Intraoperative Ultrasound and Contrast-Enhanced Ultrasound in Surgical Treatment of Intramedullary Spinal Tumors

Han, Bo; Wu, Depei; Jia, Wenqing; Lin, Song; Xu, Yulun

doi:10.1016/j.wneu.2020.02.059

Cited by 13 publications

(12 citation statements)

References 20 publications

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“… 27 Like Han and colleagues, we also utilized this sequence with the adjustment of administering ultrasound contrast for identification through scanning prior to durotomy. 22 Importantly, we found the contrast uptake differential between lesion and spinal cord tissue helpful for delineation of the tumor borders, even in those tumors that did not enhance during the resection. Therefore, regardless of predictions that can be made regarding hyperechogenicity through preoperative imaging, it should be considered as an intraoperative means of localizing lesions that is particularly advantageous for both small pathologies and large neoplasms that span multiple levels.…”

Section: Discussionmentioning

confidence: 71%

“…In all 3 cases with hemangioblastoma, superficial vascular pedicles within the pial plane were seen, facilitating early coagulation and ligation of the arterial supply. Similarly, Han et al 22 noted this ability to delineate afferent vascular channels, facilitating safe resection.…”

Section: Discussionmentioning

confidence: 94%

“…A recent study by Han et al reported the use of intraoperative CEUS in 14 patients with intramedullary spine pathology. 22 Despite these initial efforts, intraoperative ultrasound characteristics of various pathologies have yet to be catalogued. Our case series offers insights into preoperative imaging characteristics that may predict intraoperative visibility of lesions with this method.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Barkley

McGrath

Hofstetter

2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDPrimary intramedullary spinal tumors cause significant morbidity and death. Intraoperative ultrasound as an adjunct for localization and monitoring the extent of resection has not been systematically evaluated in these patients; the effectiveness of intraoperative contrast-enhanced ultrasound (CEUS) remains almost completely unexplored.OBSERVATIONSA retrospective case series of patients at a single institution who had consented to the off-label use of intraoperative CEUS was identified. Seven patients with a mean age of 52.8 ± 15.8 years underwent resection of intramedullary tumors assisted by CEUS performed by a single attending neurosurgeon. Histopathological evaluation revealed 3 cases of hemangioblastoma, 1 case of pilocytic astrocytoma, 2 cases of ependymoma, and 1 case of subependymoma. Contrast enhancement correlated with gadolinium enhancement on preoperative magnetic resonance imaging. Intraoperative CEUS facilitated precise lesion localization and myelotomy planning. Dynamic CEUS studies were useful in demonstrating the blood supply to lesions with a dominant vascular pedicle. Regardless of contrast uptake, the differential enhancement between spinal cord tissue and neoplasm assisted in determining interface boundaries.LESSONSIntraoperative CEUS constitutes a useful adjunct for the intraoperative delineation of contrast-enhancing intramedullary tumors and in vivo confirmation of gross-total resection. Systematic investigation is needed to establish the role of CEUS for resection of intramedullary spinal tumors of various pathologies.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Barkley

McGrath

Hofstetter

2021

Journal of Neurosurgery: Case Lessons

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“…With the help of neurophysiological monitoring, accurate and minimal injury incision of the spinal cord can lead to a good prognosis. In recent years, the use of intraoperative ultrasound was reported for the resection of intracranial and intraspinal tumors [16,17] as well as the treatment of intracranial hemorrhage [18], showing good application prospects.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Ultrasound-assisted Treatment of Idiopathic Spontaneous Intramedullary Hemorrhage: A Case Report and Literature Review

Liu

Zhu

et al. 2020

Preprint

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Background: Idiopathic spontaneous intramedullary hemorrhage is a rare clinical disease. No cases of intraoperative ultrasound-assisted treatment of the disease have been reported in the literature. To present a case of idiopathic spontaneous intramedullary hemorrhage treated with intraoperative ultrasound and review the diagnosis and treatment of the disease.Case presentation: An 11-year-old child was admitted to our department because of a sudden severe pain on the left side of her back. Magnetic resonance images of the thoracic vertebrae showed abnormal signals in T2-T3 and spontaneous intramedullary hemorrhage was suspected. Intraoperative ultrasound-assisted evacuation of the intramedullary hematoma was performed and no abnormal blood vessels or malformations were found during intraoperative exploration.Conclusion: We report a rare case of idiopathic spontaneous intramedullary hemorrhage with intraoperative ultrasound-assisted hematoma clearance and a good prognosis.

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“…Intraoperative ultrasound has been validated both in spinal tumour surgery and in surgery for degenerative spine disease for optimal visualisation of the spinal cord and the surrounding subarachnoid space [ 8 , 21 , 23 , 26 , 28 ]. However, whether the visualisation of the subarachnoid space by intraoperative ultrasound correlates with the results of the postoperative MRI or the postoperative clinical course is yet unclear.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative ultrasonography in laminectomy for degenerative cervical spondylotic myelopathy: a clinical and radiological evaluation

et al. 2022

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Background The incidence of cervical myelopathy due to spinal stenosis is constantly growing in an aging population. Especially in multisegmental disease, dorsal laminectomy is the intervention of choice. Intraoperative imaging with ultrasound might provide additional information about extent and sufficiency of spinal cord decompression. Methods In this prospective study, the width of the subarachnoid space was systematically measured by intraoperative ultrasound at predefined sites at the cranial and caudal edge of decompression in axial and sagittal reconstruction. These data were compared with corresponding sites on postoperative T2-weighted MRI imaging. In addition, the functional outcome was assessed by modified Japanese Orthopaedic Association (mJOA) score. A historical patient cohort treated without ultrasound-guided laminectomy served as control group. Results Altogether, 29 patients were included. According to mJOA score at last follow-up, 7/29 patients reported stable symptoms and 21/29 patients showed a substantial benefit with no or minor residual neurological deficits. One patient suffered from a new C5 palsy. Intraoperative ultrasound-guided posterior decompression provided excellent overview in all cases. Measurement of the width of the subarachnoid space acquired by intraoperative ultrasound and postoperative MRI images showed a very high correlation, especially at the cranial level (p < 0.001, r = 0.880). Bland–Altman analysis showed that most patients were within the 1.96 × SD limits of agreement throughout all measurements. No ultrasound procedure-related complications were observed. Compared to a historical cohort of 27 patients, no significant differences were found regarding functional outcome (p = 0.711). Conclusion Intraoperative sonography visualises the surgically achieved restoration of the subarachnoid space in good correlation with postoperative MRI and might serve as a fast, precise and reliable tool for intraoperative imaging in cervical laminectomy. However, we could not demonstrate a clinical benefit with regard to functional outcome.

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Intraoperative Ultrasound and Contrast-Enhanced Ultrasound in Surgical Treatment of Intramedullary Spinal Tumors

Cited by 13 publications

References 20 publications

Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series

Intraoperative Ultrasound-assisted Treatment of Idiopathic Spontaneous Intramedullary Hemorrhage: A Case Report and Literature Review

Intraoperative ultrasonography in laminectomy for degenerative cervical spondylotic myelopathy: a clinical and radiological evaluation

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