Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high–field strength MR imaging for tumor resection control: a prospective comparative study

Gerganov, Venelin; Samii, Amir; Akbarian, Arasch; Stieglitz, Lennart; Samii, Madjid; Fahlbusch, Rudolf

doi:10.3171/2009.2.jns08535

Cited by 70 publications

(58 citation statements)

References 39 publications

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“…Another technique extensively used during neurosurgical procedures is intra-operative Ultrasounds (iUS); in recent years, multiple studies demonstrated their value in tumor detection during surgery, giving to iUS a foreground position in the field of intraoperative imaging [6][7][8][9]. The main point of value of iUS consists in obtaining a real-time scan repeatable as many times as necessary without the cost and the duration of other intraoperative techniques.…”

Section: Introductionmentioning

confidence: 99%

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

et al. 2014

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The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.Keywords Navigation Á Brain shift Á Intraoperative imaging Á Ultrasound Á Brain tumor Á Fusion imaging Sommario Il principale difetto della neurochirurgia guidata da immagini è il basarsi su immagini acquisite prima dell'intervento, che per ovvie ragioni non possono tenere conto di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti e l'asportazione di tessuto patologico. L'ecografia intra-operatoria (iUS) sta acquisendo sempre maggior rilevanza in ambito neurochirurgico ma è limitata dalla difficoltosa interpretazione dell'orientamento delle immagini e dalla scarsa panoramicità. In questo articolo descriviamo la nostra tecnica di neuronavigazione real-time basata sull'ecografia intra-operatoria. Fino ad ora abbiamo impiegato la fusione d'immagini tra la risonanza magnetica (MRI) pre-operatoria e l'iUS in 67 pazienti affetti da neoplasie cerebrali. La pianificazione dell'intervento e l'approccio chirurgico è basata sulla (MRI) pre-operatoria mentre l'intervento è guidato dall'iUS. Basandosi sull'iUS è possibile correggere la calibrazione delle immagini (MRI) pre-operatorie correggendo il brain-shift, aggiornando continuamente le due modalità. L'ecografia intra-operatoria permette una eccellente identificazione dei target, dei margini e delle strutture circostanti. L'uso del navigatore basato su (MRI) pre-operatoria è utile nella comprensione delle immagini ecografiche soprattutto per quanto riguarda l'orientazione e la visione panoramica. Le correzione del sistema di neuronavigazione basate sull'iUS sono accurate e utili nel caso di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti ...

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Section: Introductionmentioning

confidence: 99%

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

et al. 2014

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“…The objective 1 of surgical treatment is to achieve complete tumor resection with minimal damage to adjacent structures. The use of intraoperative image guidance, such as neuronavigation, magnetic resonance imaging (MRI) or ultrasonography (US), allows a more accurate detection of BM and reveals their anatomical relationships, possibly leading to better surgical results [16][17][18][19] . The present study reports a series of twenty patients with BM in whom intraoperative ultrasound, henceforth referred to as IOUS, was used to locate and guide tumor resection, as well as to prevent vascular injuries.…”

mentioning

confidence: 99%

Intraoperative ultrasonography for presumed brain metastases: a case series study

Picarelli¹,

Oliveira

Bor-Seng-Shu

et al. 2012

Arq. Neuro-Psiquiatr.

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Brain metastases (BM) represent more than 50% of intracranial tumors in the adult population and have shown an increasing incidence over recent decades 1,2 . Around 170,000 patients per year are diagnosed with BM in the United States of America. In addition, 10% to 40% of oncologic patients develop BM in the course of the disease [1][2][3][4][5][6][7][8] . The factors associated with this increasing incidence include advances in neuroimaging techniques, easier access to health care systems, and increased survival of cancer patients. The best strategy for treating BM remains controversial, but the management includes radiotherapy, stereotactic radiosurgery and surgical resection. Patients are typically treated according to age, functional performance, neurological status, type of cancer, number and localization of BM, radiosensitivity and chemosensitivity of the tumors, and systemic control of the primary cancer [5][6][7][8] . Local control of BM can restore neurological functional status and increase survival of patients that may die due to extracranial progression of the disease [9][10][11][12] . Some trials suggest that neurosurgical resection is a good option, presenting low recurrence rates especially when followed by radiotherapy [6][7][8]11,12 . BM resection can rapidly decrease the mass effect and surrounding edema, improve symptoms and quality of life, control epileptic seizures and provide tissue for histological analysis and diagnosis of suspected lesions [6][7][8] . In addition, resection of multiple BM can also bring positive outcomes if systemic cancer is controlled [13][14][15] . The objective ABSTRACTBrain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. Methods: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. Results: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. Conclusion: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.Key words: intraoperative ultrasound, brain metastases, neurosurgery. RESUMOAs metástases cerebrais (MC) são os tumores intracranianos mais frequentes e seu tratamento cirúrgico pode melhorar a sobrevida e a funcionalidade do paciente, especialmente quando a doença sistêmica está controlada. A ressecção das MC guiada por imagens de exames intraoperatórios, como ultrassom intraoper...

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“…However, iMRI requires very high standard infrastructure, which is expensive both in installment and maintenance, and its image acquisition time is relatively long. A popular alternative is ultrasound, which is also capable of real-time imaging of brain tumors [19,20]. However, its reliability in detecting tumor is less than that of iMRI; Gerganov et al compared the ultrasound technique with iMRI and pointed out that ultrasound could be used to detect more confined deeply located remnants of low-or high-grade tumors with high accuracy, though its accuracy is limited when detecting superficial remnants [20].…”

Section: Aimmentioning

confidence: 99%

“…It is capable of detecting neoplastic tumors because of their hyperechoic characteristic, which is associated with the structural abnormalities of brain tumors [19,20]. While it is very accurate in detecting confined, deeply located remnants of low-or high-grade tumors, the accuracy of ultrasound imaging is limited when detecting superficial remnants [20]. In addition, ultrasound is less likely to differentiate tumor from peritumoral edema that is also hyperechoic [21,22].…”

Section: Ultrasoundmentioning

confidence: 99%

“…A popular alternative is ultrasound, which is also capable of real-time imaging of brain tumors [19,20]. However, its reliability in detecting tumor is less than that of iMRI; Gerganov et al compared the ultrasound technique with iMRI and pointed out that ultrasound could be used to detect more confined deeply located remnants of low-or high-grade tumors with high accuracy, though its accuracy is limited when detecting superficial remnants [20]. by simply analyzing the intensities of diffuse reflectance spectra in the near infrared region [64].…”

Section: Aimmentioning

confidence: 99%

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Intraoperative Guidance for Pediatric Brain Surgery based on Optical Techniques

Song¹

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Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high–field strength MR imaging for tumor resection control: a prospective comparative study

Cited by 70 publications

References 39 publications

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery

Intraoperative ultrasonography for presumed brain metastases: a case series study

Intraoperative Guidance for Pediatric Brain Surgery based on Optical Techniques

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