Use Of Intraoperative Ultrasonography Research Articles

Intraoperative Ultrasonography (IOUS) in Thoracolumbar Fractures

The thoracolumbar levels are the second most common region for spinal trauma. A major surgical effort often entails removal of retropulsed bone fragments with decompression of the spinal contents or realignment of vertebral subluxations. The ability to determine intraoperatively the completeness of such a procedure could impact on the surgical approach and, ultimately, the operative result. The intraoperative use of ultrasonography has gained popularity and applicability. This comparison study of intraoperative ultrasonography versus postoperative computed tomography (CT) assessed the accuracy of intraoperative ultrasonography in determining the status of the spinal canal following surgical intervention in a group of 21 patients with thoracolumbar fractures. In all cases a patent ventral subarachnoid space or complete spinal canal decompression was deduced following intraoperative ultrasonography. The postoperative assessment by CT concurred in 20 of 21 (95%) situations. Intraoperative ultrasonography proved useful during the operative management of these fractures and gave good supportive evidence that the neural elements were decompressed by surgical procedure.

Surgical management of insulinoma: diagnosis of tumor location and high incidence of malignancy.

The findings in twenty-two patients with insulinoma were reviewed, as continuous efforts should be made to establish preoperative localization of the tumor. Superselective arteriography and percutaneous, transhepatic portal vein and pancreatic venous catheterization are highly recommended approaches. At the time of surgical intervention, a cautious exploration of the pancreas after thorough mobilization is most important. Recent use of intraoperative ultrasonography increases the likelihood of finding these occult tumors which locate deeply in the head of the pancreas. Apart from the diagnostic problems, we wish to emphasize the high incidence of malignancy (7/22, 31.8 per cent) in our series. Although patients with malignant insulinoma had a much better prognosis compared to those with a pancreatic ductal malignancy, pancreatic resection with regional lymphnode dissection seems to be a rational procedure. Enucleation can be done when intraoperative findings of the tumor and regional lymphnode indicate no malignant features and no multiple lesions. However, at the first operation, enucleation is still a procedure of choice, even for the malignant insulinoma in the head with a well-defined capsule and no metastatic lesions, the objective being to avoid a duodenopancreatectomy or total pancreatectomy.

Intraoperative ultrasonographic study of the liver: Methods and anatomic results

In this study, we have reported our experience with the use of intraoperative ultrasonography in the field of liver surgery. Using the method, the intrahepatic segmental pedicles can be precisely located and thus, segmentectomies can be performed in an anatomic way. The technique allows the most economic parenchymal resection in cirrhotic patients which may be important for prevention of postoperative liver insufficiency.

In-utero gunshot wound to the head. Use of intraoperative ultrasonography for localization of an intracerebral projectile

Approaching full gestational age, a 1700-g male fetus sustained a penetrating gunshot wound to the left parietal region of the head while in utero. The child was delivered by emergency caesarean section. Initially in profound fetal shock and with almost no neurological function, the child was eventually stabilized. A posttraumatic intracerebral porencephalic cyst developed, with the projectile moving freely within the confines of the cyst cavity. Six weeks after the initial injury, the patient underwent an operation for extraction of the projectile. The Neuro SectOR ATL ultrasound probe was used intraoperatively and was instrumental in determining the exact position of the intracerebral projectile.