Abstract
Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.
Highlights
Maximal safe resection represents the gold standard for surgery of malignant brain tumors: gross total resection of the tumor while preserving the surrounding functional brain tissue is the main goal, since it is associated with longer survival and better patient quality of life [1]
In a technical note that is not yet published, we described the removal of high-grade gliomas under fluorescence dye, B-mode ultrasonoghraphy, and contrast-enhanced ultrasound (CEUS) technique in five patients (3 males, 2 females; mean age 55.2 years, range 36–68 years) who underwent craniotomies for intra-axial lesions, which were suspected for high-grade gliomas on preoperative magnetic resonance imaging (MRI)
Findings and the post-op Computed Tomography (CT) scan findings in the 28 pts with parenchymal tumors; 5 patients who had received prior radiation and 2 inflammatory granulomas were excluded from the analysis, there was concordance between the intra-operative ultrasound (IOUS) findings and the post-op
Summary
Maximal safe resection represents the gold standard for surgery of malignant brain tumors: gross total resection of the tumor while preserving the surrounding functional brain tissue is the main goal, since it is associated with longer survival and better patient quality of life [1]. This is true for gliomas, the most common primary malignant brain tumors whose pathogenesis is still unknown [2,3]. It is due to two main factors: the first is “brain shift” caused by the effect of gravity on the brain, brain swelling, as well as the drainage of cerebrospinal fluid (CSF); the second factor is the deformation of brain parenchyma caused by surgical maneuvers and tumor removal [5]
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