gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Intraoperative 3D-reconstructed and contrast enhanced ultrasound in brain tumor surgery

Meeting Abstract

  • F. Arlt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
  • D. Lindner - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
  • A. Müns - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
  • C. Chalopin - Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig
  • J. Meixensberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.11.04

DOI: 10.3205/12dgnc384, URN: urn:nbn:de:0183-12dgnc3840

Published: June 4, 2012

© 2012 Arlt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Complete tumor removal in the surgical treatment of malignant brain tumors is associated with a longer overall survival. For intraoperative resection control a convincing imaging modality is needed even instead of brain shift makes the neuronavigation vague. We investigate the application of 3D reconstructed and contrast enhanced ultrasound in brain tumor surgery.

Methods: Until November 2011 we investigated 34 patients suffering on a Glioblastoma (GBM, n=18), Astrocytoma WHO Grade II (n=1) and III (n=2), Oligodendroglioma Grade II (n=1), Meningeomas (n=3) and Metastasis (n=9). The navigation was performed with a LOCALITE® navigation system with a deviation less than 1.5 mm. The transdural ultrasound scans were implemented via DVI® before and after contrast agent application (SonoVue by Bracco®). After resection navigated biopsies were taken from the resection boarder referred to the 3D ultrasound data after contrast agent application. The postoperative MRI was matched on the 3D datasets after resection and the resection boarders were compared with regard to residual contrast agent uptake.

Results: The different tumor entities showed different contrast agent uptake behaviour. Malignant brain tumour showed uptake regularly in a high number of cases (16/18 patients with GBM 89%, 1/1 patient with Atrocytoma III, 7/9 patients with Metastasis 78%) while benign tumors often showed no contrast agent uptake (patient with Meningeoma 1/3 with uptake, patients with Oligodendroglioma II or Astrocytoma II no uptake). No pharmacological incidence was observed after application of 4.8 ml SonoVue® in each case. In case of residual tumor the contrast enhanced ultrasound demonstrated this tissue reliable. Also the biopsies showed high correlation with residual contrast agent uptake in the resection boarders and positive tumor verification in the histopathological examination.

Conclusions: 3D reconstructed and contrast enhanced ultrasound seems to be a convincing resection control technique in the treatment of brain tumors. Even in malignant tumors this application is a confident tool in the neurosurgical intraoperative setup.