Affiliation:
1. Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
2. Institute of Neurosurgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Abstract
Introduction: Intraoperative ultrasound (IOUS) may aid the resection of space-occupying brain lesions, though technical limits may hinder its reliability. Methods: IOUS (MyLabTwice®, Esaote, Italy) with a microconvex probe was utilized in 45 consecutive cases of children with supratentorial space-occupying lesions aiming to localize the lesion (pre-IOUS) and evaluate the extent of resection (EOR, post-IOUS). Technical limits were carefully assessed, and strategies to enhance the reliability of real-time imaging were accordingly proposed. Results: Pre-IOUS allowed us to localize the lesion accurately in all of the cases (16 low-grade gliomas, 12 high-grade gliomas, eight gangliogliomas, seven dysembryoplastic neuroepithelial tumors, five cavernomas, and five other lesions, namely two focal cortical dysplasias, one meningioma, one subependymal giant cell astrocytoma, and one histiocytosis). In 10 deeply located lesions, IOUS with hyperechoic marker, eventually coupled with neuronavigation, was useful to plan the surgical route. In seven cases, the administration of contrast ensured a better definition of the vascular pattern of the tumor. Post-IOUS allowed the evaluation of EOR reliably in small lesions (<2 cm). In large lesions (>2 cm) assessing EOR is hindered by the collapsed surgical cavity, especially when the ventricular system is opened, and by artifacts that may simulate or hide residual tumors. The main strategies to overcome the former limit are inflation of the surgical cavity through pressure irrigation while insonating, and closure of the ventricular opening with Gelfoam before insonating. The strategies to overcome the latter are avoiding the use of hemostatic agents before IOUS and insonating through normal adjacent brain instead of corticotomy. These technical nuances enhanced the reliability of post-IOUS, with a total concordance to postoperative MRI. Indeed, the surgical plan was changed in about 30% of cases, as IOUS showed a residual tumor that was left behind. Conclusion: IOUS ensures reliable real-time imaging in the surgery of space-occupying brain lesions. Limits may be overcome with technical nuances and proper training.
Reference43 articles.
1. Intraoperative Ultrasound in Brain Tumor Surgery: A Review and Implementation Guide;Dixon;Neurosurg. Rev.,2022
2. de Laurentis, C., Bteich, F., Beuriat, P.A., Mottolese, C., Giussani, C., Szathmari, A., Vinchon, M., and Di Rocco, F. (2022). Sodium Fluorescein in Pediatric Neurosurgery: A Systematic Review with Technical Considerations and Future Perspectives. Childs Nerv. Syst., 1–12.
3. The Impact of Fluorescein-Guided Technique in the Surgical Removal of CNS Tumors in a Pediatric Population: Results from a Multicentric Observational Study;Cavallo;J. Neurosurg. Sci.,2019
4. Falco, J., Broggi, M., Schiariti, M., Vetrano, I.G., Esposito, S., Ferroli, P., and Acerbi, F. (2022). The Role of Sodium Fluorescein in Pediatric Supratentorial Intra-Axial Tumor Resection: New Insights from a Monocentric Series of 33 Consecutive Patients. Childs Nerv. Syst., 1–9.
5. 5-Aminolevulinic Acid-Derived Tumor Fluorescence: The Diagnostic Accuracy of Visible Fluorescence Qualities as Corroborated by Spectrometry and Histology and Postoperative Imaging;Stummer;Neurosurgery,2014
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