Visual quantification of motor function during awake brain surgery
Towards a Neuro Research Operating Room
E.C. Gommers (TU Delft - Mechanical Engineering)
Pieter Kruizinga – Mentor (TU Delft - Signal Processing Systems)
Winfred Mugge – Graduation committee member (TU Delft - Biomechatronics & Human-Machine Control)
D. (Djaina) Satoer – Mentor (Erasmus MC)
A.J.P.E. (Arnaud) Vincent – Mentor (Erasmus MC)
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Abstract
During a brain tumour resection, a neurosurgeon is constantly navigating a delicate balance between resecting as much of the tumour as possible, while avoiding any damage to healthy brain tissue. This challenge is particularly difficult when the tumour is located in a critical functional area, involved in for example language or motor function. For these types of tumours, the awake craniotomy was developed. During this surgery the patient wakes up to perform language and motor tasks, to enable the surgeon to localize these functions inside the brain. In this thesis, we investigate and develop a new quantitative method to monitoring motor function that could potentially improve intraoperative decision making and enables neuroscientific and neurosurgical research.
Chapter 1 provides a background about surgical strategies and technologies that have been developed to aid surgeons’ decisions during complex brain tumour resections. We will explain the complexity of robust research in the neurosurgical environment and the need for a dedicated Research Operating Room to create an environment to improve neurosurgical and neuroscientific research.
In Chapter 2 we make an overview of the possible solutions to quantify motor function before, during and after awake craniotomies and discuss the best solution for the Erasmus MC.
In Chapter 3 we present a new frame to create a standardized environment inside the operating room for good quality data collection of patient functionality. To design this frame, we identified and interviewed all the important stakeholders and designed three prototypes. The two most promising prototypes were developed. The final prototype was implemented during three awake craniotomies.
This newly developed frame was used in Chapter 4 to explore video tracking as a new tool to quantify hand motor function. Three patients were followed one day prior to the surgery, during the awake craniotomy, and one day postoperatively. During these three cases, we identified several prerequisites for a reliable recording set-up and explored the potential to detect clinically relevant events during fingertapping and direct electrical stimulation (DES). This showed promising results and underscores the potential for video tracking to be further investigated for quantification of hand motor function.
In Chapter 5 we put the discussed work into context, discussing it’s clinical and scientific relevance and future perspectives. In this thesis, we have demonstrated that it is possible to implement a new quantitative measurement method to monitor hand function in the challenging environment of an operating room. Quantification of visual observations has shown to be low-cost, easily available and implementable in clinical context, because of the fast technological advancements in this field. Video tracking can be used for future research to investigate the relation between intraoperative findings and long-term outcomes, and has the potential to add valuable information for neurosurgical and neuroscientific research.