J Neurol Surg B Skull Base 2016; 77 - FP-20-03
DOI: 10.1055/s-0036-1592539

Intraoperative Navigated Angiosonography for Skull Base Tumor Surgery

Francesco Prada 1, Massimiliano Del Bene 1, Marco Saini 1, Francesco DiMeco 1, 2
  • 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milano, Italy
  • 2Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland,, United States

Objective: In skull base tumor surgery, it is essential to identify the lesion, the principal vessels and their relationships. Intra-operative navigated B-mode ultrasound aids in defining the extent of brain tumor. Ultrasound contrast agent permits to study the vessels course, blood flow and perfusion characteristics of focal lesions. We report our experience with intra-operative navigated contrast-enhanced ultrasound to obtain a navigated angio-sonography (N-ASG) in a series of 28 skull base tumors.

Methods: We performed N-ASG in a series of 28 skull base tumors (20 meningiomas, 5 giant pituitary adenomas, 1 posterior fossa epidermoid, 2 dermoid cysts). N-ASG was obtained after craniotomy before resecting each lesion and during tumor removal, after intravenous injection of ultrasound contrast agent.

Results: In all 28 cases, principal vessels and their divisions were concurrently identified (both high and low flow) with N-ASG permitting to follow the course of each vessel. N-ASG also proved to be useful in highlighting the lesion compared with standard B-mode imaging and showing its perfusion patterns.

Conclusion: N-ASG can be applied to skull base tumor surgery, providing information about the relationships between major intracranial vessels and tumors. This technique could be advantageous reaching the tumor and preventing vascular damages.