Intra- and Peri-operative Ultrasound in Neurosurgery – Analysis of 1250 Examinations

Objective: Neurosurgery has the privilege to benefit from long time experience and evolution of techniques of many neighbour disciplines using ultrasound since several decades. The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery.

Methods: The ALOKA 5000 with four small probes offered a basis to improve minimally invasiveness in our discipline: TCD probe (2.14–3.75MHZ) was used in 770 cases mainly at ICU; the small part sector probe (3.8–7.5MHZ) was mainly applied intra-operatively in 220 cases and the burr hole probe (3.75–7.5MHZ) was also mainly used intra-operatively in 140 cases. The trans-endoscopic mini-probe (360°, 6F + 8F, 10–15–20MHZ) was used with strictly indication in 78 cases. In the initial 31 intra-operative cases an old b-mode machine was used.

Results: The complete spectrum of neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 437 intra-operative applications ultrasound proved to be an excellent neuro – navigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 255 tumor cases with targeting in 62 small lesions was very satisfying and in 11 cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was necessary in 20 cases preventing possible disasters. The 740 cases of application at the ICU showed a bedside use, resulting in decrease of risky out door examination reduce stress for our patients and logistic efforts for the professionals. Investigations are running in innovative applications like: brain death diagnosis (70 cases), bedside-sono-CT (117 cases), aneurysm- monitoring (55 cases), bridging-vein monitoring (18 cases), sono-pupillometry (30 cases). Intra-operatively we examine sono-angiography in tumors and for clipping control of aneurysms (72 cases), control hematoma evacuation through key holes(223 cases) and we navigate endoscopes with our „brain-radar“ (78 cases).

Conclusion: We learned to use ultrasound in the routinely as an effective, ergonomic and economic tool in neurosurgery. We saw compensation for logistic economic and ergonomic pitfalls by high-end ultrasound.