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Ultrasound-guided operations in unselected high-grade gliomas—overall results, impact of image quality and patient selection

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Abstract

Background

A number of tools, including intraoperative ultrasound, are reported to facilitate surgical resection of high-grade gliomas. However, results from selected surgical series do not necessarily reflect the effectiveness in common neurosurgical practice. Delineation of seemingly similar brain tumours vary in different ultrasound-guided operations, perhaps limiting usefulness in certain patients.

Methods

We explore and describe the results associated with use of the SonoWand system with intraoperative ultrasound in a population-based, unselected, high-grade glioma series. Surgeons filled out questionnaires about presumed extent of resection, use of ultrasound and ultrasound image quality just after surgery. We evaluate the impact of ultrasound image quality. We also explore the importance of patient selection for surgical results.

Results

Of 156 consecutive malignant glioma operations, 142 (91%) were resections whilst 14 (9%) were only biopsies. We achieved gross total resection (GTR) in 37% of all high-grade glioma resections, whilst worsening of functional status was seen in 13%. The risk of getting worse was significantly higher in reoperations, resections in eloquent locations, resections in cases with poor ultrasound image quality, resection when surgeons’ resection grade estimates were inaccurate and in cases with surgery-related complications. Aiming for GTR, unifocality of lesion, non-eloquent location and medium or good ultrasound image quality were identified as independent factors associated with achieving GTR.

Conclusion

We report good overall results, both in terms of resection grades and functional outcome in consecutive malignant glioma resections, in which intraoperative ultrasound was used in 95%. We observed a seeming dose–response relationship between ultrasound image quality and clinical and radiological results. This may suggest that better ultrasound facilitates better surgery. The study also clearly demonstrates that, in terms of surgical results, the selection of patients seems to be much more important than the selection of surgical tools.

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Acknowledgements

The neuroradiologists Kjell A. Kvistad, Mari Folvik and Jana Rydland helped with size measurement of lesions, and Eirik Magnus Berntsen did manual segmentation of some lesions. The project was supported by the Norwegian Ministry of Health and Social Affairs through the National Centre for 3D Ultrasound in Surgery, the Norwegian University of Science and Technology (NTNU) and Helse Midt-Norge (the regional health authorities of Central Norway).

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Authors and Affiliations

  1. Department of Neuroscience, Norwegian University of Science and Technology, 7005, Trondheim, Norway

    Ole Solheim & Geirmund Unsgård

  2. Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway

    Ole Solheim, Asgeir Store Jakola & Geirmund Unsgård

  3. National Centre for 3D Ultrasound in Surgery, St. Olavs University Hospital, Trondheim, Norway

    Ole Solheim, Tormod Selbekk & Geirmund Unsgård

  4. SINTEF, Trondheim, Norway

    Tormod Selbekk

  5. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway

    Tormod Selbekk

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  1. Ole Solheim
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Correspondence to Ole Solheim.

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Solheim, O., Selbekk, T., Jakola, A.S. et al. Ultrasound-guided operations in unselected high-grade gliomas—overall results, impact of image quality and patient selection. Acta Neurochir 152, 1873–1886 (2010). https://doi.org/10.1007/s00701-010-0731-5

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