Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas
Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas
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DOI：
10.1007/s00701-013-1881-z
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发表时间：
2013-12-01
影响因子：
2.4
通讯作者：
Sridhar, Epari
中科院分区：
文献类型：
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作者：
Moiyadi, Aliasgar V.;Shetty, Prakash M.;Sridhar, Epari
术中影像在脑肿瘤切除术中的应用越来越广泛。可导航三维(3D)超声是一种用于计划和指导此类切除的新工具。我们回顾了我们使用该系统的经验，并分析了我们的初步结果，特别是在恶性胶质瘤方面。我们查询了自2011年6月引入该手术以来在我们中心接受超声导航手术的所有患者的预期数据库，以检索临床数据和技术参数。根据增强程度和可切除性对肿瘤进行影像分类。手术切除90例，其中75%为胶质瘤。87%的患者使用了三维超声模式(40例单独使用，38例联合使用)。使用组合模式功能[超声(US)和磁共振(MR)图像]促进了解剖数据的定位。术中1/3的病例使用了能量多普勒血管造影术，这对实时显示血管解剖结构非常有利。平均手术时间为4.4小时。约88%的病例图像分辨率为良好或中等。术中影像的使用促使59%的病例再次切除。在51例恶性胶质瘤中，大体全切除率为47%，在可切除亚型中的切除率为88%。在脑肿瘤的术中切除中，Navigable 3D US是一种通用、有用和可靠的成像工具，特别是在资源有限的情况下，术中MR(IOMR)无法获得。它具有多种功能，可以根据手术程序和外科医生的经验进行定制。
Intraoperative imaging is increasingly being used in resection of brain tumors. Navigable three-dimensional (3D)-ultrasound is a novel tool for planning and guiding such resections. We review our experience with this system and analyze our initial results, especially with respect to malignant gliomas.A prospective database for all patients undergoing sononavigation-guided surgery at our center since this surgery's introduction in June 2011 was queried to retrieve clinical data and technical parameters. Imaging was reviewed to categorize tumors based on enhancement and resectability. Extent of resection was also assessed.Ninety cases were operated and included in this analysis, 75 % being gliomas. The 3D ultrasound mode was used in 87 % cases (alone in 40, and combined in 38 cases). Use of combined mode function [ultrasound (US) with magnetic resonance (MR) images] facilitated orientation of anatomical data. Intraoperative power Doppler angiography was used in one-third of the cases, and was extremely beneficial in delineating the vascular anatomy in real-time. Mean duration of surgery was 4.4 hours. Image resolution was good or moderate in about 88 % cases. The use of the intraoperative imaging prompted further resection in 59 % cases. In the malignant gliomas (51 cases), gross-total resection was achieved in 47 % cases, increasing to 88 % in the "resectable" subgroup.Navigable 3D US is a versatile, useful and reliable intraoperative imaging tool in resection of brain tumors, especially in resource-constrained settings where Intraoperative MR (IOMR) is not available. It has multiple functionalities that can be tailored to suit the procedure and the experience of the surgeon.