Navigated versus Non-Navigated Intraoperative Ultrasound: Is There Any Impact on the Extent of Resection of High-Grade Gliomas? A Retrospective Clinical Analysis

INTRODUCTION The extent of tumor resection is a significant predictor of survival in high-grade gliomas. In recent years, several authors showed the benefit of intraoperative ultrasound partially matched with magnetic resonance imaging (MRI). The aim of this study was to find out if intraoperative neuronavigation in combination with intraoperative ultrasound has any impact on the complete resection of gliomas. A comparison between the ultrasound-controlled resection of brain tumors and operations controlled by navigated ultrasound was performed. MATERIALS AND METHODS A total of 92 patients (54 men and 39 women) with a mean age of 53.2 years underwent 93 operations over a period of 4 years (2007-2010). They harbored a tumor with suspicion of glioma; 32 of them had undergone previous surgery, and additional chemotherapy, and 29 of them had undergone irradiation. Overall, 49 operations were performed with navigated ultrasound (group A) and 44 with non-navigated ultrasound (group B). A standardized early postoperative MRI was performed . Complete or gross total resection (GTR) was defined by a resection of ≥ 95% of the tumor. Skin incision and craniotomy were planned after registration of the neuronavigation system. The ultrasound system was used systematically before and after opening the dura, and during and at the end of resection. RESULTS GTR could be achieved in 28 of 49 cases in group A and in 23 of 44 cases in group B. In group A, sensitivity and specificity of tumor remnants detected by ultrasound were higher than in group B. Concerning recurrent gliomas, the sensitivity of ultrasound visualizing tumor remnants was lower than in primary tumors. In case of preoperatively planned GTR, in both groups (navigated and non-navigated ultrasound) similar tumor remnant sizes were postoperatively detected by MRI. In nine cases the removal was incomplete because of eloquently located tumors. There was no significant difference between navigated and not-navigated ultrasound concerning GTR (p > 0.05). CONCLUSION Navigated ultrasound is an important technical tool that helps in intraoperative orientation. Further prospective investigation is needed to assess the impact on GTR.

[1]  Geirmund Unsgaard,et al.  Brain Operations Guided by Real-time Two-dimensional Ultrasound: New Possibilities as a Result of Improved Image Quality , 2002, Neurosurgery.

[2]  A. Brodbelt,et al.  Intraoperative ultrasound in neurosurgery – a practical guide , 2010, British journal of neurosurgery.

[3]  Jörg-Christian Tonn,et al.  Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study. Clinical article. , 2011, Journal of neurosurgery.

[4]  Tormod Selbekk,et al.  Functional Magnetic Resonance Imaging and Diffusion Tensor Tractography Incorporated Into an Intraoperative 3‐Dimensional Ultrasound‐Based Neuronavigation System: Impact on Therapeutic Strategies, Extent of Resection, and Clinical Outcome , 2010, Neurosurgery.

[5]  T. Peters,et al.  Intraoperative ultrasound for guidance and tissue shift correction in image-guided neurosurgery. , 2000, Medical physics.

[6]  L. Auer,et al.  Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT , 2005, Acta Neurochirurgica.

[7]  Mitchel S Berger,et al.  An extent of resection threshold for newly diagnosed glioblastomas. , 2011, Journal of neurosurgery.

[8]  R. Sawaya,et al.  Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. , 1996, Journal of neurosurgery.

[9]  Rudolf Fahlbusch,et al.  Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high-field strength MR imaging for tumor resection control: a prospective comparative study. , 2009, Journal of neurosurgery.

[10]  S. Torp,et al.  Did Survival Improve after the Implementation of Intraoperative Neuronavigation and 3D Ultrasound in Glioblastoma Surgery? A Retrospective Analysis of 192 Primary Operations , 2012, Journal of Neurological Surgery—Part A.

[11]  O Ganslandt,et al.  Neuronavigation: concept, techniques and applications. , 2002, Neurology India.

[12]  Tormod Selbekk,et al.  Ultrasound-guided operations in unselected high-grade gliomas—overall results, impact of image quality and patient selection , 2010, Acta Neurochirurgica.

[13]  Neurochirurgische Klinik,et al.  Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study , 2011 .

[14]  Geirmund Unsgaard,et al.  Neuronavigation by Intraoperative Three-dimensional Ultrasound: Initial Experience during Brain Tumor Resection , 2002, Neurosurgery.

[15]  J Meixensberger,et al.  Application of Intraoperative 3D Ultrasound During Navigated Tumor Resection , 2006, Minimally invasive neurosurgery : MIN.

[16]  Max A. Viergever,et al.  Brain shift estimation in image-guided neurosurgery using 3-D ultrasound , 2005, IEEE Transactions on Biomedical Engineering.

[17]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[18]  Tormod Selbekk,et al.  Comparison of navigated 3D ultrasound findings with histopathology in subsequent phases of glioblastoma resection , 2008, Acta Neurochirurgica.