Navigated versus Non-Navigated Intraoperative Ultrasound: Is There Any Impact on the Extent of Resection of High-Grade Gliomas? A Retrospective Clinical Analysis

Abstract

Introduction The extent of tumor resection is a significant predictor of survival in highgrade gliomas. In recent years, several authors showed the benefit of intraoperative ultrasound partially matched with magnetic resonance imaging (MRI). The aim of this study was to find out if intraoperative neuronavigation in combination with intraoperative ultrasound has any impact on the complete resection of gliomas. A comparison between the ultrasound-controlled resection of brain tumors and operations controlled by navigated ultrasound was performed. Materials and Methods A total of 92 patients (54 men and 39 women) with a mean age of 53.2 years underwent 93 operations over a period of 4 years (2007)(2008)(2009)(2010). They harbored a tumor with suspicion of glioma; 32 of them had undergone previous surgery, and additional chemotherapy, and 29 of them had undergone irradiation. Overall, 49 operations were performed with navigated ultrasound (group A) and 44 with nonnavigated ultrasound (group B). A standardized early postoperative MRI was performed . Complete or gross total resection (GTR) was defined by a resection of 95% of the tumor. Skin incision and craniotomy were planned after registration of the neuronavigation system. The ultrasound system was used systematically before and after opening the dura, and during and at the end of resection. Results GTR could be achieved in 28 of 49 cases in group A and in 23 of 44 cases in group B. In group A, sensitivity and specificity of tumor remnants detected by ultrasound were higher than in group B. Concerning recurrent gliomas, the sensitivity of ultrasound visualizing tumor remnants was lower than in primary tumors. In case of preoperatively planned GTR, in both groups (navigated and non-navigated ultrasound) similar tumor remnant sizes were postoperatively detected by MRI. In nine cases the removal was incomplete because of eloquently located tumors. There was no significant difference between navigated and not-navigated ultrasound concerning GTR (p > 0.05).

A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery

“…There were 19 studies identified using craniotomy [3,4,7,9,10,11,12,32,33,34,35,36,37,38,39,40,41,42,43]. Of these, 6 articles were excluded [3,32,37,42,43] due to an inability to break out complications related to surgery in areas of eloquence.…”

“…Of these, 6 articles were excluded [3,32,37,42,43] due to an inability to break out complications related to surgery in areas of eloquence. Additionally, one article was excluded [12] due to the assumption that these patients were reported on in Kim et al [33] and to reduce the chance of double counting.…”

Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology

“…8 , 9 ). Renovanz et al [ 7 ] showed that the sensitivity and specificity of the detection of tumor remnants were higher in nUS than in non-nUS imaging. Additional comparative studies are needed to critically analyze the benefits of nUS.…”

Intraoperative Ultrasound-Guided Resection of Gliomas: A Meta-Analysis and Review of the Literature

“…Another study compared high field IoMRI and linear array IoUS in 44 grade II astrocytoma biopsies to evaluate their accuracy and found imaging results of linear-array IoUS significantly correlated to high field IoMRI images (Spearman's Rho p < 0.009), the specificity of both modalities was 67%, and the sensitivity of IoMRI was higher than IoUS (83% versus 79% respectively) 52 . Another randomised study of GTR between IGS and IoUS was used to compare GTR of 95% or more in 93 HGG; the IoUS sensitivity and specificity were higher than IGS alone, the sensitivity of IoUS was superior in newly diagnosed HGG compared to recurrent HGG, and there was no significant difference in the GTR rates between IoUS and IGS 53 . One of the major limitations of IoUS was that it cannot assist in the size or location of the skull opening and hence it is best used in conjunction with other IGS technologies.…”