Navigated three-dimensional intraoperative ultrasound-guided awake resection of low-grade glioma partially infiltrating optic radiation

Šteňo, Andrej; Karlík, Martin; Mendel, Peter; Čík, Miroslav; Štěňo, Juraj

doi:10.1007/s00701-012-1357-6

Cited by 42 publications

(29 citation statements)

References 28 publications

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“…The B-mode evaluation after subtotal tumor resection was not helpful in classifying a hyperechoic area as residual tumor, mainly because of artifacts and surgical manipulation 13,27,29,32,33 (Figs. 3-5).…”

Section: Discussionmentioning

confidence: 99%

“…6,7,16,18 Artifacts are in fact the main limitation in iUS B-mode interpretation in glioma surgery. 13,27,29,32,33 Surgical maneuvers inevitably lead to difficulty in ultrasound discrimination between residual tumor and surgically induced edema or artifacts. In particular, at the end of tumor resection it is difficult to assess if a hyperechoic area is actually residual tumor (Figs.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, because the surgical bed is not homogeneous but extremely indented, the ultrasound beam is subjected to reflection and transmission in a changeable manner. 13,27,29,32,33 To overcome these problems and to improve image quality, several solutions have been introduced. Thanks to the possibility of navigating the iUS probe, it is possible to compare the location of a hyperechoic area on iUS with the location of the tumor on preoperative MRI, when the studies are displayed in a coplanar fashion.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is possible using a navigated iUS device. 5,15,[21][22][23]27,32 Anyway, this solution has major limitations because of the impossibility of taking into account not brain deformation but only brain shift. For this reason the comparison between iUS and preoperative MRI can only be suggestive.…”

Section: Discussionmentioning

confidence: 99%

“…Especially at the end of the surgery it is difficult to assess if a hyperechoic area is truly a residual tumor. 13,29,32,33 Contrast-enhanced US (CEUS) is an iUS modality that uses an ultrasound contrast agent (UCA) to improve the contrast between tumor, healthy tissue, and artifacts.…”

mentioning

confidence: 99%

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Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection

Prada¹,

Bene²,

Fornaro³

et al. 2016

FOC

114

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OBJECTIVE The purpose of this study was to assess the capability of contrast-enhanced ultrasound (CEUS) to identify residual tumor mass during glioblastoma multiforme (GBM) surgery, to increase the extent of resection. METHODS The authors prospectively evaluated 10 patients who underwent surgery for GBM removal with navigated ultrasound guidance. Navigated B-mode and CEUS were performed prior to resection, during resection, and after complete tumor resection. Areas suspected for residual tumors on B-mode and CEUS studies were localized within the surgical field with navigated ultrasound and samples were sent separately for histopathological analysis to confirm tumor presence. RESULTS In all cases tumor remnants were visualized as hyperechoic areas on B-mode, highlighted as CEUS-positive areas, and confirmed as tumoral areas on histopathological analysis. In 1 case only, CEUS partially failed to demonstrate residual tumor because the residual hyperechoic area was devascularized prior to ultrasound contrast agent injection. In all cases CEUS enhanced B-mode findings. CONCLUSIONS As has already been shown in other neoplastic lesions in other organs, CEUS is extremely specific in the identification of residual tumor. The ability of CEUS to distinguish between tumor and artifacts or normal brain on B-mode is based on its capacity to show the vascularization degree and not the echogenicity of the tissues. Therefore, CEUS can play a decisive role in the process of maximizing GBM resection.