Unraveling the Efficiency of Non-Navigated 2D Intraoperative Ultrasound in Glioma Surgery: Challenging the Demand for Increased Technological Sophistication in Intraoperative Imaging

Abstract

ABSTRACTBackgroundIn an era characterized by rapid progression in neurosurgical technologies, traditional tools such as the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) risk being overshadowed. Against this backdrop, this study endeavors to provide a comprehensive and rigorous assessment of the clinical efficacy and surgical relevance of nn-2D-IOUS, specifically in the context of glioma resections.MethodsThis retrospective study undertaken at a single center evaluated 99 consecutive, non-selected patients diagnosed with both high-grade and low-grade gliomas. The primary objective was to assess the proficiency of nn-2D-IOUS in generating satisfactory image quality, identifying residual tumor tissue, and its influence on the extent of resection. To validate these results, early postoperative MRI data served as the reference standard.ResultsThe nn-2D-IOUS exhibited a high level of effectiveness, successfully generating good quality images in 79% of the cases evaluated. With a sensitivity rate of 68% and a perfect specificity of 100%, nn-2D-IOUS unequivocally demonstrated its utility in intraoperative tumor detection. Notably, in cases where total tumor removal was the surgical objective, a resection exceeding 95% of the initial tumor volume was achieved in 86% of patients. Additionally, in cases where residual tumor was not detected by nn-2D-IOUS, the mean volume of undetected tumor tissue was remarkably minimal, averaging at 0.29 cm3.ConclusionOur study provides compelling evidence supporting the invaluable role and efficacy of nn-2D-IOUS in glioma surgery. The results underscore the potential of harnessing traditional, cost-effective technologies such as nn-2D-IOUS to achieve enhanced surgical outcomes, even in the face of more advanced alternatives. These insights carry significant implications, particularly for resource-constrained settings, emphasizing the importance of optimizing the use of existing tools to improve patient care in a practical and efficient manner.