Acta Neurochirurgica

, Volume 155, Issue 12, pp 2293–2298 | Cite as

A practical grading system of ultrasonographic visibility for intracerebral lesions

  • Richard Mair
  • James Heald
  • Ion Poeata
  • Marcel IvanovEmail author
Clinical Article - Neurosurgical Techniques



Intraoperative ultrasound for intracranial neurosurgery was largely abandoned in the 1980s due to poor image resolution. Despite many technological advances in ultrasound since then, the use of this imaging modality in contemporary practice remains limited. Our aim was to evaluate the utility of modern intraoperative ultrasound in the resection of a wide variety of intracranial pathologies.


A total of 105 patients who underwent intracranial lesion resection in a contiguous fashion were prospectively included in the study. Ultrasound images acquired intraoperatively were used to stratify lesions into one of four grades (grades 0–3) on the basis of their ultrasonic echogenicity and border visibility.


Forty-two out of 105 lesions (40 %) were clearly identifiable and had a clear border with normal tissue (grade 3). Fifty-five of 105 lesions (52 %) were clearly identifiable but had no clear border with normal tissue (grade 2). Eight of 105 lesions (8 %) were difficult to identify and had no clear border with normal tissue (grade 1). None (0 %) of the lesions could not be identified (grade 0). High-grade gliomas, cerebral metastases, meningiomas, ependymomas, and haemangioblastomas all demonstrated a median ultrasonic visibility grade of 2 or greater. Low-grade astrocytomas and oligodendrogliomas demonstrated a median ultrasonic visibility grade of 2 or less.


Intraoperative ultrasound can be of tremendous benefit in allowing the surgeon to appraise the location, extent, and local environment of their target lesion, as well as to reduce the risk of preventable complications. We believe that our grading system will provide a useful adjunct to the neurosurgeon when deciding for which lesions intraoperative ultrasound would be useful.


Intraoperative imaging Intraoperative ultrasound Ultrasonography Brain tumour imaging 



The lead author would like to express his great appreciation to Mr. Andrew Brodbelt (Consultant Neurosurgeon at the Walton Centre for Neurology and Neurosurgery, Liverpool, UK) for his valuable support with the data collection and for his enthusiastic encouragement of this research.

Conflict of interest



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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Richard Mair
    • 1
  • James Heald
    • 1
  • Ion Poeata
    • 2
  • Marcel Ivanov
    • 1
    Email author
  1. 1.Department of NeurosurgeryRoyal Hallamshire HospitalSheffieldUK
  2. 2.Department of Neurosurgery, Hospital Nicolae ObluUniversity of Medicine and Pharmacy Gr. T. PopaIasiRomania

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