrared Fluorescence- and Raman spectra were analyzed.

Results: Measurements prolonged the duration of surgery about 5 min at most. Consistently to previous ex vivo studies, Raman bands assigned to lipids (e.g. 1437 cm-1) were significantly reduced across all tumor entities (p<0.0001), whereas protein bands (e.g. 1240-1280 cm-1) were significantly increased (p<0.0001). Fluorescence intensity also showed significant reduction for all types of tumors compared to the adjacent tissue (p<0.0001).

Interestingly, we found a strong positive correlation of Fluorescence- and lipid band intensity and in contrast a negative correlation for Fluorescence- and protein band intensity.

Conclusion: We showed successful clinical application of intraoperative Raman Spectroscopy through minimal delay of surgical workflow. Typical tumor features of Raman spectra, previously described in ex-vivo studies were confirmed in an in-vivo setting. Thus, utilizing intensities of Raman bands related to lipids and proteins might be a suited approach to contribute achieving MTR long-term. The differences in fluorescence intensity of tumor and adjacent tissue are yet to be understood. However, our results strongly suggest the feasibility of a fluorescence based tissue classification. Further development could lead to a standalone Near-infrared Fluorescence application, which would simplify the intraoperative setup.