Intraoperative Ultrasound for Spinal Lesions

Abstract

A variety of spinal pathological processes demonstrated by intraoperative ultrasound is presented. Use of spinal ultrasound proved helpful in viewing alignment, assessing spinal cord pathology, and viewing anterior to the cord in cases of spinal trauma. As an operative adjunct, ultrasound was especially helpful for viewing extradural spinal metastases and cavitary lesions of the spinal cord, such as syrinxes, cystic tumors, and hematomas. In cases of spondylotic myelopathy, intraoperative ultrasound allowed assessment of the adequacy of the decompression, the space ventral to the cord, and the size and configuration of the spinal cord.

Discrete or diffuse intramedullary tumor? Contrast-enhanced intraoperative ultrasound in a case of intramedullary cervicothoracic hemangioblastomas mimicking a diffuse infiltrative glioma: technical note and case report

“…2,8,12,13,26,28,33 However, in certain cases the use of other US techniques as adjuncts could be helpful in better characterizing the nature of the lesions, in particular if they present as intramedullary.…”

Very High Resolution Ultrasound Imaging for Real-Time Quantitative Visualization of Vascular Disruption after Spinal Cord Injury

“…1 Various studies in clinical and experimental settings have shown that ultrasound (US) imaging can be used to visualize the PH subsequent to SCI. [15][16][17][18][19][20][21] In experimental studies, the highest frequencies used were 10-12 MHz, [18][19][20][21] but the small diameter of the rat spinal cord (3-4 mm) limited the resolution of imaging. More recent US devices using very high frequencies (40-55 MHz) have been specifically designed to image small animals with spatial resolutions as low as 30 microns per pixel.…”

Intraoperative Ultrasound of the Spine

“…Multiple early reports identified numerous benefits of the sonographic imaging of tumors, particularly for surgical planning. [2][3][4][5][7][8][9] Typically performed after removal of the posterior elements but before durotomy, intraoperative sonography of the spine first assesses the adequacy of the surgical exposure. If the exposure is too small, incomplete tumor excision may result, while an excessively large exposure may lead to instability in adults or scoliosis in children.…”

“…2 Multiple groups reported applications for the technique including management of acute traumatic injuries, [3][4][5][6] preoperative planning for spinal tumor resection, [2][3][4][5][7][8][9][10][11][12][13][14][15][16] guiding placement of drainage catheters into posttraumatic cysts, 17 evaluation of disk herniation and identification of residual disk material after diskectomy, 3,5,7,18 visualization of spinal canal stenosis before and after surgical decompression, 4,5,[18][19][20] identification of intramedullary vascular malformations, 4 and for guidance of syrinx catheter placement and confirmation of adequate drainage. [2][3][4][5]7 We report the added utility of IOUS in 14 patients (5 men and 9 women with a mean age of 55 years) between 2011 and 2013. Most cases were of spinal tumors (12 of 14) including hemangioblastoma (2), schwan-noma (3), paraganglioma (2) meningioma (1) ependymoma (1), metastasis (2), and cavernous malformation (1).…”

“…In a typical intraoperative case, removal of the osseous posterior elements is followed by gentle instillation of sterile saline into the surgical site. A high frequency, small footprint transducer, Acuson 14 L5-SP (5)(6)(7)(8)(9)(10)(11)(12)(13)(14) [Siemens Medical Systems, Erlangen, Germany]) is placed with sonography gel into a sterile probe cover. It is critical to remove all the air bubbles between the probe and the cover to avoid ring-down artifact.…”