Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Shetty, Prakash; Yeole, Ujwal; Singh, Vikas; Moiyadi, Aliasgar

doi:10.3171/2020.10.focus20550

Cited by 15 publications

(21 citation statements)

References 15 publications

(24 reference statements)

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“…A 100% concordance rate between 3D iUS and iMRI was reported in the study, which is different from those reported in the literature (20). Considering only newly diagnosed gliomas, iUS's sensitivity and specificity in this study were 100% when finding residual tumors following tumor resection.…”

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confidence: 95%

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Advantages of Using 3D Intraoperative Ultrasound and Intraoperative MRI in Glioma Surgery

Hou

Tang²

2022

Front. Oncol.

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We read with great interest the recent article by Bastos et al (1):" Challenges and Opportunities of Intraoperative 3D Ultrasound with Neuronavigation in Relation to Intraoperative MRI".In this study, the authors reported their experiences using both 3D intraoperative ultrasound (iUS) and intraoperative MRI (iMRI) in 23 glioma surgeries. In 65% of patients, the tumors are located near the eloquent areas. 43% were recurrent cases. Three 3D iUS scans were routinely performed before and after dural opening and before the iMRI scan. More 3D iUS scans might be added if necessary. After tumor resection, one or two iMRI scans were performed to confirm the residual tumor. Multimodule neuro-navigation and electrophysiological monitoring techniques were also utilized during surgery. After surgery, 53% of patients achieved gross total resection. 21% of patients had temporary neurological deficits. None of them were permanent. In 82% of patients, the results of iUS were consistent with iMRI findings. While in the other four recurrent cases, the image quality of iUS was poor for the authors to decide.Three cases were presented in the paper. Case one was a small tumor located just before the precentral gyrus. IUS showed an apparent brain shift just after the dural opening. This information helped the surgeon choose the right site without causing injuries to the precentral gyrus. Case two was a giant left temporal glioma surrounded by bunches of fiber tracts. Multiple iUS scans were utilized to assess the resection process serially and helped the surgeon find the residual tumor. Case three was a low-grade glioma growing along the cingulate gyrus. 3D iUS helped the surgeon choose a safe corridor between functional areas and delineate the anatomical structures surrounding the tumor. The small residual tumor was found by iUS and confirmed by iMRI. The authors concluded that using 3D iUS in relation to iMRI had practical benefits for glioma surgeries and challenges.We agree with the authors' opinion regarding the advantages and limitations of the iUS and iMRI. Combining these two techniques in glioma surgery seems reasonable and promising. Their conclusions are well supported by the data and illustrated cases. In addition to congratulating the authors, we would like to point out a few issues.The initial surgical treatment of glioma aims to obtain the maximal extent of resection (EOR) while preserving neurological function (2, 3). However, surgeon assessment of EOR based on visualization is prone to error, even when performed by experienced clinicians (4). Therefore, intraoperative imaging techniques such as iUS and iMRI were introduced into glioma surgery to achieve reliable resection control.iUS has been used in neurosurgery since the 1980s and is significantly correlated with preoperative MRI assessment of tumor volume (5-7). Mounting evidence also demonstrates the beneficial effects of ioUS for resection control in glioma surgery (8-10). The notable advantage of

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confidence: 95%

“…In 65% of selected patients, the tumors were located near the eloquent areas. The functional result after surgery was also excellent compared with the literature data (20,24). Previous iUS series reported that surgery-induced permanent neurological deficits occurred in 8%-13% of patients (25,26).…”

supporting

confidence: 57%

Advantages of Using 3D Intraoperative Ultrasound and Intraoperative MRI in Glioma Surgery

Hou

Tang²

2022

Front. Oncol.

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“…Over the last few years, navigated IOUS has been developed in order to enable the fusion between intraoperative imaging (IOUS) and preoperative imaging (MRI) used for neuronavigation in order to obtain a real-time anatomical and functional feedback from IOUS imaging without interrupting surgery. Moreover, navigated IOUS promotes familiarity with IOUS for neurosurgeons, and it helps to adapt the surgical strategy on real intraoperative scenarios (2)(3)(4)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

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

Giammalva

Ferini²,

Musso

et al. 2022

Front. Oncol.

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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.

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“…iUS allowed us to enhance neuronavigation by providing important information regarding the best window between two functional areas to proceed with a corticectomy (Case 3). A recent study of 210 glioma patients reported that serially acquired navigated iUS played an important role in assessing resection progress (32).…”

Section: Ius and Navigationmentioning

confidence: 99%

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

et al. 2021

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IntroductionNeuronavigation greatly improves the surgeon’s ability to approach, assess and operate on brain tumors, but tends to lose its accuracy as the surgery progresses and substantial brain shift and deformation occurs. Intraoperative MRI (iMRI) can partially address this problem but is resource intensive and workflow disruptive. Intraoperative ultrasound (iUS) provides real-time information that can be used to update neuronavigation and provide real-time information regarding the resection progress. We describe the intraoperative use of 3D iUS in relation to iMRI, and discuss the challenges and opportunities in its use in neurosurgical practice.MethodsWe performed a retrospective evaluation of patients who underwent image-guided brain tumor resection in which both 3D iUS and iMRI were used. The study was conducted between June 2020 and December 2020 when an extension of a commercially available navigation software was introduced in our practice enabling 3D iUS volumes to be reconstructed from tracked 2D iUS images. For each patient, three or more 3D iUS images were acquired during the procedure, and one iMRI was acquired towards the end. The iUS images included an extradural ultrasound sweep acquired before dural incision (iUS-1), a post-dural opening iUS (iUS-2), and a third iUS acquired immediately before the iMRI acquisition (iUS-3). iUS-1 and preoperative MRI were compared to evaluate the ability of iUS to visualize tumor boundaries and critical anatomic landmarks; iUS-3 and iMRI were compared to evaluate the ability of iUS for predicting residual tumor.ResultsTwenty-three patients were included in this study. Fifteen patients had tumors located in eloquent or near eloquent brain regions, the majority of patients had low grade gliomas (11), gross total resection was achieved in 12 patients, postoperative temporary deficits were observed in five patients. In twenty-two iUS was able to define tumor location, tumor margins, and was able to indicate relevant landmarks for orientation and guidance. In sixteen cases, white matter fiber tracts computed from preoperative dMRI were overlaid on the iUS images. In nineteen patients, the EOR (GTR or STR) was predicted by iUS and confirmed by iMRI. The remaining four patients where iUS was not able to evaluate the presence or absence of residual tumor were recurrent cases with a previous surgical cavity that hindered good contact between the US probe and the brain surface.ConclusionThis recent experience at our institution illustrates the practical benefits, challenges, and opportunities of 3D iUS in relation to iMRI.

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Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Cited by 15 publications

References 15 publications

Advantages of Using 3D Intraoperative Ultrasound and Intraoperative MRI in Glioma Surgery

Advantages of Using 3D Intraoperative Ultrasound and Intraoperative MRI in Glioma Surgery

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

Challenges and Opportunities of Intraoperative 3D Ultrasound With Neuronavigation in Relation to Intraoperative MRI

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