Correlation of intraoperative ultrasound tumor volumes and margins with preoperative computerized tomography scans

LeRoux, Peter D.; Berger, Mitchel S.; Ojemann, George A.; Wang, Keith; Mack, L A

doi:10.3171/jns.1989.71.5.0691

Cited by 83 publications

(54 citation statements)

References 34 publications

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“…[22,32,44,70,[74][75][76]79,80,82,86,87] In these reports the population of the patients studied is heterogeneous and subject to different combinations of adjuvant treatments. The evaluation of the extent of resection is usually based on the judgment of the surgeon, which may not be reliable.…”

mentioning

confidence: 99%

Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients

Nikas

Bello²,

Zamani³

et al. 1998

FOC

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The authors reviewed 175 low-grade hemispheric gliomas surgically treated by one surgeon (P.B.) between 1987 and 1996: 74 astrocytomas (42%), 35 oligodendrogliomas (20%), 52 mixed gliomas (30%), 12 gangliogliomas (7%), and two ependymomas (1%). Patient age ranged from 7.5 to 81.9 years (mean 39.2 years); 84 patients (48%) were males and 91 (52%) females. Postsurgical follow-up review ranged from 0.1 to 225.2 months (mean 36.2 months, median 24.9 months). Either T2-weighted or contrast-enhanced T1-weighted magnetic resonance (MR) images were used to evaluate the percentage of resection achieved and volume of residual disease postoperatively. The majority of patients (55%) had seizures as the presenting symptom, and 45% experienced preoperative symptoms for more than 12 months. Tumor enhancement was present in 21% of cases. In 66% of surgical procedures at least one of the following technical adjuncts was used: monitored local anesthesia, real-time MR imaging, stereotactic guidance with computerized tomography, three dimensional reconstruction, cortical mapping with cortical stimulation, somatosensory or visual evoked potential recording, corticography, or intraoperative ultrasound. Intraoperative MR imaging was used for 40 (22.9%) of the craniotomies and nine (5.14%) biopsies. There were no surgery-related deaths. Complications appeared in 6% of the patients. Progression to a higher-grade tumor occurred in 9.2% of patients within the 3-year follow-up period.

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confidence: 99%

Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients

Nikas

Bello²,

Zamani³

et al. 1998

FOC

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“…LeRoux et al infused Indigo Carmine intraparenchymally to confirm ultrasonography-guided resections without any adverse events, thus using the injections for a completely different purpose. 8 Another benefit of Indigo Carmine injections is the low cost and ease of use in centers that do not have access to intraoperative MRI. Only frameless stereotactic equipment is required.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative stereotactic injection of Indigo Carmine dye to mark ill-defined tumor margins: a prospective Phase I–II study

Margetis

Rajappa

Tsiouris

et al. 2015

JNS

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OBJECT A critical goal in neurosurgical oncology is maximizing the extent of tumor resection while minimizing the risk to normal white matter tracts. Frameless stereotaxy and white matter mapping are indispensable tools in this effort, but deep tumor margins may not be accurately defined because of the “brain shift” at the end of the operation. The authors investigated the safety and efficacy of a technique for marking the deep margins of intraaxial tumors with stereotactic injection of Indigo Carmine dye. METHODS Investigational New Drug study approval for a prospective study in adult patients with gliomas was obtained from the FDA (Investigational New Drug no. 112680). At surgery, 1–3 stereotactic injections of 0.01 ml of Indigo Carmine dye were performed through the initial bur holes into the deep tumor margins before elevation of the bone flap. White light microscopic resection was conducted in standard fashion by using frameless stereotactic navigation until the injected margins were identified. The resection of the injected tumor margins and the extent of resection of the whole tumor volume were determined by using postoperative volumetric MRI. RESULTS In total 17 injections were performed in 10 enrolled patients (6 male, 4 female), whose mean age was 49 years. For all patients, the injection points were identified intraoperatively and tumor was resected at these points. The staining pattern was reproducible; it was a sphere of stained tissue approximately 5 mm in diameter. A halo of stained tissue and a backflow of dye through the needle tract were also noted, but these were clearly distinct from the staining pattern of the injection point, which was vividly colored and demarcated. Postoperative MR images verified the resection of all injection points. The mean extent of resection of the tumor as a whole was 97.1%. For 1 patient, a brain abscess developed on postoperative Day 16 and needed additional surgical treatment. CONCLUSIONS Stereotactic injection of Indigo Carmine dye can be used to demarcate multiple deep tumor margins, which can be readily identified intraoperatively by using standard white light microscopy. This technique may enhance the accuracy of frameless stereotactic navigation and increase the extent of resection of intraaxial tumors.

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“…Since then, it has been used extensively, mostly in the resection of cortical lesions. It has allowed for improved localization of tumors, as well as some ability to determine the extent of resection [11, 12, 13]. It is most often employed when the lesion is close to the cortical surface with no intervening CSF spaces.…”

Section: Discussionmentioning

confidence: 99%

Use of a Portable CT Scanner during Resection of Subcortical Supratentorial Astrocytomas of Childhood

Gwinn¹,

Cleary²,

Medlock³

2000

Pediatr Neurosurg

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The development of intraoperative imaging has made it possible to visualize shifting brain structures during surgery, and may allow greater intraoperative discrimination of normal and abnormal tissue. This may provide greater confidence to the neurosurgeon to proceed with a more extensive resection while decreasing postoperative morbidity. We investigated the intraoperative use of a portable CT scanner in the resection of 4 cases of supratentorial, subcortical astrocytomas of childhood to assess its usefulness in determining the endpoint of the dissection. We operated on 4 patients, ages 3–17, with astrocytomas. Three were thalamic, and 1 was based primarily in the caudate nucleus. The approach to the basal ganglia was transcallosal in 3 and transtemporal in 1. Specific observations on the intraoperative use of the portable CT scanner included its overall facility, any additional operative time required, the overall quality of the images, intraoperative decisions made based on the images and problems associated with its use. These observations are presented with a review of intraoperative imaging as it pertains to deep pediatric brain tumors. The CT scanner was helpful in limiting the dissection of the hypothalamic and midbrain regions and in localizing remaining abnormal tissue. The scans allowed informed decisions about leaving margins of the tumor which were adjacent to vital structures, but dit not prove to be a decisive factor in providing a complete resection. The following observations are worth noting: (1) average imaging time was 20 min per scan; (2) the extent and location of residual enhancing tumor was easily identified despite other materials in the surgical bed; (3) air/tissue interfaces limit resolution; (4) tumors retain contrast long enough to obtain multiple scans without additional dye, and (5) the cost profile of a mobile CT scanner is superior to that of a fixed intraoperative CT scanner.

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Correlation of intraoperative ultrasound tumor volumes and margins with preoperative computerized tomography scans

Cited by 83 publications

References 34 publications

Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients

Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients

Intraoperative stereotactic injection of Indigo Carmine dye to mark ill-defined tumor margins: a prospective Phase I–II study

Use of a Portable CT Scanner during Resection of Subcortical Supratentorial Astrocytomas of Childhood

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