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intraoperative_ultrasound_indications

Intraoperative ultrasound indications

The use of intraoperative ultrasound (US) during neurosurgical procedures is becoming more widespread. Multiple studies have shown that US is a valuable tool in tumor detection during surgery 1) 2) 3) 4) 5).

Intraoperative ultrasound for focal cortical dysplasia

Intraoperative ultrasound in intracranial meningioma

Intraoperative ultrasound for glioma.

Combining awake surgery with intraoperative magnetic resonance is logistically challenging.

Navigable ultrasound (US) is a useful alternative in such cases.

It is a sensitive imaging modality when used in patients with Cushing's disease in whom findings on pituitary MR imaging are negative. The improved ability to detect and localize these tumors positively affects surgical outcome 6).

Intraoperative scanning of the pituitary gland with high-frequency-ultrasound probes may identify intrapituitary anatomy and pathologies even in MRI-negative cases. This may prevent extensive exploration of the gland with the risk of subsequent hypopituitarism 7).


Cavernous malformation.


Intra-operative brain swelling consider intraoperative ultrasound if rapidly available to rule-out hematoma (intracerebral, EDH, SDH) which could potentially be immediately evacuated.

Spinal surgery

Controversial, 8) favored by some experts. Astrocytomas are usually iso-echoic with the spinal cord, whereas ependymomas are usually hyperechoic.

It is a valuable tool to detect spinal lesions, evaluate the surgical approach and plan the surgical strategy considering the position and relationships of the lesion with bony, neural and vascular structures 9).

Syringomyelia

Intraoperative ultrasound is often helpful for:

a) localizing the cyst

b) assessing for septations (to avoid shunting only part of cyst)

Transpedicular thoracic discectomy

Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach 10) 11).


Intraoperative USG with measurement of CSF allows the proper selection of patients with chiari type 1 deformity that can have a less invasive surgery with bone decompression without duraplasty 12).

References

1)
Sosna J, Barth MM, Kruskal JB, Kane RA. Intraoperative sonography for neurosurgery. J Ultrasound Med. 2005;24(12):1671-1682.
2)
Unsgaard G, Gronningsaeter A, Ommedal S, Nagelhus Hernes TA. Brain operations guided by real-time two-dimensional ultrasound: new possibilities as a result of improved image quality. Neurosurgery. 2002;51(2):402-411; discussion 411-412.
3)
Selbekk T, Jakola AS, Solheim O, et al. Ultrasound imaging in neurosurgery: approaches to minimize surgically induced image artefacts for improved resection control. Acta Neurochir (Wien). 2013;155(6):973-980.
4)
WoydtM,KroneA,BeckerG,SchmidtK,RoggendorfW,RoosenK.Correlation of intra-operative ultrasound with histopathologic findings after tumour resection in supratentorial gliomas: a method to improve gross total tumour resection. Acta Neurochir (Wien). 1996;138(12):1391-1398.
5)
Woydt M, Vince GH, Krauss J, Krone A, Soerensen N, Roosen K. New ultrasound techniques and their application in neurosurgical intra-operative sonography. Neurol Res. 2001;23(7):697-705.
6)
Watson JC, Shawker TH, Nieman LK, DeVroom HL, Doppman JL, Oldfield EH. Localization of pituitary adenomas by using intraoperative ultrasound in patients with Cushing's disease and no demonstrable pituitary tumor on magnetic resonance imaging. J Neurosurg. 1998 Dec;89(6):927-32. PubMed PMID: 9833817.
7)
Knappe UJ, Engelbach M, Konz K, Lakomek HJ, Saeger W, Schönmayr R, Mann WA. Ultrasound-assisted microsurgery for Cushing's disease. Exp Clin Endocrinol Diabetes. 2011 Apr;119(4):191-200. doi: 10.1055/s-0029-1241207. Epub 2009 Dec 11. PubMed PMID: 20013609.
8)
Albright AL. Pediatric Intramedullary Spinal Cord Tumors. Childs Nerv Syst. 1999; 15:436–437
9)
Prada F, Vetrano IG, Filippini A, Del Bene M, Perin A, Casali C, Legnani F, Saini M, DiMeco F. Intraoperative ultrasound in spinal tumor surgery. J Ultrasound. 2014 Jun 7;17(3):195-202. doi: 10.1007/s40477-014-0102-9. eCollection 2014 Sep. PubMed PMID: 25177392; PubMed Central PMCID: PMC4142127.
10)
Tan LA, Lopes DK, Fontes RB. Ultrasound-guided posterolateral approach for midline calcified thoracic disc herniation. J Korean Neurosurg Soc. 2014 Jun;55(6):383-6. doi: 10.3340/jkns.2014.55.6.383. Epub 2014 Jun 30. PubMed PMID:25237439.
11)
Nishimura Y, Thani NB, Tochigi S, Ahn H, Ginsberg HJ. Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography. J Neurosurg Spine. 2014 Jul 18:1-9. [Epub ahead of print] PubMed PMID: 25036220.
12)
Brock RS, Taricco MA, de Oliveira MF, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E. Intra Operative Ultrasonography for Definition of Less Invasive Surgical Technique in Patients with Chiari Type I Malformation. World Neurosurg. 2017 Feb 9. pii: S1878-8750(17)30152-3. doi: 10.1016/j.wneu.2017.02.003. [Epub ahead of print] PubMed PMID: 28192262.
intraoperative_ultrasound_indications.txt · Last modified: 2019/08/15 18:00 by administrador