Estimation of brain deformation for volumetric image updating in protoporphyrin IX fluorescence-guided resection

Pablo A. Valdés, Xiaoyao Fan, Songbai Ji, Brent T. Harris, Keith D. Paulsen, David W. Roberts

Research output: Contribution to journalArticlepeer-review


Introduction: Fluorescence-guided resection (FGR) of brain tumors is an intuitive, practical and emerging technology for visually delineating neoplastic tissue exposed intraoperatively. Image guidance is the standard technique for producing 3-dimensional spatially coregistered information for surgical decision making. Both technologies together are synergistic: the former detects surface fluorescence as a biomarker of the current surgical margin while the latter shows coregistered volumetric neuroanatomy but can be degraded by intraoperative brain shift. We present the implementation of deformation modeling for brain shift compensation in protoporphyrin IX FGR, integrating these two sources of information for maximum surgical benefit. Methods: Two patients underwent FGR coregistered with conventional image guidance. Histopathological analysis, intraoperative fluorescence and image space coordinates were recorded for biopsy specimens acquired during surgery. A biomechanical brain deformation model driven by intraoperative ultrasound data was used to generate updated MR images. Results: Combined use of fluorescence signatures and updated MR image information showed substantially improved accuracy compared to fluorescence or the original (i.e., nonupdated) MR images, detecting only true positives and true negatives, and no instances of false positives or false negatives. Conclusion: Implementation of brain deformation modeling in FGR shows promise for increasing the accuracy of neurosurgical guidance in the delineation and resection of brain tumors.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalStereotactic and Functional Neurosurgery
Issue number1
StatePublished - Jan 2010
Externally publishedYes


  • Aminolevulinic acid
  • Brain shift
  • Brain tumor
  • Deformation modeling
  • Fluorescence-guided resection
  • Protoporphyrin IX

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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