Advantages and Limitations of Intraoperative 3D Ultrasound in Neurosurgery. Technical note

Bozinov, Oliver; Burkhardt, Jan‐Karl; Fischer, C.; Kockro, Ralf A.; Bernays, René-Ludwig; Bertalanffy, Helmut

doi:10.1007/978-3-211-99651-5_30

Cited by 22 publications

(14 citation statements)

References 17 publications

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“…Without the navigable component, even 3D ultrasound is of limited use. 3 When the ultrasound probe is tracked, the exact spatial coordinates of the ultrasound volume scanned are known, and the system is able to navigate instruments within this volume. Our system uses digitally transferred and reconstructed tracked 3D ultrasound images (SonoWand).…”

Section: Discussionmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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OBJECTIVE Navigated 3D ultrasound is a novel intraoperative imaging adjunct permitting quick real-time updates to facilitate tumor resection. Image quality continues to improve and is currently sufficient to allow use of navigated ultrasound (NUS) as a stand-alone modality for intraoperative guidance without the need for preoperative MRI. METHODS The authors retrospectively analyzed cases involving operations performed at their institution in which a 3D ultrasound navigation system was used for control of resection of brain tumors in a “direct” 3D ultrasound mode, without preoperative MRI guidance. The usefulness of the ultrasound and its correlation with postoperative imaging were evaluated. RESULTS Ultrasound was used for resection control in 81 cases. In 53 of these 81 cases, at least 1 intermediate scan (range 1–3 intermediate scans) was obtained during the course of the resection, and in 50 of these 53 cases, the result prompted further resection. In the remaining 28 cases, intermediate scans were not performed either because the first ultrasound scan performed after resection was interpreted as showing no residual tumor (n = 18) and resection was terminated or because the surgeon intentionally terminated the resection prematurely due to the infiltrative nature of the tumor and extension of disease into eloquent areas (n = 10) and the final ultrasound scan was interpreted as showing residual disease. In an additional 20 cases, ultrasound navigation was used primarily for localization and not for resection control, making the total number of NUS cases where radical resection was planned 101. Gross-total resection (GTR) was planned in 68 of these 101 cases and cytoreduction in 33. Ultrasound-defined GTR was achieved in 51 (75%) of the cases in which GTR was planned. In the remaining 17, further resection had to be terminated (despite evidence of residual tumor on ultrasound) because of diffuse infiltration or proximity to eloquent areas. Of the 33 cases planned for cytoreduction, NUS guidance facilitated ultrasound-defined GTR in 4 cases. Overall, ultrasound-defined GTR was achieved in 50% of cases (55 of 111). Based on the postoperative imaging (MRI in most cases), GTR was achieved in 58 cases (53%). Final (postresection) ultrasonography was documented in 78 cases. The findings were compared with the postoperative imaging to ascertain concordance in detecting residual tumor. Overall concordance was seen in 64 cases (82.5%), positive concordance was seen in 33 (42.5%), and negative in 31 (40%). Discordance was seen in 14 cases—with ultrasound yielding false-positive results in 7 cases and false-negative results in 7 cases. Postoperative neurological worsening occurred in 15 cases (13.5%), and in most of these cases, it was reversible by the time of discharge. CONCLUSIONS The results of this study demonstrate that 3D ultrasound can be effectively used as a stand-alone navigation modality during the resection of brain tumors. The ability to provide repeated, high-quality intraoperative updates is useful for guiding resection. Attention to image acquisition technique and experience can significantly increase the quality of images, thereby improving the overall utility of this modality.

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Section: Discussionmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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“…In this series, we did not resect radically in eloquent areas when significant damage was likely (e.g., hypothalamic infiltration, cases 2 and 16) or when radical resection of an eloquent lesion (because of additional other lesions) did not represent any prognostic advantage (e.g., case 4). All other current IOUS publications address this issue with a similar opinion and results [7,11,19,28]. There are no reports of increased neurological deficits associated with IOUSguided radical resections.…”

Section: Extent Of Resection and Rt-3-d Iousmentioning

confidence: 71%

“…The ability to visualize the live ultrasound images in the convenient axial, coronal, and sagittal planes next to the corresponding preoperative MRI would further improve orientation and reduce surgical time [7]. However, as this capability requires a high amount of constant data transfer and accompanying calculation, it is currently difficult to realize.…”

Section: Outlook and Futurementioning

confidence: 99%

Resection of pediatric intracerebral tumors with the aid of intraoperative real-time 3-D ultrasound

et al. 2011

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Purpose Intraoperative ultrasound (IOUS) has become a useful tool employed daily in neurosurgical procedures. In pediatric patients, IOUS offers a radiation-free and safe imaging method. This study aimed to evaluate the use of a new real-time 3-D IOUS technique (RT-3-D IOUS) in our pediatric patient cohort. Material and methods Over 24 months, RT-3-D IOUS was performed in 22 pediatric patients (8 girls and 14 boys) with various brain tumors. These lesions were localized by a standard navigation system followed by analyses before, intermittently during, and after neurosurgical resection using the iU22 ultrasound system (Philips, Bothell, USA) connected to the RT-3-D probe (X7-2). Results In all 22 patients, real-time 3-D ultrasound images of the lesions could be obtained during neurosurgical resection. Based on this imaging method, rapid orientation in the surgical field and the approach for the resection could be planned for all patients. In 18 patients (82%), RT-3-D IOUS revealed a gross total resection with a favorable neurological outcome. Conclusion RT-3-D IOUS provides the surgeon with advanced orientation at the tumor site via immediate live two-plane imaging. However, navigation systems have yet to be combined with RT-3-D IOUS. This combination would further improve intraoperative localization.

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“…[16,22] Recent advances in ultrasound technology, such as high frequency transducer and true real time 3D probes should be able to further improve surgical interventions. [4,15] We evaluated those two new probes in six challenging cases for localization, visualization and possible resection control.…”

Section: Discussionmentioning

confidence: 99%

“…[4] One probe was a 7-15 MHz extended frequency range intra-operative transducer (L15-7io, Philips) with a phased linear array with 128 elements, explora connector and eight degrees of trapezoidal imaging and 23 mm effective aperture length with highresolution intra-operative imaging. The tip of the probe measures 11mm times 31mm.…”

Section: Intra-operative Ultrasound (Ious)mentioning

confidence: 99%

Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

et al. 2011

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Intra-operative ultrasound (ioUS) is a very useful tool in surgery of spinal lesions. Here we focus on modern ioUS to analyze its use for localisation, visualisation and resection control in intramedullary cavernous malformations (IMCM). A series of 35 consecutive intradural lesions were operated in our hospital in a time period of 24 months using modern ioUS with a high frequency 7-15 MHz transducer and a true real time 3D transducer (both Phillips iU 22 ultrasound system). Six of those cases were treated with the admitting diagnosis of a deep IMCM (two cervical, four thoracic lesions). IoUS images were performed before and after the IMCM resection. Pre-operative and early postoperative MRI images were performed in all patients. In all six IMCM cases a complete removal of the lesion was achieved microsurgically resulting in an improved neurological status of all patients. High frequency ioUS emerged to be a very useful tool during surgery for localization and visualization. Excellent resection control by ultrasound was possible in three cases. Minor resolution of true real time 3D ioUS decreases the actual advantage of simultaneous reconstruction in two planes. High frequency ioUS is the best choice for intraoperative imaging in deep IMCM to localize and to visualize the lesion and to plan the perfect surgical approach. Additionally, high frequency ioUS is suitable for intra-operative resection control of the lesion in selected IMCM cases. Methods: A series of 35 consecutive intradural lesions were operated in our hospital in a time period of 24 months using modern ioUS with a high frequency 7-15 MHz transducer and a true real time 3D transducer (both Phillips iU 22 ultrasound system).Six of those cases were treated with the admitting diagnosis of a deep IMCM (two cervical, four thoracic lesions). IoUS images were performed before and after the IMCM resection. Pre-and early postoperative MRI images were performed in all patients.Results: In all six IMCM cases a complete removal of the lesion was achieved microsurgically resulting in an improved neurological status of all patients. High frequency ioUS emerged to be a very useful tool during surgery for localization and visualization. Excellent resection control by ultrasound was possible in 3 cases. Minor resolution of true real time 3D ioUS decreases the actual advantage of simultaneous reconstruction in 2 planes. Conclusion:High frequency ioUS is the best choice for intra-operative imaging in deep IMCM to localize and to visualize the lesion and to plan the perfect surgical approach.Additionally, high frequency ioUS is suitable for intra-operative resection control of the lesion in non acute IMCM cases. Resection control in acute IMCM lesions is difficult to interpret since sometimes perifocal edema and/or perifocal hemosiderin can hinder the accurate differentiation of medullary to pathological tissue.

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Advantages and Limitations of Intraoperative 3D Ultrasound in Neurosurgery. Technical note

Cited by 22 publications

References 17 publications

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Resection of pediatric intracerebral tumors with the aid of intraoperative real-time 3-D ultrasound

Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations

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