Brain tumors represent one of the most devastating and difficult-to-treat malignancies, which are responsible for substantial mortality. Treatment of patients with brain tumors imposes a major burden on the healthcare and social systems worldwide due to a global increase in incidence of intracranial cancers originated inside or outside the brain, amounting to 60 cases for every 100,000 of population. Medical technology innovations are necessary in order to extend patients’ lifespan after diagnosis and improve their quality of life.
Current standard treatment consists of maximal surgical removal of the tumor, followed by associated radiotherapy and chemotherapy. Tragically, the imperative to respect healthy regions of the patients’ brain limits the therapeutic success of surgery. The whole tumor could be removed but at the cost of impaired cognitive or motor functions. Moreover, drugs are less effective in the brain due to the existence of the blood-brain-barrier (BBB) – a biochemical shield necessary for brain protection and ensuring its normal function, which however prevents the delivery of large therapeutic molecules into the brain tissue.
To reduce surgically induced adverse effects, neurosurgeons need specialized tools to visualize and remove the tumor while minimizing negative impacts of the surgery. Preoperative MRI fused into real-time microscopy of the operation field has become standard in today’s operation theaters. However, once the skull is open, the intracranial pressure is released and brain tissue converts from a well-supported, geometrically stable organ into a compliant structure compressed by its own weight thus creating significant mismatches with preoperative MRI. Fluorescence imaging used to intraoperatively identify the tumor volume suffers from strong light scattering and provides no adequate resolution and penetration. On the other hand, ultrasound imaging can delineate brain tumors, but standard diagnostic devices are not appropriate for guiding simultaneous surgical tumor removal.
Focused ultrasound (FUS) therapy facilitates minimally-invasive tumor removal by thermal coagulation (cooking the tissue), thereby minimizing undesirable injury to surrounding tissue. FUS is also known to enhance drug delivery through the BBB into the brain. However, strong attenuation and heating of the skull during today’s transcranial FUS interventions and the need for MRI-guidance makes the technique inconvenient and hardly applicable in a delicate neuro-oncological setting.