Article
Is the image guidance of ultrasonography beneficial for neurosurgical routine?
Ist die navigierte Ultraschalltechnologie in der operativen Routine von Vorteil?
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Published: | May 8, 2006 |
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Objective: Intraoperative ultrasound has been extensively used in neurosurgical procedures as it has the advantage of producing real-time images. However, images are often difficult to interpret. Ultrasound-navigation combines real-time sonographic data and image guidance. The intraoperative images, in alignment with preoperative MRI-scans, can compensate for brain shift and help in resection control and approach planning. It is thus a potentially valuable adjunct during the surgical excision of brain tumours. In the present study we evaluate our new sononavigation system and compare it to conventional intraoperative ultrasound.
Methods: From January to June 2005, 29 tumour patients were operated on with the aid of intraoperative ultrasound. Sononavigation was used in 13 cases, the non-navigated ultrasound technology in the remaining individuals. We compared our one-platform sononavigation system containing an integrated ultrasound device (VectorVision2, BrainLAB, Germany) with a high end ultrasound system (Aplio, Toshiba, Tokyo, Japan) that is not connected to a navigation platform. Special considerations were taken in regard to image quality, tumour demarcation, orientation and whether anatomical landmarks were easily visualized.
Results: The pathology could be visualized in all patients. The tumour was well defined in 12/16 non-navigated and 11/13 navigated cases, respectively. Although image quality was good in most cases, orientation remained difficult in 8/16 patients in whom conventional sonography was used. Image fusion for sononavigation was performed without difficulties in all cases and a good-quality ultrasound picture was achieved in 11/13 navigated patients. In our hands the orientation in the sononavigated cases was judged to be superior to non-navigated ultrasound.
Conclusions: Intraoperative ultrasound provides valuable real-time information during tumour removal but is sometimes difficult to read. In our hands, integration of the ultrasound into the navigation system facilitates anatomical understanding as the preoperative MRI-data set helps to interpret the sonographic data. Thus, we feel that this technology is beneficial for neurosurgical routine.