Clinical Scorecard: Utilizing Mechanical Indentation Measurements to Differentiate Brain Tumor Tissue During Neurosurgery

At a Glance

Key Highlights

• Mechanical properties of fresh brain tumor samples and healthy brain tissue were objectively measured ex vivo within five minutes of collection to preserve tissue consistency.
• Young’s modulus was derived for the three most common brain tumor types and healthy tissue to facilitate differentiation during surgery.
• Intraoperative tactile (haptic) feedback is an important but subjective tool; objective mechanical measurements could support real-time surgical decision making.

Guideline-Based Recommendations

Diagnosis

• Use mechanical indentation measurements on fresh tumor and brain tissue samples to objectively assess tissue stiffness intraoperatively.
• Complement existing multimodal technologies such as neuronavigation, fluorescence dyes, intraoperative ultrasound, and MRI with mechanical property assessment.

Management

• Perform tumor resection aiming to maximize removal while preserving healthy and functional brain tissue, guided by mechanical tissue characterization.
• Collect multiple tumor samples per surgery for mechanical testing and histopathological correlation.

Monitoring & Follow-up

• Monitor tissue mechanical properties within five minutes post-extraction to avoid alterations due to dehydration or autolysis.
• Screen patients postoperatively for complications related to surgical and study procedures.

Risks

• Avoid prolonged delay (>20 minutes) between tissue extraction and mechanical measurement to prevent significant changes in tissue stiffness.
• Exclude patients with coagulation disorders, pregnancy, blood thinners, or serious comorbidities to minimize procedural risks.

Patient & Prescribing Data

Patients undergoing brain tumor resection with supratentorial tumors outside functional areas, aged over 18 years.

Standard neurosurgical treatment protocols were followed; mechanical indentation measurements were adjunctive and did not alter standard care.

Clinical Best Practices

• Perform mechanical indentation measurements within five minutes of tissue extraction at room temperature to maintain original tissue properties.
• Use a numerical scale (1 to 10) for surgeon-assessed tumor consistency to complement objective mechanical data.
• Integrate mechanical property data with other intraoperative modalities to improve tumor margin detection, especially when neuronavigation or fluorescence is limited.

References

• Neuronavigation and fluorescence dyes in neurosurgery
• Intraoperative ultrasound and MRI
• Ultrasound elastography and thermography
• Optical coherence tomography and Raman spectroscopy
• Mechanical behavior of brain tissue and mathematical modeling
• Ethics Committee University of Luebeck approval AZ 19–319