Ultrasound-guided brain surgery: echographic visibility of different pathologies and surgical applications in neurosurgical routine

Policicchio, Domenico; Doda, Artan; Sgaramella, E.; Ticca, Stefano; Santonio, Filippo Veneziani; Boccaletti, Riccardo

doi:10.1007/s00701-018-3532-x

Cited by 26 publications

(23 citation statements)

References 24 publications

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“…Technical adjuncts including the intraoperative ultrasonography and neuronavigation were used only for tumor localization but not for resection control. Similar to what other authors have described (55)(56)(57), the visibility of intraoperative ultrasonography remained clear during the surgical procedure and was helpful in tumor resection in 86.67% (13/15) of cases (56). There were few reports referring to combination of ultrasound and fluorescence-guided BM resection.…”

Section: Advances In Technologysupporting

confidence: 80%

Surgical Management of Brain Metastases in the Perirolandic Region

Zuo

Hu²,

Kong³

et al. 2020

Front. Oncol.

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Brain metastases (BM) are the most frequent intracranial tumors, which may result in significant morbidity and mortality when the lesions involve the perirolandic region. Surgical intervention for BM in the perirolandic region is still under discussion even though prompt relief of mass effect and avoidance of necrosis together with brain edema may not be achieved by radiotherapy. More recently, several researchers attempt to evaluate the benefit of surgery for BM within this pivotal sensorimotor area. Nevertheless, data are sparse and optimal treatment paradigm is not yet widely described. Since the advance in intraoperative neuroimaging and neurophysiology, resection of BM in the perirolandic region has been proven to be safe and efficacious, sparing this eloquent area while retaining reasonably low morbidity rates. Although management of BM becomes much more tailored and multimodal, surgery remains the cornerstone and principles of resection as well as indications for surgery should be well defined. This is the first review concerning the characteristics of BM involving the perirolandic region and the current impact of surgical therapy for the lesions. Future perspectives of advanced neurosurgical techniques are also presented.

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Section: Advances In Technologysupporting

confidence: 80%

Surgical Management of Brain Metastases in the Perirolandic Region

Zuo

Hu²,

Kong³

et al. 2020

Front. Oncol.

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“…11,12 Literature data suggest that US could detect residual tumor tissue with high specificity and thus improve GTR. 12,[30][31][32][33][34][35][36] We therefore thought of integratingIONM (which identifies the "functional" limit of resection) with the US data (which identify the "anatomical" limits). The integration of IONM and 3D-iUS acquisitions identifies the eloquent areas in the surgical field, then tumor and the steps of tumor removal.…”

Section: Discussionmentioning

confidence: 99%

“…It is common to observe a reduction of the image quality during the procedure due to surgical artifacts that decrease the US visibility of the lesion and particularly the definition of its edges. 12 The role of 3D US was widely studied by the Trondheim group. [31][32][33]35 Their studies show that while US is highly accurate in delineating tumors before resection, it appears less accurate during and after that.…”

Section: Discussionmentioning

confidence: 99%

“…We had similar results in our previous experience on 162 patients in whom resection control was found to be persuasive in 83%. 12 Schucht et al 37 and Feigl et al 38 used neurophysiological mapping during intraoperative 5-ALA-guided resection of GBMs adjacent to motor-eloquent areas. Of 67 patients in the Schucht et al series, complete resection was achieved in 49 (73%), whereas 4% had persisting postoperative motor deficits 37 after 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…The system has been previously described elsewhere. 11,12 In all the patients, in addition to the previously described complete neuroradiological diagnostic protocol, a preoperative volumetric examination with standard skin-adhering fiducials placed on the scalp was acquired on the day prior to surgery (MRI with gadolinium in 19 patients and CECT in 6 patients). Images were transferred to the neuronavigation system.…”

Section: Neuronavigation and Intraoperative Ultrasoundmentioning

confidence: 99%

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Multimodal Surgical Management of Cerebral Lesions in Motor-Eloquent Areas Combining Intraoperative 3D Ultrasound with Neurophysiological Mapping

Policicchio

Ticca

Dipellegrini

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background Resection of tumors adjacent to motor pathways carries risks of both postoperative motor deficit and incomplete resection. Our aim was to assess usefulness and limitations of a multimodal strategy that combines intraoperative ultrasound (iUS) guided resection with intraoperative neurophysiology. Methodology This is a prospective study of 25 patients with brain lesions adjacent to motor areas who underwent intracranial surgery with assistance of the iUS guidance system and intraoperative neurophysiological monitoring and mapping. Pathologies treated included 19 gliomas, 3 metastases, 1 anaplastic meningioma, 1 arteriovenous malformation (AVM), and 1 ependymoma. The iUS-guided lesion removal accuracy and the extent of resection were estimated and compared with a 30-day postoperative brain MRI. The results were assessed considering the extent of resection related to 6-month motor function outcome. Results iUS was accurate in checking the extent of resection in 17 patients, whereas in 8 cases the decline of the iUS images quality did not allow a valuable assessment. Positive mapping was obtained in 16 patients. Gross total resection was achieved in 16 patients. In five of nine cases with subtotal resection, surgery was stopped because a functional area was reached. In four patients, tumor removal was limited due to the difficulty of identifying neoplastic tissue. Motor function worsening was transient in six patients and permanent in two. Conclusions The integrated use of intraoperative neuromonitoring to identify motor areas and iUS to identify tumor–tissue interface could help increase the rate of radical resection respecting the eloquent areas.

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