gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Characterising tumour boundary with intraoperative shear wave elastography

Meeting Abstract

  • Huan Wee Chan - Queen’s Medical Centre, Department of Neurosurgery, Nottingham, United Kingdom
  • Christopher Uff - Royal London Hospital, Department of Neurosurgery, London, United Kingdom
  • Aabir Chakraborty - Southampton General Hospital, Department of Neurosurgery, Southampton, United Kingdom
  • Jeffrey Bamber - Institute of Cancer Research and Royal Marsden Hospital, Joint Department of Physics, Sutton, United Kingdom
  • Neil Dorward - National Hospital for Neurology & Neurosurgery, Department of Neurosurgery, London, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.24.09

doi: 10.3205/17dgnc148, urn:nbn:de:0183-17dgnc1489

Published: June 9, 2017

© 2017 Chan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Introduction: Neurosurgeons have always tried to identify the potential surgical plane of cleavage (slip boundary) to initiate safe resection. However, this may not be immediately obvious. Shear wave elastography (SWE) images soft tissue stiffness but the potential usefulness of detecting slippery boundary has not been shown. We report the laboratory experiment with gelatine phantoms, mimicking the presence and absence of slippery boundary, and clinical application during brain tumour resection.

Methods: Twelve cuboidal gelatine phantoms with a central cylindrical inclusion (3 of each configuration – slip stiff and soft inclusions, and adhered stiff and soft inclusions) were imaged with SWE. Thirty five patients (aged 1-62 years, 15 males and 20 females) were recruited and scanned with SuperSonic Aixplorer® using the SWE function before resection. The presence or absence of surgical cleavage plane was noted by the surgeon during resection.

Results: A characteristic soft ‘bracket’ sign was present in both stiff- and soft-inclusion phantoms with slip boundary (n=6). This was absent in those with adhered boundary (n=6). Of 35 patients, only 4 demonstrated a surgical cleavage plane. The soft ‘bracket’ sign was demonstrated in 3 of 4 patients. The patient that did not have the sign had a small craniotomy precluding direct contact of the transducer with the dura, and insufficient water standoff due the location of the tumour.

Conclusion: These preliminary results showed that SWE was able to characterise slip boundary with a novel soft ‘bracket’ sign in vitro and in vivo, thereby suggesting the potential of SWE to be a useful tool during brain tumour resection.