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The Value of Intraoperative Ultrasound in Brain Surgery

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 50))

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Abstract

Favorable clinical outcomes in adult and pediatric neurosurgical oncology generally depend on the extent of tumor resection (EOR). Maximum safe resection remains the main aim of surgery in most intracranial tumors. Despite the accuracy of intraoperative magnetic resonance imaging (iMRI) in the detection of residual intraoperatively, it is not widely implemented worldwide owing to enormous cost and technical difficulties. Over the past years, intraoperative ultrasound (IOUS) has imposed itself as a valuable and reliable intraoperative tool guiding neurosurgeons to achieve gross total resection (GTR) of intracranial tumors.

Being less expensive, feasible, doesn’t need a high level of training, doesn’t need a special workspace, and being real time with outstanding temporal and spatial resolution; all the aforementioned advantages give a superiority for IOUS in comparison to iMRI during resection of brain tumors.

In this chapter, we spot the light on the technical nuances, advanced techniques, outcomes of resection, pearls, and pitfalls of the use of IOUS during the resection of brain tumors.

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References

  1. Chandler WF, Knake JE. Intraoperative use of ultrasound in neurosurgery. Neurosurgery. 1984;31:550–63.

    Article  Google Scholar 

  2. Reid M. Ultrasonic visualization of a cervical cord cystic astrocytoma. Am J Roentgenol. 1978;131:907–8.

    Article  CAS  Google Scholar 

  3. Coburger J, König RW. Intraoperative findings in brain tumor surgery. In: Prada F, Solbiati L, Martegani A, DiMeco F, editors. Intraoperative ultrasound (IOUS) in neurosurgery: from standard B-mode to elastosonography. Cham: Springer International Publishing; 2016. p. 41–58.

    Chapter  Google Scholar 

  4. Unsgaard G, Gronningsaeter A, Ommedal S, Nagelhus Hernes TA. Brain operations guided by real-time two-dimensional ultrasound: new possibilities as a result of improved image quality. Neurosurgery. 2002;51:402–11. discussion 411–412.

    Article  PubMed  Google Scholar 

  5. Dixon L, Lim A, Grech-Sollars M, Nandi D, Camp S. Intraoperative ultrasound in brain tumor surgery: a review and implementation guide. Neurosurg Rev. 2022;45:2503–15.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sweeney JF, Smith H, Taplin A, Perloff E, Adamo MA. Efficacy of intraoperative ultrasonography in neurosurgical tumor resection. J Neurosurg Pediatr. 2018;21:504–10.

    Article  PubMed  Google Scholar 

  7. Del Bene M, Perin A, Casali C, Legnani F, Saladino A, Mattei L, Vetrano IG, Saini M, DiMeco F, Prada F. Advanced ultrasound imaging in glioma surgery: beyond gray-scale B-mode. Front Oncol. 2018;8:576.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Serra C, Stauffer A, Actor B, Burkhardt J-K, Ulrich NH-B, Bernays R-L, Bozinov O. Intraoperative high frequency ultrasound in intracerebral high-grade tumors. Ultraschall Med. 2012;33:E306–12.

    Article  CAS  PubMed  Google Scholar 

  9. Aleo D, Elshaer Z, Pfnür A, Schuler PJ, Fontanella MM, Wirtz CR, Pala A, Coburger J. Evaluation of a navigated 3D ultrasound integration for brain tumor surgery: first results of an ongoing prospective study. Curr Oncol. 2022;29:6594–609.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Saß B, Zivkovic D, Pojskic M, Nimsky C, Bopp MHA. Navigated intraoperative 3D ultrasound in glioblastoma surgery: analysis of imaging features and impact on extent of resection. Front Neurosci. 2022;16:883584.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Roth J, Biyani N, Beni-Adani L, Constantini S. Real-time neuronavigation with high-quality 3D ultrasound SonoWand® in pediatric neurosurgery. PNE. 2007;43:185–91.

    Google Scholar 

  12. de Quintana-Schmidt C, Salgado-Lopez L, Aibar-Duran JA, Alvarez Holzapfel MJ, Cortes CA, Alvarado JDP, Rodriguez RR, Teixidó JM. Neuronavigated ultrasound in neuro-oncology: a true real-time intraoperative image. World Neurosurg. 2022;157:e316–26.

    Article  PubMed  Google Scholar 

  13. Frassanito P, Stifano V, Bianchi F, Tamburrini G, Massimi L. Enhancing the reliability of intraoperative ultrasound in pediatric space-occupying brain lesions. Diagnostics (Basel). 2023;13:971.

    Article  PubMed  Google Scholar 

  14. Mair R, Heald J, Poeata I, Ivanov M. A practical grading system of ultrasonographic visibility for intracerebral lesions. Acta Neurochir. 2013;155:2293–8.

    Article  PubMed  Google Scholar 

  15. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. JCO. 2008;26:1338–45.

    Article  Google Scholar 

  16. El Beltagy MA, Atteya MME. The benefits of navigated intraoperative ultrasonography during resection of fourth ventricular tumors in children. Childs Nerv Syst. 2013;29:1079–88.

    Article  PubMed  Google Scholar 

  17. Yeole U, Singh V, Mishra A, Shaikh S, Shetty P, Moiyadi A. Navigated intraoperative ultrasonography for brain tumors: a pictorial essay on the technique, its utility, and its benefits in neuro-oncology. Ultrasonography. 2020;39:394–406.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Moiyadi AV, Shetty P. Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance. Neurosurg Focus. 2016;40:E5.

    Article  PubMed  Google Scholar 

  19. Rasmussen I-A, Lindseth F, Rygh OM, Berntsen EM, Selbekk T, Xu J, Nagelhus Hernes TA, Harg E, Håberg A, Unsgaard G. Functional neuronavigation combined with intra-operative 3D ultrasound: initial experiences during surgical resections close to eloquent brain areas and future directions in automatic brain shift compensation of preoperative data. Acta Neurochir. 2007;149:365–78.

    Article  PubMed  Google Scholar 

  20. Tao A, Chen X, Zhang L, Chen Y, Cao D, Guo Z, Chen J. Application of intraoperative contrast-enhanced ultrasound in the resection of brain tumors. Curr Med Sci. 2022;42:169–76.

    Article  PubMed  Google Scholar 

  21. Prada F, Bene MD, Fornaro R, et al. Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection. Neurosurg Focus. 2016;40:E7.

    Article  PubMed  Google Scholar 

  22. Chan HW, Bamber J, Dorward N, Chakraborty A, Uff C. Ultrasound elastography. In: Prada F, Solbiati L, Martegani A, DiMeco F, editors. Intraoperative ultrasound (IOUS) in neurosurgery: from standard B-mode to elastosonography. Cham: Springer International Publishing; 2016. p. 173–87.

    Chapter  Google Scholar 

  23. Prada F, Del Bene M, Rampini A, et al. Intraoperative strain elastosonography in brain tumor surgery. Oper Neurosurg. 2019;17:227.

    Article  Google Scholar 

  24. Prada F, Del Bene M, Moiraghi A, DiMeco F. Echographic brain semeiology and topographic anatomy according to surgical approaches. In: Prada F, Solbiati L, Martegani A, DiMeco F, editors. Intraoperative ultrasound (IOUS) in neurosurgery: from standard B-mode to elastosonography. Cham: Springer International Publishing; 2016. p. 29–39.

    Chapter  Google Scholar 

  25. Prada F, Bene MD, Mauri G, Lamperti M, Vailati D, Richetta C, Saini M, Santuari D, Kalani MYS, DiMeco F. Dynamic assessment of venous anatomy and function in neurosurgery with real-time intraoperative multimodal ultrasound: technical note. Neurosurg Focus. 2018;45:E6.

    Article  PubMed  Google Scholar 

  26. El Beltagy MA, Aggag M, Kamal M. Role of intraoperative ultrasound in resection of pediatric brain tumors. Childs Nerv Syst. 2010;26:1189–93.

    Article  PubMed  Google Scholar 

  27. Singhal A, Ross Hengel A, Steinbok P, Doug Cochrane D. Intraoperative ultrasound in pediatric brain tumors: does the surgeon get it right? Childs Nerv Syst. 2015;31:2353–7.

    Article  PubMed  Google Scholar 

  28. Kremer P, Tronnier V, Steiner HH, Metzner R, Ebinger F, Rating D, Hartmann M, Seitz A, Unterberg A, Wirtz CR. Intraoperative MRI for interventional neurosurgical procedures and tumor resection control in children. Childs Nerv Syst. 2006;22:674–8.

    Article  PubMed  Google Scholar 

  29. Ulrich NH, Burkhardt J-K, Serra C, Bernays R-L, Bozinov O. Resection of pediatric intracerebral tumors with the aid of intraoperative real-time 3-D ultrasound. Childs Nerv Syst. 2012;28:101–9.

    Article  PubMed  Google Scholar 

  30. Giussani C, Trezza A, Ricciuti V, Di Cristofori A, Held A, Isella V, Massimino M. Intraoperative MRI versus intraoperative ultrasound in pediatric brain tumor surgery: is expensive better than cheap? A review of the literature. Childs Nerv Syst. 2022;38:1445–54.

    Article  PubMed  Google Scholar 

  31. Mahboob S, McPhillips R, Qiu Z, et al. Intraoperative ultrasound-guided resection of gliomas: a meta-analysis and review of the literature. World Neurosurg. 2016;92:255–63.

    Article  PubMed  Google Scholar 

  32. Moiyadi AV. Objective assessment of intraoperative ultrasound in brain tumors. Acta Neurochir. 2014;156:703–4.

    Article  PubMed  Google Scholar 

  33. van Velthoven V. Intraoperative ultrasound imaging: comparison of pathomorphological findings in US versus CT, MRI and intraoperative findings. In: Bernays RL, Imhof H-G, Yonekawa Y, editors. Intraoperative imaging in neurosurgery. Vienna: Springer; 2003. p. 95–9.

    Chapter  Google Scholar 

  34. Gerganov VM, Samii A, Akbarian A, Stieglitz L, Samii M, Fahlbusch R. Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high-field strength MR imaging for tumor resection control: a prospective comparative study: clinical article. J Neurosurg. 2009;111:512–9.

    Article  PubMed  Google Scholar 

  35. Selbekk T, Jakola AS, Solheim O, Johansen TF, Lindseth F, Reinertsen I, Unsgård G. Ultrasound imaging in neurosurgery: approaches to minimize surgically induced image artefacts for improved resection control. Acta Neurochir. 2013;155:973–80.

    Article  PubMed  Google Scholar 

  36. Erdoğan N, Tucer B, Mavili E, Menkü A, Kurtsoy A. Ultrasound guidance in intracranial tumor resection: correlation with postoperative magnetic resonance findings. Acta Radiol. 2005;46:743–9.

    Article  PubMed  Google Scholar 

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El Beltagy, M.A., Elbaroody, M. (2024). The Value of Intraoperative Ultrasound in Brain Surgery. In: Di Rocco, C. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 50. Springer, Cham. https://doi.org/10.1007/978-3-031-53578-9_6

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  • DOI: https://doi.org/10.1007/978-3-031-53578-9_6

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