Intraoperative ultrasonography in brain tumor surgery

Abstract

Introduction Intraoperative ultrasonography (IOUS) is an accessible imaging modality that provides real-time surgical guidance with minimal risk or additional operative time. There is a strong correlation between IOUS and postoperative CT findings when evaluating the extent of tumor resection, suggesting that IOUS can have significant clinical implications. Purpose The objective of this study was to provide more evidence on the usage of IOUS in the determination of gross-total resection (GTR) in adult patients with brain tumors. Material and methods This study consisted of a retrospective review of adult neurosurgical patients who were treated at Institute of Neurology and Neurosurgery between 2015 and 2020 for a tumor of the brain. All patients were treated with IOUS and then underwent postoperative CT with or without contrast within first 3 days after surgery. Results A total of 85 patients met inclusion criteria for the study. IOUS results showed a strong association with postoperative CT results. IOUS was able to accurately identify residual tumor in 100% of subtotal resection cases where resection was stopped due to invasion of tumor into eloquent locations. Cases involving gliomas had a 75% intended GTR rate. Cases involving metastatic tumors had an 87% intended GTR rate. The sensitivity and specificity were reported for IOUS in all included tumor pathologies, glioma cases, and metastatic tumor cases, respectively. Conclusions The use of IOUS may allow for a reliable imaging modality to achieve a more successful GTR of brain tumors in adult neurosurgical patients. When attempting GTR, it was demonstrated an 81% GTR rate. IOUS can be used in CNS tumor surgery to improve surgical outcomes.