High-Frequency Intraoperative Ultrasound (ioUS)-Guided Treatment of Superficial Intracerebral Lesions via a Single Burr Hole Approach

J.-K. Burkhardt; C. Serra; N. H. Ulrich; C. M. Fischer; R.-L. Bernays; O. Bozinov

doi:10.1055/s-0032-1316232

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

High-Frequency Intraoperative Ultrasound (ioUS)-Guided Treatment of Superficial Intracerebral Lesions via a Single Burr Hole Approach

J.-K. Burkhardt ¹, C. Serra ¹, N. H. Ulrich ¹, C. M. Fischer ¹, R.-L. Bernays ¹, O. Bozinov ¹

¹Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

Abstract

Aim: In this study, we analyze the feasibility of minimizing the surgical approach to a single burr hole in the treatment of superficial intracerebral lesions with the use of high-frequency intraoperative ultrasound (hfioUS).

Methods: Using a standard navigation system, placement of a single burr hole was performed and ultrasound scanning with the L15-7 hfioUS probe (iU22 Ultrasound System, Philips) was performed through the burr hole to display the lesion in real-time intermittently throughout the entire procedure. A cohort of 13 consecutive patients with various lesions including gliomas (n = 5), metastasis (n = 3), abscesses (n = 2), lymphoma (n = 1), cavernoma (n = 1), and cysticercosis (n = 1) were operated on using this technique.

Results: In all 13 patients (6 females, 7 males; mean age 48 years [SD 17.5]), lesions could be localized and resected/biopsied instantly, while preserving adjacent vessels. All the lesions were supratetorial, located in the temporal (n = 7), parietal (n = 3), frontal (n = 2), and occipital (n = 1) lobe. Mean volume of the lesions was 20.6 cm³ (SD 29.8) with a mean cortex surface-to-lesion distance (CSLD) of 5.8 mm (SD 8.3). Mean operating time was 63 minutes (SD 30.6). We aimed for gross total resection in six lesions (three metastases, two gliomas, and one cavernoma) with a mean volume of 3.1 cm³ (SD 5.1) and a mean CSLD of 4 mm (SD 4.2). In all six cases, complete resection was achieved and confirmed. Abscess drainage (n = 2) showed a postoperative volume reduction of 49 and 39% with a CSLD of 6.7 and 18.4 mm, respectively. Biopsy in the remaining five cases led to a histopathological diagnosis in all cases.

Conclusions: The localization and resection of various intracerebral lesions with the guidance of hfioUS via a single burr hole approach was feasible in this study. Complete resection of small and superficial lesions was achieved and abscess drainage was displayed in real time. No postoperative complications occurred with fast surgical and recovery time leading to a favorable starting position for adjuvant therapy.