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Cranial sonolucent prosthesis: a window of opportunity for neuro-oncology (and neuro-surgery)

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Abstract

Introduction

Ultrasound (US) is a versatile technology, able to provide a real-time and multiparametric intraoperative imaging, and a promising way to treat neuro-oncological patients outside the operating room. Anyhow, its potential is limited both in imaging and therapeutic purposes by the existence of the bone shielding. To enhance the spectrum of uses, our group has designed a dedicated US-translucent cranial prosthesis. Herein, we provide the proof of concept of a long-term US-based follow-up and a potential bedside therapeutic exploitation of US.

Methods

The prosthesis was first implanted in a cadaveric specimen to record any issue related to the cranioplasty procedure. Hence, the device was implanted in a patient undergoing surgery for a multi-recurrent anaplastic oligodendroglioma. US multiparametric scans through the device were acquired at 3, 6, 9, and 30 months after the procedure.

Results

The prosthesis could be modeled and implanted through ordinary instruments, with no concerns over safety and feasibility. Trans-prosthesis multiparametric US imaging was feasible, with image quality comparable to intraoperative US. Long-term follow-up in an outpatient setting was possible with no adverse events. Trans-prosthesis mechanical interaction with microbubbles was also feasible during follow-up.

Conclusions

This report provides the first proof of concept for a potential breakthrough in the management of neuro-oncological patients. Indeed, through the implantation of an artificial acoustic window, the road is set to employ US both for a more dynamic long-term follow-up, and for US-guided therapeutic applications.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

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Author information

Author notes

  1. Massimiliano Del Bene and Luca Raspagliesi have contributed equally to this article.

Authors and Affiliations

  1. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy

    Massimiliano Del Bene, Luca Raspagliesi, Giovanni Carone, Francesco Prada & Francesco DiMeco

  2. Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy

    Massimiliano Del Bene

  3. Neuro-Oncological Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Paola Gaviani & Antonio Silvani

  4. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Luigi Solbiati

  5. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

    Luigi Solbiati

  6. Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, VA, USA

    Francesco Prada

  7. Focused Ultrasound Foundation, Charlottesville, VA, USA

    Francesco Prada

  8. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    Francesco DiMeco

  9. Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, USA

    Francesco DiMeco

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  1. Massimiliano Del Bene
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MDB, LR, GC, LS, FP, FDM. The first draft of the manuscript was written by LR and MDB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Massimiliano Del Bene.

Ethics declarations

Conflict of interest

FP and FDM have patented the prosthesis LS, FP and FDM are stockholders of “Intelligenza Trasparente SRL”, the company which manufactures the prosthesis.

Ethical approval

The procedure was approved by the Italian Ministry of Health.

Consent to participate

Informed consent was obtained.

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Patient signed informed consent regarding publishing his data and photographs.

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Supplementary Information

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11060_2021_3929_MOESM1_ESM.tif

Supplementary file1 (TIF 69807 KB) Supplementary Figure 1 Trans-prosthesis multiparametric US imaging is feasible. In outpatient setting, the prosthesis allows to acquire B-mode (A), CEUS (B), color doppler (C), power doppler (D), micro-V doppler (E) and fusion imaging (F) scans

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Del Bene, M., Raspagliesi, L., Carone, G. et al. Cranial sonolucent prosthesis: a window of opportunity for neuro-oncology (and neuro-surgery). J Neurooncol 156, 529–540 (2022). https://doi.org/10.1007/s11060-021-03929-x

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  • DOI: https://doi.org/10.1007/s11060-021-03929-x

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