Intra-operative 3D ultrasound in neurosurgery

Unsgaard, Geirmund; Rygh, Ola M.; Selbekk, Tormod; Müller, Tomm B.; Kolstad, Frode; Lindseth, Frank; Hernes, Toril A. Nagelhus

doi:10.1007/s00701-005-0688-y

Cited by 232 publications

(139 citation statements)

References 82 publications

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“…Intraoperative ultrasound is becoming routine in some surgical disciplines, e.g. neurosurgery (Unsgaard et al, 2006). Another approach is to update or morph preoperative data based on intraoperative ultrasound (Bucholz et al, 1997;Reinertsen et al, 2007) to better match the intraoperative situation.…”

Section: Challenges -Organ Shifts and Tissue Deformationsmentioning

confidence: 99%

Navigated ultrasound in laparoscopic surgery

Solberg

Langø

Tangen

et al. 2009

Minimally Invasive Therapy & Allied Technologies

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Section: Challenges -Organ Shifts and Tissue Deformationsmentioning

confidence: 99%

Navigated ultrasound in laparoscopic surgery

Solberg

Langø

Tangen

et al. 2009

Minimally Invasive Therapy & Allied Technologies

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“…8,9,13,22,24 Navigated 3D ultrasound is a type of NUS using 3D ultrasound volumes. 33 It can be used in conjunction with preoperative MR images or as a stand-alone modality. There are advantages to using NUS directly.…”

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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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“…26,[51][52][53][55][56][57] Still, many neurosurgeons have been reluctant to try advanced versions of iUS due to negative past experiences. The quality of iUS imaging has improved significantly, such that the surgeon can readily assess ICH dimensions and identify structures within the brain in real time.…”

Section: Ultrasound-guided Evacuation Of Ichmentioning

confidence: 99%

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

Goren

Monteith

Hadani

et al. 2013

FOC

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This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green–based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and the extent of vascular anomaly resection. Intraoperative ultrasound aids navigation and evacuation assessment during intracerebral hematoma evacuation surgeries. It supports the concept of minimally invasive surgery and has undergone extensive development in recent years, with the quality of ultrasound imaging having improved considerably. Image-guided therapy, combined with modern intraoperative imaging modalities, has changed the fundamentals of conventional vascular neurosurgery by presenting real-time visualization of both normal tissue and pathological entities. These imaging techniques are important adjuncts to the surgeon's standard surgical armamentarium. Familiarity with these imaging modalities may help the surgeon complete procedures with improved safety, efficiency, and clinical outcome.

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Intra-operative 3D ultrasound in neurosurgery

Cited by 232 publications

References 82 publications

Navigated ultrasound in laparoscopic surgery

Navigated ultrasound in laparoscopic surgery

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

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

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