Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas

Moiyadi, Aliasgar; Shetty, Prakash; Mahajan, Abhishek; Udare, Amar; Epari, Sridhar

doi:10.1007/s00701-013-1881-z

Cited by 68 publications

(55 citation statements)

References 31 publications

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“…This system has been previously described in detail. 7,16 Although it can function as a routine navigation platform using preoperative MR images, it includes the capability of acquiring reformatted 3D ultrasound images that can be tracked. The 3D ultrasound can be used in conjunction with preoperative MR images, or it can be used by itself as a stand-alone direct navigated ultrasound (dNUS) option.…”

Section: Methodsmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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OBJECTIVE Navigated 3D ultrasound is a novel intraoperative imaging adjunct permitting quick real-time updates to facilitate tumor resection. Image quality continues to improve and is currently sufficient to allow use of navigated ultrasound (NUS) as a stand-alone modality for intraoperative guidance without the need for preoperative MRI. METHODS The authors retrospectively analyzed cases involving operations performed at their institution in which a 3D ultrasound navigation system was used for control of resection of brain tumors in a “direct” 3D ultrasound mode, without preoperative MRI guidance. The usefulness of the ultrasound and its correlation with postoperative imaging were evaluated. RESULTS Ultrasound was used for resection control in 81 cases. In 53 of these 81 cases, at least 1 intermediate scan (range 1–3 intermediate scans) was obtained during the course of the resection, and in 50 of these 53 cases, the result prompted further resection. In the remaining 28 cases, intermediate scans were not performed either because the first ultrasound scan performed after resection was interpreted as showing no residual tumor (n = 18) and resection was terminated or because the surgeon intentionally terminated the resection prematurely due to the infiltrative nature of the tumor and extension of disease into eloquent areas (n = 10) and the final ultrasound scan was interpreted as showing residual disease. In an additional 20 cases, ultrasound navigation was used primarily for localization and not for resection control, making the total number of NUS cases where radical resection was planned 101. Gross-total resection (GTR) was planned in 68 of these 101 cases and cytoreduction in 33. Ultrasound-defined GTR was achieved in 51 (75%) of the cases in which GTR was planned. In the remaining 17, further resection had to be terminated (despite evidence of residual tumor on ultrasound) because of diffuse infiltration or proximity to eloquent areas. Of the 33 cases planned for cytoreduction, NUS guidance facilitated ultrasound-defined GTR in 4 cases. Overall, ultrasound-defined GTR was achieved in 50% of cases (55 of 111). Based on the postoperative imaging (MRI in most cases), GTR was achieved in 58 cases (53%). Final (postresection) ultrasonography was documented in 78 cases. The findings were compared with the postoperative imaging to ascertain concordance in detecting residual tumor. Overall concordance was seen in 64 cases (82.5%), positive concordance was seen in 33 (42.5%), and negative in 31 (40%). Discordance was seen in 14 cases—with ultrasound yielding false-positive results in 7 cases and false-negative results in 7 cases. Postoperative neurological worsening occurred in 15 cases (13.5%), and in most of these cases, it was reversible by the time of discharge. CONCLUSIONS The results of this study demonstrate that 3D ultrasound can be effectively used as a stand-alone navigation modality during the resection of brain tumors. The ability to provide repeated, high-quality intraoperative updates is useful for guiding resection. Attention to image acquisition technique and experience can significantly increase the quality of images, thereby improving the overall utility of this modality.

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Section: Methodsmentioning

confidence: 99%

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Moiyadi¹,

Shetty²

2016

FOC

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“…In a series of 81 patients in which three-dimensional USG was used, diagnostic images close to preoperative MRI were acquired due to intraoperative use [7]. In another series of 90 patients, the presence of concurrent vascular structures was demonstrated using intraoperative doppler USG in addition to three-dimensioned USG support [16]. Successful results were acquired in demonstrating tumor borders in studies using contrast-enhanced USG in the intraoperative imaging of intracranial pathologies [17,18].…”

Section: Journal Of Clinical and Analytical Medicinementioning

confidence: 79%

Intraoperative ultrasound use in intracranial lesion surgery: An initial institution experience

Aydın¹

2018

Ann Clin Anal Med

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Aim: Intraoperative ultrasound imaging is used in brain tumor surgery to identify tumor remnants. In this study, we aimed to evaluate the resection success of the brain lesions in different nature using ultrasonography (USG) and to analyze the effects of USG. Material and Method: USG assisted surgical resection was performed in 23 patients who had a preliminary diagnosis of brain tumors in our hospital. The resection borders and residual tumor tissue were checked intraoperatively by USG and postoperatively by magnetic resonance imaging in all patients. Results: The borders, cavities, and locations of operated 8 patients with glial tumors, 6 patients with meningiomas, 7 patients with metastases and 2 patients with intracranial abscesses were all determined with accuracy.Glial tumors were hypoechoic, and meningiomas were hyperechoic in USG, and the borders could be clearly distinguished. Difficulty in determining the exact border of the tumor was experienced only in tumors with large edema and diffuse nature. Gross total excision was achieved in all cases, and no additional neurological deficit was observed in any patient. Discussion: Color Doppler USG shows the relationship between the brain lesions and vascular structures, and this increases the success of the surgery. Another advantage of the USG is the real-time intraoperative determination of the resection degree, low cost, and the device being portable.

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“…Recent publications from other groups also show that there are many others exploring the use of ultrasound imaging in neurosurgery, and it is our impression that the clinical interest in using ultrasound for intraoperative brain imaging is steadily increasing. 9,[11][12][13]17 To encourage more research in this field, we have launched the fully open source software CustusX as a research platform for ultrasound-and image-guided therapy. 3 The software can be downloaded at www.custusx.org.…”

Section: Concluding Remarks and Suggestions For Further Actionsmentioning

confidence: 99%

Editorial: Ultrasound-guided neurosurgery: experiences from 20 years of cross-disciplinary research in Trondheim, Norway

Selbekk

Solheim

Unsgård

2016

FOC

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Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas

Cited by 68 publications

References 31 publications

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance

Intraoperative ultrasound use in intracranial lesion surgery: An initial institution experience

Editorial: Ultrasound-guided neurosurgery: experiences from 20 years of cross-disciplinary research in Trondheim, Norway

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