gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Intraoperative navigated ultrasound for the control of tumor resection in cerebral gliomas

Meeting Abstract

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  • N. Hopf - Neurochirurgische Klinik, Klinikum Stuttgart
  • C. Würth - Neurochirurgische Klinik, Klinikum Stuttgart
  • M. Nadji-Ohl - Neurochirurgische Klinik, Klinikum Stuttgart

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.06-09

doi: 10.3205/09dgnc035, urn:nbn:de:0183-09dgnc0356

Published: May 20, 2009

© 2009 Hopf et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Outcome in glioma treatment is still highly dependent on the amount of tumor resection. Currently, this is evaluated most frequently by neuronavigation. In larger tumors, neuronavigation tends to fail due to brain shift. Therefore, intraoperative ultrasound (iUS) is being used more often as a reliable “real time” procedure. Problems with iUS are unusual image orientation and recognition of anatomical landmarks. To overcome these problems we investigated the use of iUS in combination with neuronavigation in a large number of patients with gliomas.

Methods: Intraoperative navigated ultrasound (inUS) was used in 74 operations for the control of resection in glioma surgery. Histology revealed low-grade gliomas WHO II in 21 cases, in 4 cases anaplastic gliomas WHO III, and in 59 cases glioblastomas WHO IV. In 6 patients inUS was used during awake craniotomies for gliomas in the language area. A 4-8,5 MHz sector probe (Aplio 50: Toshiba) was tracked by the neuronavigation system (VectorVision II: BrainLab) enabling reconstruction of the preoperative MRI data in the exact same orientation as the ultrasound image. InUS was performed before opening of the dura, during tumor resection and before closing the dura. The amount of resection was classified as complete (>95%), gross total (90-95%), and partial (<90%) resection and compared with an early postoperative MRI performed within 48 hours after surgery in all patients.

Results: Intended complete resection could be achieved in 47 of 58 patients (81%) based on postoperative MRI. Overall correlation between inUS and postoperative MRI was seen in 63 of 74 patients (85%). In 11 cases inUS could not detect tumor remnants that were seen on postoperative MRI and in 1 case inUS showed a small tumor remnant that was not present on postoperative MRI. Most frequently, discrepancies were seen in recurrent gliomas and patients with previous radiotherapy. Image quality of inUS was highly dependent on positioning of the patient, amount of blood/air, and operation time.

Conclusions: InUS is an effective technique for the control of tumor resection in glioma surgery. Limits are inferior image quality due to positioning, blood/air in the field, or extended operation time and insufficient differentiation of tumor tissue after radiotherapy or in recurrent tumors.