Real-time ultrasound imaging of cerebral lesions during ?target point? stereotactic procedures through a burr hole

Abstract

Stereotactic burr-hole procedures like biopsies of brain tumours based on CT scan or MRI and angiographic data have so far usually been carried out without real-time ultrasound image control. Intra-operative real-time ultrasound imaging was carried out during twelve target-point stereotactic procedures via a single standard burr-hole using a new slender ultrasound transducer with a diameter of 8 mm. The technical parameters of the transducer are: frequency range of 5 < - > 3.5 MHZ, phased array sector scan, 90 degree sector. The transducer has a bayonet-like configuration and can be sterilized. Sufficient quality of the images was achieved in these twelve cases with different pathological entities such as malformation cysts (3 cases), gliomas (7 cases), one metastasis and one intracerebellar haemorrhage. Moreover, co-ordinate values may be calculated from the ultrasound images generated peroperatively, allowing the surgeon to choose additional targets. Colour flow mapping provides the visualization of vascular structures. For the beginner stereotaxy may be easier to learn using ultrasound real-time imaging.

Ultrasound-Guided Aspiration of Brain Abscesses Through a Single Burr Hole

“…Moringlane et al used a similar probe like ours to survey frame-based stereotactic procedures and clearly demonstrated sufficient quality of imaging although image resolution tended to be relatively poor at distances longer than 60 mm due to the limited acoustic aperture of the probe. Nevertheless, they demonstrated the case of a retroclival cyst excellently visualized through a coronal burr hole [16]. As a consequence we abandoned frame-based stereotaxy and used the presented small probe as an independent guiding tool.…”

“…Furthermore, this consecutive technique did not allow real-time imaging of the procedure. This was achieved by Tsutsumi et al in 1989 with a round ultrasound probe of 12 mm [15] and finally Moringlane et al demonstrated real-time ultrasound imaging of frame-based stereotactic procedures using a probe with tip dimensions of 8 8 mm [16]. The question of this study is whether it is possible to safely localize and aspirate brain abscesses under ultrasound guidance alone using a probe that is small enough to allow a single standard burr hole approach.…”

Comparison of outcomes of free-hand 2-dimensional ultrasound-guided versus navigated 3-dimensional ultrasound-guided biopsy for supratentorial tumours: a single-institution experience with 125 cases

“…In addition, US can help in assessing the presence of residue, looking for hematomas, and identifying the surrounding normal anatomy, and it also provides information about the vasculature [2]. With advances in technology and the development of special small probes, it is possible to obtain accurate, high-resolution, and high-quality images of intracranial structures, even through burr holes or small craniotomies [3,4]. There is no need for preoperative navigation MRI sequences or fiducial markers, thus eliminating inaccuracies in image-to-patient registration.…”

A new method of ultrasonic guidance of neuroendoscopic procedures

“…That finally was achieved after development of miniaturized probes that allowed a single burr-hole approach. 18,28 In a recent paper we presented our experience with guiding cannulas to create intracranial punctures in the ventricular system, cysts, tumors, hematomas, and abscesses. 27 Endoscopy is a very old neurosurgical procedure first described by Lespinasse in 1910, 9 but modern neuroendoscopy started in the late 1980s as frame-based "stereotactic neuroendoscopy."…”