gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Image guided ultrasound in cavernoma surgery

Anwendung von navigiertem Ultraschall bei der Resektion von Kavernomen

Meeting Abstract

  • corresponding author D. Miller - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • O. Bozinov - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • T. Mikami - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • W. Tirakotai - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg
  • U. Sure - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.06.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc172.shtml

Veröffentlicht: 11. April 2007

© 2007 Miller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Computer-assisted image guidance systems have been introduced to support approach planning for small lesions and to reduce the risk of neurological deficit for the patient. Intraoperative imaging techniques allow an online update of the anatomy and an intraoperative resection control. We present our experience with image-guided ultrasound to aid in the resection of intracerebral cavernomas.

Methods: Ultrasound guided neuronavigation was used in 48 of 71 patients with cavernous angiomas treated microsurgically during the time period from January 2005 to October 2006. In ten patients the lesion was located within the brainstem, in one lady within the thalamus, in 13 cases within the deep white matter of the hemispheres and in the remaining 14 patients in the superficial areas of the hemisphere. The minimum size of the cavernomas was 8 mm. Neuronavigation was planned by MRI or CT using standard fiducials. After performing a tailored navigated craniotomy, a transdural 2D- or 3D-ultrasound scan was performed in all cases and the exact approach was planned. After resection a control scan was done except in cases where the patient was operated in a sitting position.

Results: Intraoperative ultrasound allowed an easy identification of the lesions. The sonographic appearance was either hyperechogenic, irregular or hypoechogenic with a hyperechogenic rim depending on age, time course and size of the associated hematoma. For transsulcal approaches the correct sulcus was identified by ultrasound and landmarked with the image guidance system. A significant initial shift was detected in fourteen cases by comparing ultrasound images and preoperative data. The approach was subsequently adjusted according to the ultrasound images. Resection control could be performed intraoperatively and verified by postoperative MRI or CT.

Conclusions: Image guided ultrasound is a useful adjunct for approach planning and resection control in cavernoma surgery as it provides intraoperative image updating and usually allows compensation of the brain shift.