| الوصف: |
Introduction: Since its introduction to modern neurosurgery, neuronavigation has aided the surgeon during presurgical planning. However, this technique loses power throughout the surgical intervention due to brain shifting, thus not being reliable to assess whether the optimal resection rate has been achieved. One possible solution to this is the acquisition of intraoperative neuroimaging. In this original study, we evaluate the efficiency of navigated ultrasound as a potential tool for acquiring intraoperative real time imaging. Materials and Methods: Prospective study including all intracerebral tumors operated with navigated ultrasound at Sant Pau Hospital. Follow up started in July 2015 until present day. Results: N = 70 patients. 38 (54,3%) female and 32 (45,7%) male. Mean age 56,3 (19-79) years. Tumors by histology: glioblastoma 22 (31,4%), metastases 18 (25,7%), low-grade glioma 7 (10%), anaplasic glioma 6 (8,5%), anaplasic oligodendroglioma 5 (7,1%), oligodendroglioma 4 (5,7%), gliosarcoma 2 (2,8%), cavernoma 2 (2,8%), lymphoma 1 (1,4%), pilocytic astrocitoma 1 (1,4%), nonspecific inflammation 1 (1,4%) and demyelinating disease 1 (3%). All lesions were classified according to the ultrasonographic visibility scale, described in the literature: Grade 3: Lesion clearly identifiable and clear border with normal tissue, Grade 2: Lesion clearly identifiable but no clear border with normal tissue, Grade 1: Lesion difficult to visualize and no clear border with normal tissue and Grade 0: Lesion not visible. Of all included cases, 51 (72,8%) where Grade 3 tumors, 16 (22,8%) Grade 2, 2 (2,8%) Grade 1 and 1 (1,4%) Grade 0. Interestingly, the most frequently operated intracranial lesions (metastases and glioblastoma) present a high degree of adequate intraoperative visualization with a mean 94,4% Grade 3 for metastases and 77,2% for glioblastoma. Despite being regularly visualized, low-grade gliomas tend to show blurred margins, presenting on our series with a 54,5% Grade 3 and 57,1% grade 2. We need to consider the infiltrative nature of low-grade gliomas when interpreting these results. On 11 (15,7%) of all cases, the navigated ultrasound provided imaging information to lead to further tumor resection. On 5 (7,1%) of all cases, a Doppler study was performed to assess vascular permeability. There were no complications associated to the use of navigated ultrasound. Conclusions: Navigated ultrasound is an effective, economic and secure technique that provides good quality real-time intraoperative images. |