Intraoperative ultrasound for resection control in transsphenoidal surgery

Abstract INTRODUCTION Intraoperative ultrasound (iUS) is a promising tool for glioma surgery. Navigated 3-D (n3D) iUS has many benefits over standard 2-D iUS. METHODS This was a retrospective comparative cohort study using propensity score matching (PSM). 500 consecutive histologically confirmed gliomas were divided into 2 cohorts – 2DiUS - Cohort A; and n3DiUS -Cohort B. PSM was used to account for known confounders (250 in each group; 1:1 matching). Gross total resection rates (based on iUS findings as well as postoperative MR) and perioperative morbidity were analyzed across the groups as were factors influencing these outcomes (using univariate as well as multivariate regression models). RESULTS Overall, the majority of the patients were adults (94%), males (71%) with hemispheric tumors (96%). 35% had tumors close to eloquent regions and 23% had received some prior treatment. The majority were high-grade gliomas (85%). 2D iUS was employed mainly for localization (80%) whereas n3D was used predominantly for resection control (84%) [p < 0.001]. GTR rate was higher in the n3D cohort (55.2% vs 38.4% in 2D; p = 0.001). The odds of having a complete resection in the n3D cohort was twice that of the 2D. Prior treatment, hemispheric location, and use of fluorescence were also significantly associated with higher GTR rates on univariate analysis. On multivariate analysis, all of these remained significant. There was no difference in the morbidity rates in the two cohorts. N3D iUS had a higher specificity and positive likelihood ratio in detecting tumor residue. CONCLUSION For hemispheric gliomas undergoing resective surgery, the use of navigated 3D ultrasound improves GTR rates, with no added morbidity. It is more likely to be used for resection control mode than is 2DUS and this is probably because n3DUS is more specific and likely to pick up tumor residues contributing to its better accuracy.

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Corrigendum to “Intraoperative Ultrasound in Patients Undergoing Transsphenoidal Surgery for Pituitary Adenoma: Systematic Review” [World Neurosurgery 106 (2017) 680-685]

World Neurosurgery ◽

10.1016/j.wneu.2017.10.068 ◽

2018 ◽

Vol 109 ◽

pp. 514

Author(s):

Hani J. Marcus ◽

Tom Vercauteren ◽

Sebastien Ourselin ◽

Neil L. Dorward

Keyword(s):

Systematic Review ◽

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Intraoperative Ultrasound

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Transsellar Ultrasound in Pituitary Surgery With a Designated Probe

Operative Neurosurgery ◽

10.1227/neu.0000000000001108 ◽

2015 ◽

Vol 12 (2) ◽

pp. 128-134 ◽

Cited By ~ 4

Author(s):

Ole Solheim ◽

Tonni Franke Johansen ◽

Johan Cappelen ◽

Geirmund Unsgård ◽

Tormod Selbekk

Keyword(s):

Transsphenoidal Surgery ◽

Intraoperative Imaging ◽

Intraoperative Ultrasound ◽

Pituitary Surgery ◽

Extent Of Resection ◽

Center Frequency ◽

Ultrasound Probe ◽

Flexible Form ◽

Intraoperative Ultrasound Imaging ◽

Surgical Field

Abstract BACKGROUND Anatomic orientation in transsphenoidal surgery can be difficult, and residual tumors are common. A major limitation of both direct microscopy and endoscopic visualization is the inability to see below the surface of the surgical field to confirm the location of vessels, nerves, tumor remnants, and normal pituitary tissue. OBJECTIVE To present our initial experience with a new forward-looking, custom-designed ultrasound probe for transsellar imaging. METHODS The center frequency of the prototype tightly curved linear array, bayonet-shaped probe is 12 MHz. Twenty-four patients with pituitary adenomas were included after informed consent. RESULTS With the use of transsellar ultrasound, we could confirm the location of important neurovascular structures and improve the extent of resection in 4 of 24 cases, as rated subjectively by the operating surgeons. Image quality was good. In 17 patients (71%), biochemical cures and/or complete resections were confirmed at 3 months. CONCLUSION We found the images from our custom-designed ultrasound probe to be clinically helpful for anatomic orientation during surgery, and the technology is potentially helpful for improving the extent of resection during transsphenoidal surgery. This quick and flexible form of intraoperative imaging in transsphenoidal surgery could be of great support for surgeons in both routine use and difficult cases. The concept of transsellar intraoperative ultrasound imaging can be further refined and developed.

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Navigable Intraoperative Ultrasound and Fluorescence-Guided Resections Are Complementary in Resection Control of Malignant Gliomas: One Size Does Not Fit All

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1372436 ◽

2014 ◽

Vol 75 (06) ◽

pp. 434-441 ◽

Cited By ~ 10

Author(s):

Prakash Shetty ◽

Aliasgar Moiyadi

Keyword(s):

Malignant Gliomas ◽

Intraoperative Ultrasound ◽

Resection Control

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Intrasellar Ultrasound in Transsphenoidal Surgery

Neurosurgery ◽

10.1227/01.neu.0000360571.11582.4f ◽

2010 ◽

Vol 66 (1) ◽

pp. 173-186 ◽

Cited By ~ 26

Author(s):

Ole Solheim ◽

Tormod Selbekk ◽

Lasse Løvstakken ◽

Geir A. Tangen ◽

Ole V. Solberg ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

Color Doppler ◽

Power Doppler ◽

Intraoperative Ultrasound ◽

Residual Tumor ◽

Image Resolution ◽

Technical Solution ◽

Ultrasound Images ◽

High Frequency Ultrasound ◽

Clinical Magnetic Resonance Imaging

Abstract OBJECTIVE Residual tumor masses are common after transsphenoidal surgery. The risk of a residual mass increases with tumor size and parasellar or suprasellar growth. Transsphenoidal surgery is usually performed without image guidance. We aimed to investigate a new technical solution developed for intraoperative ultrasound imaging during transsphenoidal surgery, with respect to potential clinical use and the ability to identify neuroanatomy and tumor. METHODS In 9 patients with pituitary macroadenomas, intrasphenoidal and intrasellar ultrasound was assessed during transsphenoidal operations. Ultrasound B-mode, power-Doppler and color-Doppler images were acquired using a small prototype linear array, side-looking probe. The long probe tip measures only 3 × 4 mm. We present images and discuss the potential of intrasphenoidal and intrasellar and ultrasound in transsphenoidal surgery. RESULTS We present 2-dimensional, high-resolution ultrasound images. A small side-looking, high-frequency ultrasound probe can be used to ensure orientation in the midline for the surgical approach to identify important neurovascular structures to be avoided during surgery and for resection control and identification of normal pituitary tissue. The image resolution is far better than what can be achieved with current clinical magnetic resonance imaging technology. CONCLUSION We believe that the concept of intrasellar ultrasound can be further developed to become a flexible and useful tool in transsphenoidal surgery.

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Navigated ultrasound-based image guidance during resection of gliomas: practical utility in intraoperative decision-making and outcomes

Neurosurgical FOCUS ◽

10.3171/2020.10.focus20550 ◽

2021 ◽

Vol 50 (1) ◽

pp. E14

Author(s):

Prakash Shetty ◽

Ujwal Yeole ◽

Vikas Singh ◽

Aliasgar Moiyadi

Keyword(s):

Decision Making ◽

Predictive Value ◽

Intraoperative Imaging ◽

False Negative ◽

Intraoperative Ultrasound ◽

Image Resolution ◽

Related Factors ◽

Resection Control ◽

Navigated Ultrasound ◽

Eloquent Location

OBJECTIVEIntraoperative imaging is increasingly being used for resection control in diffuse gliomas, in which the extent of resection (EOR) is important. Intraoperative ultrasound (iUS) has emerged as a highly effective tool in this context. Navigated ultrasound (NUS) combines the benefits of real-time imaging with the benefits of navigation guidance. In this study, the authors investigated the use of NUS as an intraoperative adjunct for resection control in gliomas.METHODSThe authors retrospectively analyzed 210 glioma patients who underwent surgery using NUS at their center. The analysis included intraoperative decision-making, diagnostic accuracy, and operative outcomes, particularly EOR and related factors influencing this.RESULTSUS-defined gross-total resection (GTR) was achieved in 57.6% of patients. Intermediate resection control scans were evaluable in 115 instances. These prompted a change in the operative decision in 42.5% of cases (the majority being further resection of unanticipated residual tumor). Eventual MRI-defined GTR rates were similar (58.6%), although the concordance between US and MRI was 81% (170/210 cases). There were 21 false positives and 19 false negatives with NUS, resulting in a sensitivity of 78%, specificity of 83%, positive predictive value of 77%, and negative predictive value of 84%. A large proportion of patients (13/19 patients, 68%) with false-negative results eventually had near-total resections. Tumor resectability, delineation, enhancement pattern, eloquent location, and US image resolution significantly influenced the GTR rate, though only resectability and eloquent location were significant on multivariate analysis.CONCLUSIONSNUS is a useful intraoperative adjunct for resection control in gliomas, detecting unanticipated tumor residues and positively influencing the course of the resection, eventually leading to higher resection rates. Nevertheless, resection is determined by the innate resectability of the tumor and its relationship to eloquent location, reinforcing the need to combine iUS with functional mapping techniques to optimize resections.

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