Artikel
Usefullness and limits of 3D-Ultrasound used for intra-operative imaging and resection control in brain tumors and vascular malformations
Möglichkeiten und Grenzen des 3D-Ultraschalls bei der intraoperativen Bildgebung und Resektionskontrolle bei Hirntumoren und Gefäßanomalien
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Autoren
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Nikolai Hopf
- Department of Neurosurgery, Katharinenhospital, Stuttgart
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M. Glaser
- Department of Neurosurgery, Johannes Gutenberg University, Mainz
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A. Perneczky
- Department of Neurosurgery, Johannes Gutenberg University, Mainz
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
Presently, ultrasound is the only real-time imaging technique for neurosurgical operations. Current technical development makes 3D-ultrasound appear to be most suitable for intraoperatiev localization and resection control in a variety of different intracranial lesions.
Methods
3D-ultrasound was used without (Toshiba: Aplio) or with an integrated neuronavigation system (Mison: SonoWand) in 100 patients. Lesions consisted of tumors in 85 patients (35 anaplastic gliomas, 33 low grade gliomas, 5 Meningeomas, 9 Metastases, 3 Hemangioblastomas) and vascular malformations in 15 patients (8 Cavernomas, 7 AVM´s). 3D-ultrasound data were acquired and documented before opening of the dura, during and at the end of the resection.
Results
3D-ultrasound in combination with neuronavigation was found to be most helpful in localization of small subcortical lesions. In 5 cases, obvious brain-shift following opening of the dura could be detected and corrected with this method. In low grade gliomas exact imaging of the tumor borders was possible throughout the entire surgical procedures. In high grade gliomas differentiation between tumor and edema was found to be more difficult or even impossible in 5 of 35 patients. Additional use of doppler mode was found to be helpful for both, localization and resection control in AVM´s.
Conclusions
3D-ultrasound is a very useful intraoperative tool to visualize margins and progress of resection in low grade gliomas. Handling is easy and technical reliability high. The integration of doppler mode makes it also most suitable for intraoperativ imaging of AVM´s.
