Intraoperative Ultrasound: Emerging Technology and Novel Applications in Brain Tumor Surgery.

Giuseppe Roberto Giammalva,Francesca Graziano,Paolo Palmisciano,Domenico Gerardo Iacopino,Federica Paolini,Rina Di Bonaventura,Sofia Musso,Silvana Tumbiolo,Massimo Midiri,Rosa Maria Gerardi,Maria Angela Pino,Roberta Costanzo,Rosario Maugeri,Giuseppe Salvaggio,Lara Brunasso,Gianluca Scalia,Giuseppe Emmanuele Umana,Gianluca Ferini

doi:10.3389/fonc.2022.818446

Abstract

Intraoperative ultrasound (IOUS) is becoming progressively more common during brain tumor surgery. We present data from our case series of brain tumor surgery performed with the aid of IOUS in order to identify IOUS advantages and crucial aspects that may improve the management of neurosurgical procedures for brain tumors. From January 2021 to September 2021, 17 patients with different brain tumors underwent brain tumor surgery aided by the use of IOUS. During surgery, the procedure was supported by the use of multiples ultrasonographic modalities in addition to standard B-mode: Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS). In selected cases, the use of IOUS during surgical procedure was combined with neuronavigation and the use of intraoperative fluorescence by the use of 5-aminolevulinic acid (5-ALA). In one patient, a preoperative ultrasound evaluation was performed through a former iatrogenic skull defect. This study confirms the role of IOUS in maximizing the EOR, which is strictly associated with postoperative outcome, overall survival (OS), and patient’s quality of life (QoL). The combination of ultrasound advanced techniques such as Doppler, color Doppler, elastosonography, and contrast-enhanced intraoperative ultrasound (CEUS) is crucial to improve surgical effectiveness and patient’s safety while expanding surgeon’s view.

Highlights

Ultrasound (US) is an imaging technique widely used in medicine, thanks to the variety of information that it can provide together with its simplicity of use
All patients underwent standardized protocol of intraoperative ultrasound with B-Mode US, Doppler, color Doppler ultrasonography, and contrast-enhanced intraoperative ultrasound (CEUS); strain elastosonography was performed in eight patients (47.1%). 5-aminolevulinic acid (5-ALA) was administered as tumor-specific fluorescent dye in all patients diagnosed with glioblastoma (29.4%)
In one patient (5.9%), a preoperative Intraoperative ultrasound (IOUS) evaluation was performed through an acoustic window given by a previous iatrogenic skull defect in order to anticipate the following surgical strategy

Summary

Introduction

Ultrasound (US) is an imaging technique widely used in medicine, thanks to the variety of information that it can provide together with its simplicity of use. Brain surgery offers a unique opportunity to employ intraoperative ultrasound (IOUS); the acoustic windows offered by craniotomy let US penetrate the brain, directly visualizing neural structures and supporting the surgical procedure [1]. The first application field of IOUS is represented by the neuro-oncological surgery. Since the 1980s, several studies have shown that IOUS is capable of accurately identifying brain tumor during neurosurgical procedures and facilitating tumor resection, both in case of intra- and extra-axial lesions. IOUS allows surgeons to maximize the extent of resection while preserving normal brain parenchyma and, as a consequence, neurological functions, reducing the mortality and increasing the progression-free survival (PFS) [2,3,4,5,6,7,8,9]

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