Multimodal Imaging in Glioma Surgery

Šteňo, Andrej; Giussani, Carlo; Riva, Mattéo

doi:10.1007/978-3-319-25268-1_8

Cited by 4 publications

(4 citation statements)

References 91 publications

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“…Combination of IOUS and 5-ALA may be potentially useful also when focally malignized low-grade gliomas with no or non-significant contrast-enhancement are resected ( 50 ). In such cases, 3D IOUS provides adequate visualization of the whole hyperechoic tumor, while the small foci of anaplasia can be intraoperatively identified by 5-ALA fluorescence using the methodology pioneered by Widhalm et al.…”

Section: Suboptimal Ultrasound Imagingmentioning

confidence: 99%

“…However, horizontal placement of the craniotomy may not be optimal in every type of surgery—for example in awake resections of tumors growing close to the Rolandic area and/or supplementary motor area performed in semi-sitting position (which is most comfortable for patients) ( Figure 10 ). In order to keep the fluid within the resection cavity in cases when the craniotomy is not placed horizontally, a miniature barrier made from bone-vax may be effectively used ( 50 ) ( Figure 11 ). This “miniature dam” allows sufficient filing of the resection cavity with fluid and appropriate scanning.…”

Section: Challenging Patient Positioningmentioning

confidence: 99%

“…However, it is necessary to emphasize that patient positioning during intraoperative MRI-guided surgeries on the MRI table is sometimes also less-than-ideal, especially during awake tumor resections ( 80 ). Regarding awake procedures, it is worth noting that IOUS is a less time-consuming imaging modality than intraoperative MRI ( 50 ). This might be an important factor during procedures performed in conscious patients, as awake tumor resections have limited duration due to patient fatigue ( 81 ).…”

Section: Future Perspectivesmentioning

confidence: 99%

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Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

et al. 2021

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While benefits of intraoperative ultrasound (IOUS) have been frequently described, data on IOUS limitations are relatively sparse. Suboptimal ultrasound imaging of some pathologies, various types of ultrasound artifacts, challenging patient positioning during some IOUS-guided surgeries, and absence of an optimal IOUS probe depicting the entire sellar region during transsphenoidal pituitary surgery are some of the most important pitfalls. This review aims to summarize prominent limitations of current IOUS systems, and to present possibilities to reduce them by using ultrasound technology suitable for a specific procedure and by proper scanning techniques. In addition, future trends of IOUS imaging optimization are described in this article.

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Section: Suboptimal Ultrasound Imagingmentioning

confidence: 99%

Section: Challenging Patient Positioningmentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

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Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery

et al. 2021

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“…In most of cases B-mode imaging overlap pre-operative FLAIR MRI scan in LGG (Figure 2). The main difficulty in these tumors is to identify the margins/areas of invasion from peri-lesional edema (23, 33, 35–38).…”

Section: Intraoperative Ultrasound In Glioma Surgerymentioning

confidence: 99%

Advanced Ultrasound Imaging in Glioma Surgery: Beyond Gray-Scale B-mode

et al. 2018

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Introduction: Glioma surgery is aimed at obtaining maximal safe tumor resection while preserving or improving patient's neurological status. For this reason, there is growing interest for intra-operative imaging in neuro-oncological surgery. Intra-operative ultrasound (ioUS) provides the surgeon with real-time, anatomical and functional information. Despite this, in neurosurgery ioUS mainly relies only on gray-scale brightness mode (B-mode). Many other ultrasound imaging modalities, such as Fusion Imaging with pre-operative acquired magnetic resonance imaging (MRI), Doppler modes, Contrast Enhanced Ultrasound (CEUS), and elastosonography have been developed and have been extensively used in other organs. Although these modalities offer valuable real-time intra-operative information, so far their usage during neurosurgical procedures is still limited.Purpose: To present an US-based multimodal approach for image-guidance in glioma surgery, highlighting the different features of advanced US modalities: fusion imaging with pre-operative acquired MRI for Virtual Navigation, B-mode, Doppler (power-, color-, spectral-), CEUS, and elastosonography.Methods: We describe, in a step-by-step fashion, the applications of the most relevant advanced US modalities during different stages of surgery and their implications for surgical decision-making. Each US modality is illustrated from a technical standpoint and its application during glioma surgery is discussed.Results: B-mode offers dynamic morphological information, which can be further implemented with fusion imaging to improve image understanding and orientation. Doppler imaging permits to evaluate anatomy and function of the vascular tree. CEUS allows to perform a real-time angiosonography, providing valuable information in regards of parenchyma and tumor vascularization and perfusion. This facilitates tumor detection and surgical strategy, also allowing to characterize tumor grade and to identify residual tumor. Elastosonography is a promising tool able to better define tumor margins, parenchymal infiltration, tumor consistency and permitting differentiation of high grade and low grade lesions.Conclusions: Multimodal ioUS represents a valuable tool for glioma surgery being highly informative, rapid, repeatable, and real-time. It is able to differentiate low grade from high grade tumors and to provide the surgeon with relevant information for surgical decision-making. ioUS could be integrated with other intra-operative imaging and functional approaches in a synergistic manner to offer the best image guidance for each patient.

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