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

Intraoperative 3D ultrasound in neurosurgery – an alternative technique

Intraoperativer 3D-Ultraschall in der Neurochirurgie – eine alternative Methode

Meeting Abstract

  • corresponding author D. Lindner - Klinik für Neurochirurgie, Universität Leipzig
  • C. Trantakis - Klinik für Neurochirurgie, Universität Leipzig
  • S. Arnold - Localite, Bonn
  • H. Roth - Klinik für Diagnostische Radiologie, Abteilung für Neuroradiologie, Universität Leipzig
  • W. Korb - Klinik für Diagnostische Radiologie, Abteilung für Neuroradiologie, Universität Leipzig
  • J. Meixensberger - Klinik für Neurochirurgie, Universität Leipzig

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.09.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc185.shtml

Veröffentlicht: 11. April 2007

© 2007 Lindner 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

Text

Objective: Ultrasound image quality has improved dramatically in recent years. The key to using intraoperative ultrasound images with neuronavigation was the development of an 3D-ultrasound system. Since the first results were published in 2002 it has become a real alternative for intraoperative imaging. However only few neurosurgical centres are familiar with 3D-IUS. There is a lack of information about usability, stability and accuracy of the system. The aim of the paper is the presentation of our experience with 45 patients.

Methods: For navigation support, a freehand 3D ultrasound workstation was used consisting of a standard personal computer containing a video grabber card in combination with an optical tracking system (NDI Polaris) and an ultrasound device (Siemens G 60 S). Preoperative 3D-MRI data were acquired with an 1, 5 Tesla magnet unit (Siemens, Germany). In cases with tumor localisation near the circuit of Willis an TOF-MRA (time of flight mRA) was implemented. All patients had an early postoperative MRI. The ultrasound probe worked directly in different depths (6-12cm). 3D-Power Doppler and 3D ultrasound datasets were obtained by the transdural route, after dural incision and at the end of the operation as well. The tracked microscope was used as a pointer to define tumor remnants.

Results: Up to November 2006, 45 patients were included in the study. The 3D ultrasound navigator was successful and robust in all patients. The accuracy of the US-navigator was generally 0.8 mm; the FFE was at least 1, 3 mm. The expenditure of time for one 3D-IUS datasets is with 2-5 minutes which is fast enough for intraoperative condition. Maximum brain shift was detected in all cases in a range from 1 to 12 mm. In gliomas the hyperechoic zone could detected and removed with 3D-IUS using iterative technique. Except for one, both the last 3D-IUS and the postoperative MRI demonstrated the same resection result of tumor remnants (95%) in all patients. Operative strategy was changed to more radical resection after 3D-IUS in seven patients (35%). In vascular malformations and hemangioblastomas, 3D rendering of the vessels with Power Doppler allows additional information about feeders and draining vessels for resection control and operative approach.

Conclusions: Up to November 2006, 45 patients were included in the study. The 3D ultrasound navigator was successful and robust in all patients. The accuracy of the US-navigator was generally 0.8 mm; the FFE was at least 1, 3 mm. The expenditure of time for one 3D-IUS datasets is with 2-5 minutes which is fast enough for intraoperative condition. Maximum brain shift was detected in all cases in a range from 1 to 12 mm. In gliomas the hyperechoic zone could detected and removed with 3D-IUS using iterative technique. Except for one, both the last 3D-IUS and the postoperative MRI demonstrated the same resection result of tumor remnants (95%) in all patients. Operative strategy was changed to more radical resection after 3D-IUS in seven patients (35%). In vascular malformations and hemangioblastomas, 3D rendering of the vessels with Power Doppler allows additional information about feeders and draining vessels for resection control and operative approach.