Quantifying extent of meningioma preoperative embolization through volumetric analysis: A retrospective case series.

BACKGROUND: Endovascular embolization is an adjunct to meningioma resection. Isolating the effectiveness of embolization is difficult as MR imaging is typically performed before embolization and after resection, and volumetric assessment of embolization on 2D angiographic imaging is challenging. We investigated the correlation between 2D angiographic and 3D MR measurements of meningioma devascularization following embolization. METHODS: We implemented a protocol for postembolization, preresection MRI. Angiographic devascularization was graded according to reduction of tumor blush from 1 (partial embolization) to 4 (complete embolization with no residual circulation supply). Volumetric extent of embolization was quantified as the percent of tumor contrast enhancement lost following embolization. Tumor embolization was analyzed according to tumor location and vascular supply. RESULTS: Thirty consecutive patients met inclusionary criteria. Grade 1 devascularization was achieved in 7% of patients, grade 2 in 43%, grade 3 in 20%, and grade 4 in 30%. Average extent of embolization was 37 ± 6%. Extent of tumor embolization was low (<25%) in 40%, moderate (25%-75%) in 40%, and high (>75%) in 20% of patients. Convexity, parasagittal/falcine and sphenoid wing tumors were found to have distinct vascular supply patterns and extent of embolization. Angiographic devascularization grade was significantly correlated with volumetric extent of tumor embolization (p < 0.001, r = 0.758). CONCLUSION: This is the first study to implement postembolization, preoperative MRI to assess extent of embolization prior to meningioma resection. The study demonstrates that volumetric assessment of contrast reduction following embolization provides a quantitative and spatially resolved framework for assessing extent of tumor embolization.

Optimization Strategies Used for Boosting Piezoelectric Response of Biosensor Based on Flexible Micro-ZnO Composites.

Piezoelectric ZnO-based composites have been explored as a flexible and compact sensor for the implantable biomedical systems used in cardio surgery. In this work, a progressive development route was investigated to enhance the performance of piezoelectric composites incorporated with different shape, concentration and connectivity of ZnO fillers. ZnO microrods (MRs) have been successfully synthesized homogeneously in aqueous solution using a novel process-based on chemical bath deposition (CBD) method. The morphological analysis along with Raman scattering and cathodoluminescence spectroscopy of ZnO MRs confirm their high crystalline quality, their orientation along the polar c-axis and the presence of hydrogen-related defects acting as shallow donors in their center. The experimental characterizations highlight that ZnO MR-based composites, with a higher aspect ratio (AR), lead to a significant improvement in the mechanical, dielectric and piezoelectric properties as opposed to the ZnO microparticles (MP) counterparts. The dielectrophoretic (DEP) process is then subjected to both ZnO MP- and MR-based composites, whose performance is expected to be improved as compared to the randomly dispersed composites, thanks to the creation of chain-like structures along the electric field direction. Furthermore, a numerical simulation using COMSOL software is developed to evaluate the influence of the material structuration as well as the filler's shape on the electric field distribution within different phases (filler, matrix and interface) of the composites. Finally, the aligned MR piezoelectric composites are revealed to be high potential in the development of innovative compact and biocompatible force-sensing devices. Such a technological breakthrough allows the achievement of a real-time precise characterization of mitral valve (MV) coaptation to assist surgeons during MV repair surgery.

Stimulating the Facial Nerve to Treat Ischemic Stroke: A Systematic Review.

Acute ischemic stroke (AIS) is a common devastating disease that has increased yearly in absolute number of cases since 1990. While mechanical thrombectomy and tissue plasminogen activator (tPA) have proven to be effective treatments, their window-of-efficacy time is very short, leaving many patients with no viable treatment option. Over recent years there has been a growing interest in stimulating the facial nerves or ganglions to treat AIS. Pre-clinical studies have consistently demonstrated an increase in collateral blood flow (CBF) following ganglion stimulation, with positive indications in infarct size and neurological scores. Extensive human trials have focused on trans-oral electrical stimulation of the sphenopalatine ganglion, but have suffered from operational limitations and non-significant clinical findings. Regardless, the potential of ganglion stimulation to treat AIS or elongate the window-of-efficacy for current stroke treatments remains extremely promising. This review aims to summarize results from recent trial publications, highlight current innovations, and discuss future directions for the field. Importantly, this review comes after the release of four important clinical trials that were published in mid 2019.

Assessment of Sentinel Node Biopsies With Full-Field Optical Coherence Tomography.

Current techniques for the intraoperative analysis of sentinel lymph nodes during breast cancer surgery present drawbacks such as time and tissue consumption. Full-field optical coherence tomography is a novel noninvasive, high-resolution, fast imaging technique. This study investigated the use of full-field optical coherence tomography as an alternative technique for the intraoperative analysis of sentinel lymph nodes. Seventy-one axillary lymph nodes from 38 patients at Tenon Hospital were imaged minutes after excision with full-field optical coherence tomography in the pathology laboratory, before being handled for histological analysis. A pathologist performed a blind diagnosis (benign/malignant), based on the full-field optical coherence tomography images alone, which resulted in a sensitivity of 92% and a specificity of 83% (n = 65 samples). Regular feedback was given during the blind diagnosis, with thorough analysis of the images, such that features of normal and suspect nodes were identified in the images and compared with histology. A nonmedically trained imaging expert also performed a blind diagnosis aided by the reading criteria defined by the pathologist, which resulted in 85% sensitivity and 90% specificity (n = 71 samples). The number of false positives of the pathologist was reduced by 3 in a second blind reading a few months later. These results indicate that following adequate training, full-field optical coherence tomography can be an effective noninvasive diagnostic tool for extemporaneous sentinel node biopsy qualification.