Application of intraoperative ultrasound in the resection of high-grade gliomas

Abstract

The incidence of gliomas is approximately 3–5/100,000, with high-grade gliomas accounting for approximately 30–40% of these tumors. Surgery is a confirmed positive factor in prolonging the survival of these patients, and a larger resection range means a longer survival time. Therefore, surgery for high-grade glioma patients should aim to maximize the extent of resection while preserving neurological function to achieve a better quality of life. There is consensus regarding the need to lengthen progression-free survival (PFS) and overall survival (OS) times. In glioma surgery, methods such as intraoperative computed tomography (ICT), intraoperative magnetic resonance imaging (IMRI), navigation, 5-aminolevulinic acid (5-ALA), and intraoperative ultrasound (IOUS) are used to achieve an expanded resection during the surgical procedure. IOUS has been increasingly used in the surgery of high-grade gliomas and various tumors due to its convenient intraoperative use, its flexible repeatability, and the relatively low cost of operating room construction. With the continuous upgrading of ultrasound equipment, IOUS has been able to better assist surgeons in achieving an increased extent of resection. This review aims to summarize the application of ultrasound in the surgery of high-grade gliomas in the past decade, its improvement in patient prognosis, and its prospects.

Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery

“…Various authors have demonstrated in patients with brain tumors an increase in survival time related to the degree of tumor resection [26,27]. Moreover, recent publications have shown that intraoperative ultrasound provides better information about the extent and location of the tumor, facilitating the neurosurgeon's orientation during its excision [28,29]. Intraoperative ultrasound also aims to complement neuronavigation images, whose validity decreases when there is a displacement of brain tissue during tumor resection, a phenomenon known as "brain shift" [24].…”

“…Detecting a possible tumor remnant during surgery can mean significant time and cost savings for the patient, avoiding a possible surgical reintervention [28][29][30][31][32]. Finally, intraoperative ultrasound is a technology that is less costly compared to other studies such as intraoperative MRI.…”

“…Although much has been written about intraoperative MRI, the enormous costs involved and the relative impracticality indicate that it is likely to remain out of reach for many neurosurgery units worldwide in the medium term. In glioma surgery, methods such as intraoperative computed tomography (ICT), intraoperative magnetic resonance imaging (IMRI), navigation, 5-aminolevulinic acid (5-ALA), and intraoperative ultrasound are used to achieve an expanded resection during the surgical procedure [29].…”

Deciphering Glioblastoma: Fundamental and Novel Insights into the Biology and Therapeutic Strategies of Gliomas

“…To enhance the rate of complete surgical resection (CSR), numerous advanced therapeutic techniques have been developed, such as multimodal MRI, intraoperative MRI (IoMRI), intraoperative ultrasound, and fluorescence-guided surgery [240][241][242] Despite extensive post-surgical management, the complete eradication of disseminated tumor cells around the tumor cavity remains unachievable under microscopic observation. Intraoperative radiation therapy (IORT) represents a strategic approach involving the application of high-dose radiation directly to the residual tumor bed during surgery.…”

“…Local recurrence is a principal factor contributing to the malignant progression of GBM in clinical settings, with the majority of recurrences occurring within a limited margin (2 to 3 cm) surrounding the tumor cavity. To enhance the rate of complete surgical resection (CSR), numerous advanced therapeutic techniques have been developed, such as multimodal MRI, intraoperative MRI (IoMRI), intraoperative ultrasound, and fluorescence-guided surgery [ 240 , 241 , 242 ]…”