Download PDF
Minim Invasive Neurosurg 2007; 50(3): 155-159
DOI: 10.1055/s-2007-985146
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Application of Intraoperative Ultrasound in Neurological Surgery

H. Sun 1 , J. Z. Zhao 1
  • 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Sciences, Beijing, People's Republic of China
Further Information

Publication History

Publication Date:
19 September 2007 (online)

    Permissions and Reprints

Abstract

Objective: The aim of this study was to evaluate the value of intraoperative ultrasound (IOUS) in neurological operations.

Patients and Methods: IOUS was applied in 110 operations, involving 68 gliomas, 7 meningiomas, 1 acoustic neuroma, 5 hemangioblastomas, 3 granulomas, 17 AVMs and 9 cavernous angiomas. A color Doppler model was used to display the blood flow. For 6 gliomas with unclear margins, IOUS was repeated after 2.5 mg Levovist had been given intravenously. Pre-operative and post-operative conditions of all patients were recorded and analyzed.

Results: In all cases IOUS provided real-time information about the localization of lesions and the distribution of vasculature, which helped in choosing the proper approach and also in controlling the extent of the resection. In the color Doppler model, IOUS displayed the distribution of vasculature, as well as the size and structure of AVMs. Total or subtotal resection was achieved in all cases. Six gliomas which were visualized with Levovist showed obvious enhancement with margins becoming more clear.

Conclusion: IOUS was a valuable tool in localizing lesions, selecting the proper approach, controlling the extent of resection and displaying the distribution of vasculature. IOUS can provide more reliable safeguard for minimally invasive neurosurgery.

Key words

intraoperative ultrasound - IOUS - brain neoplasms - AVMs - cavernous angiomas

References

  • 1 Hammoud MA, Ligon BL, elSouki R, Shi WM, Schomer DF, Sawaya R. Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging.  J Neurosurg. 1996;  84 737-741
    CrossrefPubMedGoogle Scholar
  • 2 Regelsberger J, Lohmann F, Helmke K, Westphal M. Ultrasound-guided surgery of deep seated brain lesions.  Eur J Ultrasound. 2000;  12 115-121
    PubMedGoogle Scholar
  • 3 Woydt M, Krone A, Soerensen N, Roosen K. Ultrasound-guided neuronavigation of deep-seated cavernous haemangiomas: clinical results and navigation techniques.  Br J Neurosurg. 2001;  15 485-495
    CrossrefPubMedGoogle Scholar
  • 4 Cokluk C, Iyigun O, Senel A, Celik F, Rakunt C. The guidance of intraoperative ultrasonography in the surgical treatment of arteriovenous malformation.  Minim Invas Neurosurg. 2003;  46 169-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Renner C, Lindner D, Schneider JP, Meixensberger J. Evaluation of intra-operative ultrasound imaging in brain tumor resection: a prospective study.  Neurol Res. 2005;  27 351-357
    CrossrefPubMedGoogle Scholar
  • 6 Le Roux PD, Berger MS, Wang K, Mack LA, Ojemann GA. Low grade gliomas: comparison of intraoperative ultrasound characteristics with preoperative imaging studies.  J Neurooncol. 1992;  13 189-198
    CrossrefPubMedGoogle Scholar
  • 7 Le Roux PD, Winter TC, Berger MS, Mack LA, Wang K, Elliott JP. A comparison between preoperative magnetic resonance and intraoperative ultrasound tumor volumes and margins.  J Clin Ultrasound. 1994;  22 29-36
    CrossrefPubMedGoogle Scholar
  • 8 Becker G, Krone A, Koulis D, Lindner A, Hofmann E, Roggendorf W, Bogdahn U. Reliability of transcranial colour-coded real-time sonography in assessment of brain tumours: correlation of ultrasound, computed tomography and biopsy findings.  Neuroradiology. 1994;  36 585-590
    CrossrefPubMedGoogle Scholar
  • 9 Kanno H, Ozawa Y, Sakata K, Sato H, Tanabe Y, Shimizu N, Yamamoto I. Intraoperative power Doppler ultrasonography with a contrast-enhancing agent for intracranial tumors.  J Neurosurg. 2005;  102 295-301
    PubMedGoogle Scholar
  • 10 Renner C, Lindner D, Schneider JP, Meixensberger J. Evaluation of intra-operative ultrasound imaging in brain tumor resection: a prospective study.  Neurol Res. 2005;  27 351-357
    CrossrefPubMedGoogle Scholar
  • 11 Velthoven V van. Intraoperative ultrasound imaging: comparison of pathomorphological findings in US versus CT, MRI and intraoperative findings.  Acta Neurochir Suppl. 2003;  85 95-99
    PubMedGoogle Scholar
  • 12 Chacko AG, Kumar NK, Chacko G, Athyal R, Rajshekhar V. Intraoperative ultrasound in determining the extent of resection of parenchymal brain tumors - a comparative study with computed tomography and histopathology.  Acta Neurochir (Wien). 2003;  145 743-748
    CrossrefPubMedGoogle Scholar
  • 13 Chacko AG, Kumar NK, Chacko G, Athyal R, Rajshekhar V. Intraoperative ultrasound in determining the extent of resection of parenchymal brain tumours - a comparative study with computed tomography and histopathology.  Acta Neurochir (Wien). 2003;  145 743-748
    CrossrefPubMedGoogle Scholar
  • 14 Tomancok B, Holl K, Wurm G, Pogady P, Fischer J. Stereotaxically guided versus ultrasound guided surgery - a comparative report of experiences.  Zentralbl Neurochir. 1996;  57 123-128
    PubMedGoogle Scholar
  • 15 Di Lorenzo N, Esposito V, Lunardi P, Delfini R, Fortuna A, Cantore G. A comparison of computerized tomography-guided stereotactic and ultrasound-guided techniques for brain biopsy.  J Neurosurg. 1991;  75 763-765
    PubMedGoogle Scholar
  • 16 Melada A, Heinrich Z, Chudy D, Scap M, Rotim K. The difference between ultrasound-guided and stereotactic-guided neurosurgical procedures.  Minim Invas Neurosurg. 2000;  43 149-152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Jodicke A, Deinsberger W, Erbe H, Kriete A, Boker DK. Intraoperative three-dimensional ultrasonography: an approach to register brain shift using multidimensional image processing.  Minim Invas Neurosurg. 1998;  41 13-19
    PubMedGoogle Scholar
  • 18 Woydt M, Horowski A, Krauss J, Krone A, Soerensen N, Roosen K. Three-dimensional intraoperative ultrasound of vascular malformations and supratentorial tumors.  J Neuroimaging. 2002;  12 28-34
    PubMedGoogle Scholar
  • 19 Unsgaard G, Gronningsaeter A, Ommedal S, Nagelhus H, Toril A. Brain operations guided by real-time two-dimensional ultrasound: New possibilities as a result of improved image quality.  Neurosurgery. 2002;  51 402-412
    CrossrefPubMedGoogle Scholar
  • 20 Unsgaard G, Selbekk T, Brostrup Muller T, Ommedal S, Torp SH, Myhr G, Bang J, Nagelhus Hernes TA. Ability of navigated 3D ultrasound to delineate gliomas and metastases-comparison of image interpretations with histopathology.  Acta Neurochir (Wien). 2005;  147 1259-1269
    CrossrefPubMedGoogle Scholar
  • 21 Lindner D, Trantakis C, Renner C, Arnold S, Schmitgen A, Schneider J, Meixensberger J. Application of intraoperative 3D ultrasound during navigated tumor resection.  Minim Invas Neurosurg. 2006;  49 197-202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Rygh OM, Cappelen J, Selbekk T, Lindseth F, Hernes TA, Unsgaard G. Endoscopy guided by an intraoperative 3D ultrasound-based neuronavigation system.  Minim Invas Neurosurg. 2006;  49 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Firsching R, Klug N, Borner U, Sanker P. Lesions of the sensorimotor region: somatosensory evoked potentials and ultrasound guided surgery.  Acta Neurochir (Wien). 1992;  118 87-90
    CrossrefPubMedGoogle Scholar
  • 24 Dempsey RJ, Moftakhar R, Pozniak M. Intraoperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations.  Neurosurgery. 2004;  55 155-160
    PubMedGoogle Scholar

Correspondence

J. Z. ZhaoMD 

Department of Neurosurgery

Beijing Tiantan Hospital

Capital University of Medical Sciences

100050 Beijing

People's Republic of China

Phone: +86/010/6709 65 23

Fax: +86/010/6511 34 40

Email: zhaojz@public.bta.net.cn

      >