Brain Operations Guided by Real-time Two-dimensional Ultrasound: New Possibilities as a Result of Improved Image Quality

Unsgaard, Geirmund; Grønningsaeter, Aage; Ommedal, Steinar; Hernes, Toril A. Nagelhus

doi:10.1097/00006123-200208000-00019

Cited by 100 publications

(34 citation statements)

References 26 publications

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“…However, it is logistically challenging (bigger exposure for simultaneous ultrasound and surgical instrument placement) and may often be inaccurate if the tip of the surgical tool is not exactly in the plane of the insonation. 32 Navigated ultrasound is essentially a "tracked" ultrasound. Just as preoperative MR images can be navigated, integrating intraoperative ultrasound into navigation can help track and navigate the ultrasound images.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Ultrasound strain imaging that is already being used for diagnostics of the heart (31,32) might give valuable information for delineation of the tumour during resection (33) (Figure 9). Ultrasound has also been found efficient as a 'stand-alone' imaging modality for the guidance of endoscopes (34,35) and the evacuation of haematomas (36). Other research groups have also found ultrasound useful for guidance and resection control, alone or in combination with preoperative images in neuronavigation (37)(38)(39)(40)(41), but few groups have explored the potential of this imaging modality for updating preoperative images, as demonstrated in the present work.…”

Section: Discussionmentioning

confidence: 82%

Computer-assisted 3D ultrasound-guided neurosurgery: technological contributions, including multimodal registration and advanced display, demonstrating future perspectives

Hernes

Lindseth

Selbekk

et al. 2006

Int. J. Med. Robotics Comput. Assist. Surg.

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“…The ultrasound scanners were brought to the OR, and the ultrasound acquisition parameters were optimized for better imaging of brain tumors. 20 It was found, however, that the unfamiliar direction of the ultrasound image slices made it a bit challenging for the surgeons to interpret the anatomy shown in the ultrasound images. The…”

Section: Ultrasound Imaging In Neurosurgerymentioning

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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Brain Operations Guided by Real-time Two-dimensional Ultrasound: New Possibilities as a Result of Improved Image Quality

Abstract: With proper planning and surgical setup, ultrasound imaging may provide acceptable image quality for use in image-guided brain operations.

Cited by 100 publications

References 26 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

Computer-assisted 3D ultrasound-guided neurosurgery: technological contributions, including multimodal registration and advanced display, demonstrating future perspectives

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

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