Large Residual Pilocytic Astrocytoma After Failed Ultrasound-Guided Resection: Intraoperative Ultrasound Limitations Require Special Attention

Šteňo, Andrej; Buvala, Ján; Štěňo, Juraj

doi:10.1016/j.wneu.2021.03.138

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…As a result, patients can develop clinical symptoms and signs secondary to space-occupying lesions, such as obstructive hydrocephalus, meningitis, and potentially herniation, with a mortality rate of up to 50% [ 2 , 4 ]. In addition, RNC with cerebellar involvement has scarcely been reported [ 2 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Šteňo et al. [ 10 ] reported the resection of a cerebellar pilocytic astrocytoma guided by three-dimensional-US. Important insights from this case included the preference for the prone position over the Park-bench position to fill the resection cavity with saline for better US visualization [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] reported the resection of a cerebellar pilocytic astrocytoma guided by three-dimensional-US. Important insights from this case included the preference for the prone position over the Park-bench position to fill the resection cavity with saline for better US visualization [ 10 ]. Additionally, consideration of entrapped air is necessary because it may cause acoustic artifacts and appear as a false empty resection cavity [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Resection of extra ventricular RNC of the cerebellum is a demanding task. Notable technical efforts to achieve delicate excision have included the use of a stereotactic frame to guide the resection of the fourth ventricle cysticerci [ 11 ], and the use of a retrosigmoid approach to gain better visualization of the extension of cysts into the cisterns [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The low cost, ease of use, and real-time feedback have made US-guided resection an appealing tool for the excision of brain lesions, especially in settings where intraoperative MRI may not be available [ 5 ]. Nevertheless, it has several limitations worth acknowledging: (i) US resolution is not uniform across all transducer directions and relies heavily on the depth of the area of interest, (ii) accuracy of lesion’s location can be affected by the presence of saline and the depth of the lesion relative to the transducer, (iii) it is an operator-dependent technique, and (iv) interpretation across modalities of imaging can be challenging because the rendering of US is given in a perpendicular plane to the transducer, which difficults the correlation with the normal view on CT or MRI [ 6–8 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

Rojas-Apaza,

Bocanegra-Becerra,

Ruiz-Garcia

et al. 2024

Journal of Surgical Case Reports

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Racemose neurocysticercosis (RNC) is a malignant form of Taenia solium infection. It carries high mortality due to widespread intraparenchymal invasion, mass effect, and cyst rupture. Cerebellar RNC is unusual and constitutes a surgical challenge. Scarce applications of ultrasound (US) -guided resection have been reported for RNC of the posterior fossa. We report the case of a 66-year-old woman who presented with ataxia and dysmetria. Her past medical history was relevant for seizures and hydrocephalus secondary to neurocysticercosis. Because of the increasing cyst invasion and threatening mass effect in the posterior fossa, the patient underwent US-guided resection of lesions. Postoperative computed tomography (CT) demonstrated complete excision of cysts, and a 2-year follow-up magnetic resonance imaging (MRI) showed no recurrence. On neurological examination, the patient had persistent ataxia without new-onset neurological deficits. The present case study illustrates the feasibility and cost-effective approach of US-guided resection to provide enhanced operative visualization and achieve complete cyst resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

Rojas-Apaza,

Bocanegra-Becerra,

Ruiz-Garcia

et al. 2024

Journal of Surgical Case Reports

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Intraoperative MRI versus intraoperative ultrasound in pediatric brain tumor surgery: is expensive better than cheap? A review of the literature

et al. 2022

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Navigated intraoperative ultrasound in pediatric brain tumors

Klein Gunnewiek,

van Baarsen,

Graus

et al. 2024

Childs Nerv Syst

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Purpose The aim of this study was to evaluate the diagnostic value and accuracy of navigated intraoperative ultrasound (iUS) in pediatric oncological neurosurgery as compared to intraoperative magnetic resonance imaging (iMRI). Methods A total of 24 pediatric patients undergoing tumor debulking surgery with iUS, iMRI, and neuronavigation were included in this study. Prospective acquisition of iUS images was done at two time points during the surgical procedure: (1) before resection for tumor visualization and (2) after resection for residual tumor assessment. Dice similarity coefficients (DSC), Hausdorff distances 95th percentiles (HD95) and volume differences, sensitivity, and specificity were calculated for iUS segmentations as compared to iMRI. Results A high correlation (R = 0.99) was found for volume estimation as measured on iUS and iMRI before resection. A good spatial accuracy was demonstrated with a median DSC of 0.72 (IQR 0.14) and a median HD95 percentile of 4.98 mm (IQR 2.22 mm). The assessment after resection demonstrated a sensitivity of 100% and a specificity of 84.6% for residual tumor detection with navigated iUS. A moderate accuracy was observed with a median DSC of 0.58 (IQR 0.27) and a median HD95 of 5.84 mm (IQR 4.04 mm) for residual tumor volumes. Conclusion We found that iUS measurements of tumor volume before resection correlate well with those obtained from preoperative MRI. The accuracy of residual tumor detection was reliable as compared to iMRI, indicating the suitability of iUS for directing the surgeon’s attention to areas suspect for residual tumor. Therefore, iUS is considered as a valuable addition to the neurosurgical armamentarium. Trial registration number and date PMCLAB2023.476, February 12th 2024.

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Large Residual Pilocytic Astrocytoma After Failed Ultrasound-Guided Resection: Intraoperative Ultrasound Limitations Require Special Attention

Cited by 4 publications

References 12 publications

Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

Intraoperative MRI versus intraoperative ultrasound in pediatric brain tumor surgery: is expensive better than cheap? A review of the literature

Navigated intraoperative ultrasound in pediatric brain tumors

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