Abstract
Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.
Highlights
Gliomas are among the most common highly malignant primary brain tumors, accounting for 24.7% of all primary brain tumors and 74.6% of malignant brain tumors [1, 2], with glioblastomas representing the most fatal and common type
high-grade gliomas (HGG) 23 To analyze the relationship between quantitative Contrast-enhanced ultrasound (CEUS) parameters Lowgrade gliomas (LGGs) 26 and microvessel density (MVD) in different grades of gliomas quantitative data analysis of different grades of gliomas; the quantitative CEUS parameters were closely related to MVD and were helpful in understanding glioma grade and optimizing surgical strategy
Ability of CEUS to distinguish between tumor and artifacts or normal brain on brightness mode (B-mode) is based on its ability to determine the vascularization degree
Summary
Gliomas are among the most common highly malignant primary brain tumors, accounting for 24.7% of all primary brain tumors and 74.6% of malignant brain tumors [1, 2], with glioblastomas representing the most fatal and common type. The ability to achieve GTR, including precise localization and accurate tumor border description, has promoted an increase in the popularity of real-time intraoperative imaging, which is crucial for each surgical step [6, 7]. Unlike IOMR, an established imaging tool for tumor visualization and resection, IOUS has been highly regarded for its ease of use, real-time capability, portability, and affordability [7]. IOUS offers reliable real-time updates of the operative field (“live anatomy”) [15], which could improve intraoperative image quality in patients with glioma. Considerable advancements in forms of new probes, contrast agents, and techniques have been made to intraoperative ultrasonography, which have made ultrasound a multiparametric imaging tool, improving surgical resection and survival rates in patients with gliomas [19]. Given the rapid development and popularization of IOUS over recent years, the current review is aimed at describing the new advancements in ultrasound technology and evaluating the role and limitations of IOUS in glioma surgery
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