title: Predicting Tissue Breaking Strengths in the Epileptic Brain with T2 Relaxometry: Application of Pulsed Water Jet Dissection System for Epilepsy Surgery.
abstract: BackgroundThe 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.MethodsA 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.ResultsPreoperative 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).ConclusionsT2 relaxometry may be useful to predict tissue breaking strength in the epileptic brain that allows safe application of the ADPJ system in epilepsy surgery.
authors.affiliation: Department of Neurosurgery, Tohoku University, Sendai, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Tohoku University, Sendai, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Neurosurgery, Tohoku University, Sendai, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakagawa
authors.affiliation: Department of Diagnostic Radiology Tohoku University, Sendai, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Epileptology, Tohoku University, Sendai, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Nakasato
authors.affiliation: Department of Neurosurgery, Tohoku University, Sendai, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D011300:Preoperative Care; D014867:Water; D055815:Young Adult
chemical_list: D014867:Water