Diagnostic ability of intraoperative ultrasound for identifying tumor residual in glioma surgery operation

Gliomas are the most invasive and fatal primary malignancy of the central nervous system that have poor prognosis, with maximal safe resection representing the gold standard for surgical treatment. To achieve gross total resection (GTR), neurosurgery relies heavily on generating continuous, real-time, intraoperative glioma descriptions based on image guidance. Given the limitations of currently available equipment, developing a real-time image-guided resection technique that provides reliable functional and anatomical information during intraoperative settings is imperative. Nowadays, the application of intraoperative ultrasound (IOUS) has been shown to improve resection rates and maximize brain function preservation. IOUS, which presents an attractive option due to its low cost, minimal operational flow interruptions, and lack of radiation exposure, is able to provide real-time localization and accurate tumor size and shape descriptions while helping distinguish residual tumors and addressing brain shift. Moreover, the application of new advancements in ultrasound technology, such as contrast-enhanced ultrasound, three-dimensional ultrasound, navigable ultrasound, ultrasound elastography, and functional ultrasound, could help to achieve GTR during glioma surgery. The current review describes current advancements in ultrasound technology and evaluates the role and limitation of IOUS in glioma surgery.

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ITVT-05. Intraoperative Ultrasound Guidance Improves Resection In Gliomas – Results From A Single Centre Propensity Matched Comparative Cohort Analysis Of 2D Vs Navigated 3D Ultrasound In 500 Gliomas

Neuro-Oncology ◽

10.1093/neuonc/noab196.917 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi228-vi229

Author(s):

Aliasgar Moiyadi ◽

Prakash Shetty ◽

Vikas Singh

Keyword(s):

Cohort Analysis ◽

Univariate Analysis ◽

Intraoperative Ultrasound ◽

Positive Likelihood Ratio ◽

3D Ultrasound ◽

Prior Treatment ◽

Control Mode ◽

Glioma Surgery ◽

Resection Control ◽

Tumor Residue

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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Letter to the Editor Regarding “The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection”

World Neurosurgery ◽

10.1016/j.wneu.2018.12.179 ◽

2019 ◽

Vol 125 ◽

pp. 553-554

Author(s):

Francesco Prada ◽

Ignazio G. Vetrano ◽

Massimiliano DelBene ◽

Giovanni Mauri ◽

Luca M. Sconfienza ◽

...

Keyword(s):

Tumor Resection ◽

Intraoperative Ultrasound ◽

Glioma Surgery ◽

Factors Associated ◽

Letter To The Editor ◽

Diagnostic Properties

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Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome

Operative Neurosurgery ◽

10.1093/ons/opz203 ◽

2019 ◽

Cited By ~ 1

Author(s):

Alessandro Moiraghi ◽

Francesco Prada ◽

Alberto Delaidelli ◽

Ramona Guatta ◽

Adrien May ◽

...

Keyword(s):

Real Time ◽

Karnofsky Performance Status ◽

Performance Status ◽

Intraoperative Ultrasound ◽

High Grade Glioma ◽

Extent Of Resection ◽

High Grade ◽

Glioma Surgery ◽

Supratentorial Gliomas ◽

The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter. OBJECTIVE To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN. METHODS We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated. RESULTS The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01). CONCLUSION The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

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New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review

Brain Sciences ◽

10.3390/brainsci8110202 ◽

2018 ◽

Vol 8 (11) ◽

pp. 202 ◽

Cited By ~ 6

Author(s):

Maria Pino ◽

Alessia Imperato ◽

Irene Musca ◽

Rosario Maugeri ◽

Giuseppe Giammalva ◽

...

Keyword(s):

Brain Tumor ◽

Brain Tumors ◽

Low Cost ◽

Tumor Resection ◽

Intraoperative Ultrasound ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Glioma Surgery ◽

Pubmed Database

Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.

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Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis

Neurosurgical Review ◽

10.1007/s10143-019-01160-x ◽

2019 ◽

Vol 43 (5) ◽

pp. 1221-1233 ◽

Cited By ~ 6

Author(s):

Gianluca Trevisi ◽

Paolo Barbone ◽

Giorgio Treglia ◽

Maria Vittoria Mattoli ◽

Annunziato Mangiola

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Intraoperative Ultrasound ◽

Diffuse Glioma ◽

Glioma Surgery

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The Diagnostic Properties of Intraoperative Ultrasound in Glioma Surgery and Factors Associated with Gross Total Tumor Resection

World Neurosurgery ◽

10.1016/j.wneu.2018.03.208 ◽

2018 ◽

Vol 115 ◽

pp. e129-e136 ◽

Cited By ~ 11

Author(s):

Bodil Karoline Ravn Munkvold ◽

Asgeir Store Jakola ◽

Ingerid Reinertsen ◽

Lisa Millgård Sagberg ◽

Geirmund Unsgård ◽

...

Keyword(s):

Tumor Resection ◽

Intraoperative Ultrasound ◽

Glioma Surgery ◽

Factors Associated ◽

Diagnostic Properties

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Linear array ultrasound in low-grade glioma surgery: histology-based assessment of accuracy in comparison to conventional intraoperative ultrasound and intraoperative MRI

Acta Neurochirurgica ◽

10.1007/s00701-014-2314-3 ◽

2015 ◽

Vol 157 (2) ◽

pp. 195-206 ◽

Cited By ~ 33

Author(s):

Jan Coburger ◽

Angelika Scheuerle ◽

Dietmar Rudolf Thal ◽

Jens Engelke ◽

Michal Hlavac ◽

...

Keyword(s):

Linear Array ◽

Intraoperative Ultrasound ◽

Low Grade Glioma ◽

Intraoperative Mri ◽

Low Grade ◽

Glioma Surgery ◽

Array Ultrasound

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Intraoperative ultrasound in low-grade glioma surgery

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.05.012 ◽

2015 ◽

Vol 135 ◽

pp. 96-99 ◽

Cited By ~ 10

Author(s):

Andrej Šteňo ◽

Viktor Matejčík ◽

Juraj Šteňo

Keyword(s):

Intraoperative Ultrasound ◽

Low Grade Glioma ◽

Low Grade ◽

Glioma Surgery

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Extent of Glioma Resection on Intraoperative Ultrasound Correlates Well with Postoperative MRI Results

Journal of Surgical Oncology ◽

10.31487/j.jso.2019.04.01 ◽

2019 ◽

pp. 1-7

Author(s):

Ahmed Aly ◽

Radwan Noubi ◽

Mahmoud Ragab ◽

Khalid Abdelaziz ◽

Simon Howarth ◽

...

Keyword(s):

Surgical Resection ◽

Intraoperative Imaging ◽

Intraoperative Ultrasound ◽

Extent Of Resection ◽

Control Group ◽

P Value ◽

Low Grade ◽

Ultrasound Images ◽

Glioma Surgery ◽

Number Of Patients

Background: Maximal surgical resection is thought to confer survival benefit for both high- and low-grade gliomas. Intraoperative imaging assists with achieving maximal surgical resection. Different intraoperative imaging modalities have been implemented, but intra-operative MRI has a high cost that may limit its uptake in resource scarce healthcare systems. Objectives: This study aims to evaluate intraoperative ultrasound as a surrogate for intra and post-operative MRI for assessing the extent of resection of glioma. Methods: A partially prospective comparative study, which compares a prospective cohort group with a historical control group. We evaluated 74 glioma patients, who all underwent surgery in a regional UK Neurosurgical centre between October 2013 and October 2017. The study population was divided into 2 groups based on the use of ultrasound to guide the resection. We compared the size of the lesion prior and after excision to evaluate the extent of resection and undertook comparison with post-operative MRI. Results: The mean extent of resection on the ultrasound images was 96.1 % and 97.7 % on the postoperative MR. Using Spearman’s correlation; extent of resection on the ultrasound images was strongly correlated with the extent of resection on the postoperative MR images (P=value <0.001). The use of intraoperative ultrasound was associated with a significant increase in the number of patients in whom 95% or greater extent of resection was achieved (Fisher’s exact test P= value 0.033). Conclusion: Intra-operative ultrasonography could provide a reliable and cheaper alternative to intraoperative MRI to improve the extent of resection in glioma surgery.

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