Choice of intraoperative ultrasound adjuncts for brain tumor surgery

Abstract

Background Gliomas are among the most typical brain tumors tackled by neurosurgeons. During navigation for surgery of glioma brain tumors, preoperatively acquired static images may not be accurate due to shifts. Surgeons use intraoperative imaging technologies (2-Dimensional and navigated 3-Dimensional ultrasound) to assess and guide resections. This paper aims to precisely capture the importance of preoperative parameters to decide which type of ultrasound to be used for a particular surgery. Methods This paper proposes two bagging algorithms considering base classifier logistic regression and random forest. These algorithms are trained on different subsets of the original data set. The goodness of fit of Logistic regression-based bagging algorithms is established using hypothesis testing. Furthermore, the performance measures for random-forest-based bagging algorithms used are AUC under ROC and AUC under the precision-recall curve. We also present a composite model without compromising the explainability of the models. Results These models were trained on the data of 350 patients who have undergone brain surgery from 2015 to 2020. The hypothesis test shows that a single parameter is sufficient instead of all three dimensions related to the tumor ($$p < 0.05$$ p < 0.05 ). We observed that the choice of intraoperative ultrasound depends on the surgeon making a choice, and years of experience of the surgeon could be a surrogate for this dependence. Conclusion This study suggests that neurosurgeons may not need to focus on a large set of preoperative parameters in order to decide on ultrasound. Moreover, it personalizes the use of a particular ultrasound option in surgery. This approach could potentially lead to better resource management and help healthcare institutions improve their decisions to make the surgery more effective.

Brain metastasis resection: the impact of fluorescence guidance (MetResect study)

“…According to the most recent guidelines, confirmation of complete resection still refers to the absence of tumor enhancement in the T1-weighted MRI sequence, which is strongly recommended to be performed within 48 hours after surgery. 2,8 Apart from the surgical skills and experience of the neurosurgeon, which remain the most considerable confounders, other more recent technical adjuncts to the neurosurgical armamentarium 24 are intraoperative sonography, 25 neuronavigation, 26 intraoperative MRI, 27 and fluorescence-guided techniques. 28,29 Most importantly in this context, FL in combination with a dedicated light filter has been evaluated repeatedly.…”

Advances in Neuro-Oncological Imaging: An Update on Diagnostic Approach to Brain Tumors

“…Newer literature has attempted to standardize ioUS [155]. For example, studies have attempted to identify the pre-operative parameters that would indicate the need for ioUS [168]. Still, with improvements in ultrasound technology and increasing utilization, ioUS holds substantial promise as a tool that will be increasingly implemented in the future.…”

Application of intraoperative ultrasound in the resection of high-grade gliomas

“…Therefore, IMRI may not be able to provide a real-time update on brain displacement during surgery, which may impact surgical outcomes and patient prognosis. Other intraoperative imaging technologies, such as IOUS and ICT, may offer faster and more accurate alternatives for surgeons in these cases ( 6 , 30 , 61 , 62 ). One way to overcome this is to use IOUS, which can scan and update images anytime and anywhere.…”