Intraoperative Ultrasound: Emerging Technology and Novel Applications in Brain Tumor Surgery

Abstract

Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery. We present data from our case series of brain tumor surgery performed with the aid of IOUS in order to identify IOUS advantages and crucial aspects that may improve the management of neurosurgical procedures for brain tumors. From January 2021 to September 2021, 17 patients with different brain tumors underwent brain tumor surgery aided by the use of IOUS. During surgery, the procedure was supported by the use of multiples ultrasonographic modalities in addition to standard B-mode: Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS). In selected cases, the use of IOUS during surgical procedure was combined with neuronavigation and the use of intraoperative fluorescence by the use of 5-aminolevulinic acid (5-ALA). In one patient, a preoperative ultrasound evaluation was performed through a former iatrogenic skull defect. This study confirms the role of IOUS in maximizing the EOR, which is strictly associated with postoperative outcome, overall survival (OS), and patient’s quality of life (QoL). The combination of ultrasound advanced techniques such as Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS) is crucial to improve surgical effectiveness and patient’s safety while expanding surgeon’s view.

Evaluation of a Navigated 3D Ultrasound Integration for Brain Tumor Surgery: First Results of an Ongoing Prospective Study

“…In recent years, research and technological development has led to growing evidence supporting the application of ioUS in order to obtain GTR in low- and high-grade gliomas. In particular, clinical studies are emerging to evaluate the impact of ioUS on EOR [ 38 , 39 , 40 , 41 , 42 ]. The next step of our ongoing prospective study will be to compare clinical and imaging data concerning EOR and outcome after the use of navigated 3D reconstructed ultrasound before intraoperative MRI compared to a matched pair retrospective group with neuro-navigation alone before iMRI.…”

The Long and Winding Road: An Overview of the Immunological Landscape of Intracranial Meningiomas

“…Considering extra-assial lesions, migration to the meningioma microenvironment is even easier [ 6 , 8 ]. To date, the mainstay of meningioma treatment has been represented by surgery and/or radiotherapy [ 9 ], but the role of immunotherapy is gaining more attention in the neuro-oncological field, along with the recent findings mentioned above, and with medical and prognostic progress in body tumor treatment [ 5 , 10 , 11 ].…”

Updated Systematic Review on the Role of Brain Invasion in Intracranial Meningiomas: What, When, Why?

“…According to the WHO classification, Grade I meningiomas are usually related to a better outcome, with a very low percentage of tumor recurrence and, when compatible with tumor characteristics treated with surgery alone, no need for follow-up; nevertheless, several cases reported in the literature show a mismatch in tumor recurrence for Grade I meningiomas, and after few years of scientific investigations, BI was finally accepted and added in the revised version of WHO for CNS tumors in 2016 as a further criterion of atypia [ 2 ]. All this has led to a deep revolution, still in progress, in meningioma tumor management, where the use of radiomics parameters and radiological preoperative planning, molecular markers, microscopical detection of BI, and other features may lead to an ever-growing tailored approach to the patient and a more favorable prognosis [ 3 , 4 ].…”