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A practical grading system of ultrasonographic visibility for intracerebral lesions

  • Clinical Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S102JF

    Richard Mair, James Heald & Marcel Ivanov

  2. Department of Neurosurgery, Hospital Nicolae Oblu, University of Medicine and Pharmacy Gr. T. Popa, 2 Ateneului, 700309, Iasi, Romania

    Ion Poeata

Authors
  1. Richard Mair
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  2. James Heald
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  3. Ion Poeata
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  4. Marcel Ivanov
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Corresponding author

Correspondence to Marcel Ivanov.

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*This study has not been presented at a conference

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Mair, R., Heald, J., Poeata, I. et al. A practical grading system of ultrasonographic visibility for intracerebral lesions. Acta Neurochir 155, 2293–2298 (2013). https://doi.org/10.1007/s00701-013-1868-9

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  • DOI: https://doi.org/10.1007/s00701-013-1868-9

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