Objective: To identify new central nervous system (CNS) biomarkers to be used for blood-derived liquid biopsy once the blood-brain barrier (BBB), specifically the blood-arachnoid barrier (BAB), has been transiently disrupted by BDF in patients undergoing spine surgery.
Design: Single center (Sheba Medical Center), prospective, controlled. Phase: Feasibility study
Endpoints:
Efficacy The primary endpoint of the study is the elevation in blood concentration of CNS biomarkers following the study procedure compared to biomarkers detected in cerebrospinal fluid (CSF) of the same subject.
Safety The primary safety endpoint will be the overall incidence of BDF procedure-related AEs and SAEs, with severity graded according to CTCAE v5.0 criteria.
Study population:
The study population will include up to 20 patients undergoing spine surgery.
Study period:
24 months.
Inclusion criteria:
1. Adult subjects over the age of 18 2. Able to sign informed consent 3. Candidates for intradural tumor resection spinal surgery with intraoperative neuromonitoring.
Exclusion criteria:
1. Pacemakers, or other implanted electric medical devices 2. Pregnant or lactating females 3. Major medical, neurologic or psychiatric condition who are judged as unable to fully comply with the study 4. History of skull fractures or previous brain surgery 5. American Society of Anesthesiologists grade \>2 6. Anticoagulants treatment 7. Damage to the dura resulting in CSF leak 8. Patients with seizures/epilepsy
Study procedure:
1. Candidates for intradural tumor resection spinal surgery with intraoperative neuromonitoring will be enrolled in the study prior to surgery. 2. The patient will undergo preparation for surgery according to the standard care. 3. Once anesthetized and intubated, electrodes will be attached to the patient's head. 4. After placing the electrodes, when the patient is under anesthesia, a blood sample will be taken prior to BDF. This sample will be used as baseline for BDF. 5. The patient will then undergo a BDF procedure. 6. Additional blood samples will be taken for identification of CNS biomarkers. 7. Surgery will then proceed according to the standard of care. 8. Once the dura is opened, a CSF sample will be taken, in order to compare the blood biomarkers of the specific subject with the CSF biomarkers. 9. The surgery will continue according to the standard of care.
Adult subjects over the age of 18
Able to sign informed consent
Candidates for intradural tumor resection spinal surgery with intraoperative neuromonitoring.
Pacemakers, or other implanted electric medical devices
Pregnant or lactating females
Major medical, neurologic or psychiatric condition who are judged as unable to fully comply with the study
History of skull fractures or previous brain surgery
Single group
spinal surgery
Procedure/SurgeryCandidates for intradural tumor resection spinal surgery with intraoperative neuromonitoring will be enrolled in the study prior to surgery. The patient will undergo preparation for surgery according to the standard care. Once anesthetized and intubated, electrodes will be attached to the patient's head. After placing the electrodes, when the patient is under anesthesia, a blood sample will be taken prior to BDF. This sample will be used as baseline for BDF. The patient will then undergo a BDF procedure. Additional blood samples will be taken for identification of CNS biomarkers. Surgery will then proceed according to the standard of care. Once the dura is opened, a CSF sample will be taken. The surgery will continue according to the standard of care
BDF
Deviceelectrodes couples (voltage and ground) will be placed on the patient head and will be connected to a pulse generator. 2 electrodes couples will be activated in parallel, up to 8 electrodes couples total. EEG will be acquired after each series of pulses for a few sec.
Elevation in blood concentration of CNS biomarkers following BDF compared to biomarkers detected in CSF of the same subject. The overall incidence of BDF procedure-related AEs and SAEs, with severity graded according to CTCAE v5.0 criteria.
Efficacy We will quantify potential biomarkers in pre- and post- BDF blood samples and expect to see an increase in the blood concentration in the post-BDF samples. The primary endpoint of the study is the elevation in blood concentration of CNS biomarkers including fatty acid or other lipid levels, and/or barrier opening biomarkers and/or unique vascular and cytokines-related proteins and metabolites, following BDF, compared to biomarkers detected in cerebrospinal fluid (CSF) of the same subject. Safety The primary safety endpoint will be the overall incidence of BDF procedure-related AEs and SAEs, with severity graded according to CTCAE v5.0 criteria.
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