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Post-craniotomy neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning

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Abstract

Neuronavigation has become an established technology which provides objective data for localization in 3D space and thus decreases uncertainties regarding tumor localization, relation to vasculature, safe trajectories, and craniotomy design during surgery. We have evaluated whether neuronavigation based purely on 3D ultrasound without any preoperative navigational imaging can provide necessary information for navigation and resection control. This application is a new way of utilizing ultrasound-guided neuronavigation. Eighteen patients were operated on with ultrasound-based navigation only; they represented 16% of all the 131 navigation-assisted procedures during our 1-year study period. Of the procedures, 2 were planned as diagnostic biopsies, 1 was resection of an abscess, and 15 were tumor resections. Pre- and postoperative radiological images were evaluated to assess volumes and volume reduction following surgery. Pathology results were recorded. For patients undergoing resections, the resection radicality was >99% in 12 patients and 95–99% in 4 patients undergoing resections. In the latter patients, additional radicality was avoided intentionally because of concern for sensitive central structures. The two biopsies yielded representative material. It was possible to use operative neuronavigation based on intraoperative ultrasound without relying on preoperative navigational imaging. Neuronavigation based solely on intraoperative ultrasound was feasible and may increase surgical safety when preoperative neuronavigational image is not feasible or unavailable.

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References

  1. Auer LM, van Velthoven V (1990) Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT. Acta Neurochir (Wien) 104(3–4):84–95

    Article  CAS  Google Scholar 

  2. Berger MS, Deliganis AV, Dobbins J, Keles GE (1994) The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:1784–1791

    Article  PubMed  CAS  Google Scholar 

  3. Campbell JW, Pollack IF, Martinez AJ, Shultz B (1996) High grade astrocytomas in children: radiologically complete resection is associated with an excellent long-term prognosis. Neurosurgery 38:258–264

    Article  PubMed  CAS  Google Scholar 

  4. Chandler WF, Knake JE, Mc Gillicuddy JE (1982) Intraoperative use of real-time ultrasonography in neurosurgery. J Neurosurg 57:157–163

    Article  PubMed  CAS  Google Scholar 

  5. Cokluk C, Iygun Ö, Senel A, Celik F, Rakunt F (2003) The guidance of intraoperative ultrasonography in the surgical treatment of arteriovenous malformations. Minim Invasive Neusosurg 46:169–172

    Article  CAS  Google Scholar 

  6. Gumprecht H, Darius CW, Lumenta CB (1999) BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases. Neurosurgery 44:97–105

    Article  PubMed  CAS  Google Scholar 

  7. Gronningsaeter A, Lie T, Kleven A, Morland T, Lango T, Unsgaard G, Myhrre H, Moarvik R (2000) Initial experience with stereoscopic visualization of three-dimensional ultrasound data in surgery. Surg Endosc 14:1074–1078

    Article  PubMed  CAS  Google Scholar 

  8. Hammoud MA, Lingon BL, elSouki R, Shi WM, Schomer DF, Sawaya R (1996) Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurgery 84:737–741

    Article  CAS  Google Scholar 

  9. Jödicke A, Deinsberger W, Erbe H, Kriete A, Böker DK (1998) Intraoperative three-dimensional ultrasonography: an approach to register brain shift using multidimensional image processing. Minim Invasive Neurosurgery 41:13–19

    Article  Google Scholar 

  10. Kaibara T, Saunder JK, Sutherland GR (2000) Advances in mobile intraoperative magnetic resonance imaging. Neurosurgery 47:131–138

    PubMed  CAS  Google Scholar 

  11. Kitazawa K, Nitta J, Okudera H, Kobayashi S (1998) Color Doppler ultrasound imaging in the emergency management of an intracerebral hematoma caused by cerebral arteriovenous malformations. NS 42:405–407

    CAS  Google Scholar 

  12. Knauth M, Wirtz CR, Tronnier VM, Aras N, Kunze S, Sartor K (1999) Intraoperative MR imaging increases the extent of tumor resection in patients with high-grade gliomas. ANJR Am J Neuroradiol 20:1642–1646

    CAS  Google Scholar 

  13. Koivukangas J, Louhisalmi Y, Alakuijala J (1993) Ultrasound-controlled neuronavigator-guided brain surgery. J Neurosurg 79:36–42

    Article  PubMed  CAS  Google Scholar 

  14. Lindseth F, Ommedal S, Bang J, Unsgård G, Hernes TAN (2001) Image fusion of ultrasound and MRI as an aid for assessing anatomical shifts and for improving overview and interpretation in ultrasound guided neurosurgery. In: Lemke HU, Inamura K, Doi K, Vannier MW, Farman AG (eds) CARS 2001: Proceeding of the 15th International Congress and Exhibition in Computer Assisted Radiology and Surgery, Berlin. Elsevier, Amsterdam

    Google Scholar 

  15. Muacevic A, Steiger HJ (1999) Computer assisted resection of cerebral arteriovenous malformations. Neurosurgery 45:1164–1171

    Article  PubMed  CAS  Google Scholar 

  16. Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R (2000) Quantification for brain shift using intraoperative magnetic resonance imaging. Neurosurgery 47:1070–1080

    Article  PubMed  CAS  Google Scholar 

  17. Robert DW, Miga MI, Hartov A, Eisner S, Lemery JM, Kennedy FE, Paulsen KD (1999) Intraoperatively updated neuroimaging using brain modeling and sparse data. Neurosurgery 45:1199–1207

    Article  Google Scholar 

  18. Rygh OM, Selbekk T, Torp SH, Lydersen S, Hernes TA, Unsgaard G (2008) Comparison of navigated 3d ultrasound findings with histopathology in subsequent phases of glioblastoma resection. Acta Neurochir (Wien) 150(10):1033–1041

    Article  Google Scholar 

  19. Tronnier VM, Bonsanto MM, Staubert A, Knauth M, Kunze S, Wirtz CR (2001) Comparison of intraoperative MR imaging and 3D navigated ultrasonography in the detection and resection control of lesions. Neurosurg Focus 10:1–5

    Article  Google Scholar 

  20. Unsgaard G, Ommedal S, Muller T, Gronningsaeter A, Toril A, Hernes N (2002) Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resction. Neurosurgery 50(4):804–812

    Article  PubMed  Google Scholar 

  21. Unsgaard G, Ommedal S, Gronningsaeter A, Hernes N (2002) Brain operations guided by real-time two-dimensional ultrasound: new possibilities as a result of improved image quality. Neurosurgery 50(4):804–812

    Article  PubMed  Google Scholar 

  22. Unsgaard G, Ommedal S, Rygh OM, Lindseth F (2005) Operation of arteriovenous malformations assisted by stereoscopic navigation controlled display of preoperative magnetic resonance angiography and intraoperative ultrasound angiography. Operative NS 56:281–289

    Google Scholar 

  23. Wirtz CR, Albert FK, Schwaderer M, Heuer C, Staubert A, Tronnier VM, Knauth M, Kunze S (2000) The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery. Neurol Res 22:354–360

    PubMed  CAS  Google Scholar 

  24. Woydt M, Horowski A, Krauss J, Krone A, Soerensen N, Roosen K (2002) Three-dimensional intraoperative ultrasound of vascular malformations and supratentorial tumors. J Neuroimaging 12(1):28–34

    Article  PubMed  Google Scholar 

  25. Woydt M, Krone A, Becker G, Schmidt K, Roggendorf W, Roosen K (1996) Correlation of intraoperative ultrasound with histopatologic findings after tumor resection in supratentorial gliomas: a method to improve gross total tumour resection. Achta neurochir (Wien) 138:1391–1398

    Article  CAS  Google Scholar 

  26. Woydt M, Perez J, Meixenberger J, Krone A, Sorensen N, Roosen K (1998) Intra-operative color-duplex-sonography in the surgical management of cerebral AV-malformation. Acta Neurochir 140:689–698

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Karolinska Hospital, 171 76, Stockholm, Sweden

    Inti Peredo-Harvey & Tiit Mathiesen

  2. Department of Neuroradiology, Karolinska Hospital, Stockholm, Sweden

    Anders Lilja

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  1. Inti Peredo-Harvey
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  2. Anders Lilja
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  3. Tiit Mathiesen
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Correspondence to Tiit Mathiesen.

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Comments

Oliver Bozinov, Zurich, Switzerland

Intraoperative imaging has become almost mandatory, but the preferred method by intraoperative MRI is impossible for all cranial cases and extremely time consuming and expensive. Intraoperative ultrasound technology has low initial costs and basically no maintenance costs, and neuronavigation has become a state-of-the-art tool nowadays.

We mentioned earlier that especially in economically challenging countries, such a combination of navigation with ultrasound can be the broad intraoperative imaging solution. Nevertheless, the user needs to get used and trained to interpret US images. This, in fact, is one of the key problems for neurosurgical US users. Even as a frequent US user, one has only 50 cases per year! A cardiologist or radiologist has this case load in a week or two. Our US experience is therefore low but could gain significantly if US was used more often and probably more sophisticated. The absolute advantage of navigated intraoperative 3D ultrasound (without MRI) is the better orientation through display in familiar planes (axial, coronal, and sagittal) compared to just US, and we demonstrated this (as other groups) in different settings as well (with different navigation or ultrasound companies). In my view, intraoperative US can never completely substitute intraoperative MRI, but in easy cases, like metastases, cavernomas, or hemangiomas, intraoperative US is absolutely enough for resection control. Recently, my prior colleagues have presented the same idea in a smaller setting in this journal as well [1]. I congratulate the authors for another valuable presentation of the use of this navigated 3D US in a stand-alone setting.

References

1. Miller D, Benes L, Sure U (2011) Stand-alone 3D-ultrasound navigation after failure of conventional image guidance for deep-seated lesions. Neurosurg Rev 34(3):381–7; discussion 387–8. Epub May 17, 2011.

Yavor Enchev, Varna, Bulgaria

Ultrasonography provides real-time imaging without a radiation burden to the patient. Intraoperative ultrasonography does not entail any special requirements on the neurosurgical armamentarium or the environment of the operating theater. Ultrasonographic devices are significantly cheaper than iCT and especially iMR. Intraoperative ultrasonography has been successfully integrated into neuronavigation systems, providing the potential for brain shift evaluation and correction.

In their paper, Peredo-Harvey and colleagues presented 18 patients who unintentionally underwent purely 3D ultrasound-based neuronavigational procedures without any preoperative navigational imaging, due to technical problems in loading MR images into the navigation device or to the urgency of the procedures, which did not allow additional time for immediate preoperative imaging. The procedures included 15 tumor resections, 2 biopsies, and 1 abscess resection. In the series, navigation based entirely on intraoperative ultrasound images allowed satisfactory delineation of lesions and complete performance of surgical intentions in all 18 patients. The intraoperative interpretation of ultrasound images correlated well with postoperative radiological imaging.

As mentioned in the text, neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning is a reliable and useful technique which could be helpful especially in emergency procedures and when technical problems make preoperative images inaccessible. Obviously, the main disadvantage of the technique is the non-navigational planning of craniotomy, which could be a source of inaccuracy.

In conclusion, in my opinion, neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning represents reliable, safe and cost-effective, alternative neuronavigational technique.

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Peredo-Harvey, I., Lilja, A. & Mathiesen, T. Post-craniotomy neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning. Neurosurg Rev 35, 263–268 (2012). https://doi.org/10.1007/s10143-011-0357-y

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  • DOI: https://doi.org/10.1007/s10143-011-0357-y

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