Background: Intraoperative ultrasonography (IOUS) represents a cheap and safe alternative to the more expensive intraoperative guidance modalities. In this study, we investigate the impact of introducing IOUS in the surgical management of supratentorial gliomas and compare its use objectively to unguided surgery. Methods: We conducted a prospective cohort study comparing two groups of patients with supratentorial gliomas amenable to gross total resection. One group was operated using intraoperative ultrasound guidance while the other group was operated using a more traditional approach with no intraoperative image guidance. The main outcomes assessed were the extent of tumor resection (EOR) based on early postoperative MRI, the postoperative Karnofsky performance score (KPS), and the rate of complications. Results: There were 17 patients in the ultrasound group and 13 in the control group. EOR was significantly better in the IOUS group. Gross total (GTR) and near-total (NTR) resection were achieved in 29% and 24% respectively in the IOUS group, while 0% and 8% respectively in the control group. The mean volumetric EOR was 83% and 66% in the IOUS and the control groups respectively. Ultrasound was able to detect residual tumor after surgeon perceived GTR in 76% of cases. Postoperative KPS was significantly better in the IOUS group. Conclusion: IOUS guidance is superior to non-guided surgery in terms of EOR. Higher tumor resection confers a survival benefit according to previously published literature. This is particularly useful in a limited-resource setting, where neuronavigation and intraoperative MRI are not available.

Background: Parasagittal meningiomas involving the superior sagittal sinus (SSS) pose formidable obstacles to surgical management. Invasion is often considered a contraindication to surgery because of associated morbidity, such as cerebral venous thrombosis.Aim of the work: was to evaluate the risk/benefit ratio in attempting radical excision of parasagittal meningiomas involving the superior sagittal sinus. Patients and methods:The study consisted of 25 patients who had undergone surgery for parasagittal meningioma. Patients with meningioma involving the anterior third of the sinus underwent radical removal. Patients with meningioma that was involving the middle and posterior third of the sinus had a radical removal if the sinus was completely obliterated, and subtotal removal of tumors that are infiltrating but not obliterating the SSS. Results: 23 patients (92%) had radical tumor resection achieving Simpson GI and 2 patients (8%) had subtotal tumor resection achieving Simpson GIV. There were 3 postoperative transient neurological deterioration (12%) and 2 postoperative deaths (8%).The recurrence rate in the study was 5%, with a follow-up for 24 months. Conclusion:The benefits must be carefully weighed against the risks deciding between more aggressive, radical, or less aggressive subtotal resections. The less aggressive subtotal resections if the sinus ispartially occluded may be a reasonable choice.

Background: Cavernous angioma or cavernoma is a benign vascular malformation, which can be found at any region within the brain. Brain stem cavernous angioma is rare. Although the optimal management of intracranial cavernous angiomas is open resection, Gamma Knife radiosurgery (GKR) has played an important role in treating these deeply seated and high surgical risk malformations throughout the past 20 years.