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    Frameless multimodal image guidance of localized convection-enhanced delivery of therapeutics in the brain

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    Authors
    van der Bom, Imramsjah M. J.
    Moser, Richard P.
    Gao, Guangping
    Sena-Esteves, Miguel
    Aronin, Neil
    Gounis, Matthew J.
    UMass Chan Affiliations
    Department of Medicine
    Department of Neurosurgery
    Department of Radiology
    Department of Microbiology and Physiological Systems
    Gene Therapy Center
    Document Type
    Journal Article
    Publication Date
    2013-01-01
    Keywords
    Brain
    Cone-Beam Computed Tomography
    Convection
    Drug Delivery Systems
    Magnetic Resonance Imaging
    Neuronavigation
    Molecular and Cellular Neuroscience
    Neurology
    Neuroscience and Neurobiology
    Radiology
    Surgery
    Therapeutics
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    Abstract
    INTRODUCTION: Convection-enhanced delivery (CED) has been shown to be an effective method of administering macromolecular compounds into the brain that are unable to cross the blood-brain barrier. Because the administration is highly localized, accurate cannula placement by minimally invasive surgery is an important requisite. This paper reports on the use of an angiographic c-arm system which enables truly frameless multimodal image guidance during CED surgery. METHODS: A microcannula was placed into the striatum of five sheep under real-time fluoroscopic guidance using imaging data previously acquired by cone beam computed tomography (CBCT) and MRI, enabling three-dimensional navigation. After introduction of the cannula, high resolution CBCT was performed and registered with MRI to confirm the position of the cannula tip and to make adjustments as necessary. Adeno-associated viral vector-10, designed to deliver small-hairpin micro RNA (shRNAmir), was mixed with 2.0 mM gadolinium (Gd) and infused at a rate of 3 mul/min for a total of 100 mul. Upon completion, the animals were transferred to an MR scanner to assess the approximate distribution by measuring the volume of spread of Gd. RESULTS: The cannula was successfully introduced under multimodal image guidance. High resolution CBCT enabled validation of the cannula position and Gd-enhanced MRI after CED confirmed localized administration of the therapy. CONCLUSION: A microcannula for CED was introduced into the striatum of five sheep under multimodal image guidance. The non-alloy 300 mum diameter cannula tip was well visualized using CBCT, enabling confirmation of the position of the end of the tip in the area of interest.
    Source

    J Neurointerv Surg. 2013 Jan 1;5(1):69-72. doi: 10.1136/neurintsurg-2011-010170. Epub 2011 Dec 22. Link to article on publisher's site

    DOI
    10.1136/neurintsurg-2011-010170
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29993
    PubMed ID
    22193239
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    Rights
    This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ andhttp://creativecommons.org/licenses/by-nc/3.0/legalcode
    ae974a485f413a2113503eed53cd6c53
    10.1136/neurintsurg-2011-010170
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