Anatomic visualization with ultrasound-assisted intracranial image guidance in neurosurgery: a report of 30 patients.

Abstract

The increasing application of computer-assisted, imageguided surgery has created a need for adjunctive intraoperative, real-time visualization. Techniques for combining preoperative MRI or CT with intraoperative ultrasonography, have been developed. We believe the neurosurgical application of this technique represents a significant advance in intraoperative imaging. The integration of real-time intraoperative imaging with preoperative planning images has the following advantages: it provides the ability to localize and orient relevant anatomy; it assists in achieving complete tumor resection by assisting with the interpretation of the intraoperative ultasound images; and although not specifically addressed in this article, it can provide real-time quantitative and qualitative measurements of brain and structural shift. To assess the feasibility of this approach in a uniform operative situation, 30 ultrasound-assisted, image-guided craniotomies involving resection of metastatic disease are reviewed. During the past several decades, use of multiple preoperative radiologic imaging modalities has become an integral part of preoperative and intraoperative surgical planning. Additionally, the widespread neurosurgical use of stereotactic image-guided procedures has created an increased demand for improvements in intraoperative imaging applications. Currently, intraoperative MRI, CT, and ultrasonography are potentially available for intraoperative use. Each of these intraoperative imaging techniques, in combination with an intraoperative stereotactic-image guidance system, offers more accurate lesion localization, more complete lesion resection, safer surgical trajectory planning, smaller craniotomies,