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Ultrasound-guided brain surgery: echographic visibility of different pathologies and surgical applications in neurosurgical routine

  • Original Article - Neurosurgery general
  • Published:
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Abstract

Background

The use of intraoperative ultrasound (iUS) has increased in the last 15 years becoming a standard tool in many neurosurgical centers. Our aim was to assess the utility of routine use of iUS during various types of intracranial surgery. We reviewed our series to assess ultrasound visibility of different pathologies and iUS applications during the course of surgery.

Materials and methods

This is a retrospective review of 162 patients who underwent intracranial surgery with assistance of the iUS guidance system (SonoWand). Pathologic categories were neoplastic (135), vascular (20), infectious (2), and CSF related (5). Ultrasound visibility was assessed using the Mair classification, a four-tiered grading system that considers the echogenicity of the lesion and its border visibility (from 0 to 3; grade 0, pathology not visible; grade 3, visible with clear border with normal tissue). iUS applications included lesion localization, approach planning to deep-seated lesions, and lesion removal.

Results

All pathologies were visible on iUS except one aneurysm. On average, extra-axial tumors were identified more easily and had clearer limits compared to intra-axial tumors (extra-axial 17% grade 2, 83% grade 3; intra-axial 5.5% grade 1, 46.5% grade 2, 48% grade 3). iUS provided precise and safe transcortical trajectories to deep-seated lesions (71 patients; tumors, hemangiomas, ICHs); iUS was judged to be less useful to approach skull base tumors and aneurysms. iUS was used to judge extent of resection in 152 cases; surgical artifacts reduced sonographic visibility in 25 cases: extent of resection was correctly checked in 127 patients (53 gliomas, 15 metastases, 39 meningiomas, 4 schwannomas, 4 sellar region tumors, 6 hemangiomas, 3 AVMs, 2 abscesses).

Conclusions

iUS was highly sensitive in detecting all types of pathology, was safe and precise in planning trajectories to intraparenchymal lesions (including minimally mini-invasive approaches), and was accurate in checking extent of resection in more than 80% of cases. iUS is a versatile and feasible tool; it could improve safety and its use may be considered in routine intracranial surgery.

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Abbreviations

HGG:

High-grade glioma

LGG:

Low-grade glioma

ICH:

Intracerebral hematoma

AVM:

Artero-venous malformation

US:

Ultrasound

iUS:

Intraoperative US

CECT:

Contrast-enhanced CT scan

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Acknowledgements

We would like to thank Dr. Justin Mascitelli (Neurosurgeon at Barrow Neurological Institute) for the English revision and for his precious intellectual support.

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Authors and Affiliations

  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100, Sassari, SS, Italy

    Domenico Policicchio, Artan Doda, Enrico Sgaramella, Stefano Ticca, Filippo Veneziani Santonio & Riccardo Boccaletti

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  1. Domenico Policicchio
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  2. Artan Doda
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Correspondence to Domenico Policicchio.

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Policicchio, D., Doda, A., Sgaramella, E. et al. Ultrasound-guided brain surgery: echographic visibility of different pathologies and surgical applications in neurosurgical routine. Acta Neurochir 160, 1175–1185 (2018). https://doi.org/10.1007/s00701-018-3532-x

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  • DOI: https://doi.org/10.1007/s00701-018-3532-x

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