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Acta Neurochirurgica

, Volume 152, Issue 11, pp 1873–1886 | Cite as

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

  • Ole SolheimEmail author
  • Tormod Selbekk
  • Asgeir Store Jakola
  • Geirmund Unsgård
Clinical Article

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.

Keywords

Brain neoplasms Neuronavigation Neurosurgery Ultrasound Quality control 

Notes

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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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ole Solheim
    • 1
    • 2
    • 3
    Email author
  • Tormod Selbekk
    • 3
    • 4
    • 5
  • Asgeir Store Jakola
    • 2
  • Geirmund Unsgård
    • 1
    • 2
    • 3
  1. 1.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Department of NeurosurgerySt. Olavs University HospitalTrondheimNorway
  3. 3.National Centre for 3D Ultrasound in SurgerySt. Olavs University HospitalTrondheimNorway
  4. 4.SINTEFTrondheimNorway
  5. 5.Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway

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