Tag: 3D ultrasound

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3D ultrasound–guided resection of low-grade gliomas: principles and clinical examples

Neurosurg Focus 47 (6):E9, 2019

3D ultrasound (US) is a convenient tool for guiding the resection of low-grade gliomas, seemingly without deterioration in patients’ quality of life.

This article offers an update of the intraoperative workflow and the general principles behind the 3D US acquisition of high-quality images.

The authors also provide case examples illustrating the technique in two small mesial temporal lobe lesions and in one insular glioma. Due to the ease of acquiring new images for navigation, the operations can be guided by updated image volumes throughout the entire course of surgery.

The high accuracy offered by 3D US systems, based on nearly realtime images, allows for precise and safe resections. This is especially useful when an operation is performed through very narrow transcortical corridors.

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

Acta Neurochirurgica (2018) 160:1175–1185

The use of intraoperative ultrasound (iUS) has increased in the last 15 years becoming a standard tool in many neurosurgical centers. Our aim was to assess the utility of routine use of iUS during various types of intracranial surgery. We reviewed our series to assess ultrasound visibility of different pathologies and iUS applications during the course of surgery.

Materials and methods This is a retrospective review of 162 patients who underwent intracranial surgery with assistance of the iUS guidance system (SonoWand). Pathologic categories were neoplastic (135), vascular (20), infectious (2), and CSF related (5). Ultrasound visibility was assessed using the Mair classification, a four-tiered grading system that considers the echogenicity of the lesion and its border visibility (from 0 to 3; grade 0, pathology not visible; grade 3, visible with clear border with normal tissue). iUS applications included lesion localization, approach planning to deep-seated lesions, and lesion removal.

Results All pathologies were visible on iUS except one aneurysm. On average, extra-axial tumors were identified more easily and had clearer limits compared to intra-axial tumors (extra-axial 17%grade 2, 83%grade 3; intra-axial 5.5% grade 1, 46.5%grade 2, 48% grade 3). iUS provided precise and safe transcortical trajectories to deep-seated lesions (71 patients; tumors, hemangiomas, ICHs); iUS was judged to be less useful to approach skull base tumors and aneurysms. iUS was used to judge extent of resection in 152 cases; surgical artifacts reduced sonographic visibility in 25 cases: extent of resection was correctly checked in 127 patients (53 gliomas, 15 metastases, 39 meningiomas, 4 schwannomas, 4 sellar region tumors, 6 hemangiomas, 3 AVMs, 2 abscesses).

Conclusions iUS was highly sensitive in detecting all types of pathology, was safe and precise in planning trajectories to intraparenchymal lesions (including minimally mini-invasive approaches), and was accurate in checking extent of resection in more than 80% of cases. iUS is a versatile and feasible tool; it could improve safety and its use may be considered in routine intracranial surgery.

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