Abstract
Central nervous system tumors represent the most frequent solid malignancy in the pediatric population. Maximal safe surgical resection is a mainstay of treatment, with significant prognostic impact for the majority of histotypes. Intraoperative ultrasound (ioUS) is a widely available tool in neurosurgery to assist in intracerebral disease resection. Despite technical caveats, preliminary experiences suggest a satisfactory predictive ability, when compared to magnetic resonance imaging (MRI) studies. Most of the available evidence on ioUS applications in brain tumors derive from adult series, a scenario that might not be representative of the pediatric population. We present our preliminary experience comparing ioUS-assisted resection assessment to early post-operative MRI findings in 154 consecutive brain tumor resections at our pediatric neurosurgical unit. A high concordance was observed between ioUS and post-operative MRI. Overall ioUS demonstrated a positive predictive value of 98%, a negative predictive value of 92% in assessing the presence of tumor residue compared to postoperative MRI. Overall, sensibility and specificity were 86% and 99%, respectively. On a multivariate analysis, the only variable significantly associated to unexpected tumor residue on postoperative MRI was histology. Tumor location, patient positioning during surgery, age and initial tumor volume were not significantly associated with ioUS predictive ability. Our data suggest a very good predictive value of ioUS in brain tumor resective procedures in children. Low-grade glioma, high-grade glioma and craniopharyngioma might represent a setting deserving specific endeavours in order to improve intraoperative extent of resection assessment ability.
Highlights
Several studies have demonstrated that extent of resection is a crucial prognostic factor for achieving the best outcome in neurosurgical oncology [1].For this reason, previous investigations have focused on the possible contribution of intraoperative imaging techniques in improving surgical results [2]
Intraoperative ultrasonography is a promising tool to assist the surgeon in accomplishing several tasks, including target localization, volume and margin delineation, real-time brain shift evaluation and assessment of extent of resection [3, 4]
We report our experience on the use of intraoperative ultrasonography (ioUS) in series of pediatric patients undergoing brain tumor resection
Summary
Several studies have demonstrated that extent of resection is a crucial prognostic factor for achieving the best outcome in neurosurgical oncology [1]. For this reason, previous investigations have focused on the possible contribution of intraoperative imaging techniques in improving surgical results [2]. Previous investigations have focused on the possible contribution of intraoperative imaging techniques in improving surgical results [2] In this context, intraoperative ultrasonography (ioUS) is a promising tool to assist the surgeon in accomplishing several tasks, including target localization, volume and margin delineation, real-time brain shift evaluation and assessment of extent of resection [3, 4]. Available evidence is mainly based on adult case series, which might fail to account for population specific features of pediatric disease [9, 10]
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