2020, Volume 4
2019, Volume 3
2018, Volume 2
2017, Volume 1

Volume 3, Issue 2, December 2019, Page: 13-20
Efficacy of Intraoperative Ultrasound in Resection of Posterior Fossa Lesions
Ahmed Nagaty, Neurosurgery Department, Ain Shams University, Cairo, Egypt
Ahmad Elsabaa, Neurosurgery Department, Ain Shams University, Cairo, Egypt
Hisham Anwer, Neurosurgery Department, Ain Shams University, Cairo, Egypt
Received: Sep. 3, 2019;       Accepted: Oct. 8, 2019;       Published: Oct. 20, 2019
DOI: 10.11648/j.ijn.20190302.11      View  147      Downloads  37
To evaluate the important role of Intraoperative Ultrasound (IOUS) in measurement of pre & postoperative resection volume of an intra-axial posterior fossa lesions and to compare these results with that measured in pre and post-operative MRI brain. Also, to assess the principal surgeon opinion regarding the ability of IOUS in localization and differentiating the borders of those lesions, and his comfortability during handling of this device. There are different methods, which are helpful to localize precisely and allow maximum tumor resection, such as neuro-navigation, intraoperative MRI, 5-aminolevulinic acid, as well as IOUS. Every method has its pros & cons. Although Intraoperative MRI Provides real time updated images, however it’s not available in most of neurosurgery centers in developing countries. So, with these financial and ergonomic limitations of the Intraoperative MRI, usage of Intraoperative Ultrasound could be considered as a potential competitor in developing world. This is a prospective study conducted at Ain Shams University hospital in the period from February 2016 to July 2018, we enrolled 23 patients presented with posterior fossa intra axial neoplasms that operated with Intra Operative Ultrasound (IOUS) assistance. IOUS was able to well localize the lesions in 96% of cases and it was able to differentiate solid and cystic parts in all the cases. IOUS was able to define well the lesion borders in 20/23 (87%) of cases. There was no difference between volumes calculated from preoperative MRI and the pre-resection IOUS, also there was no significant difference between the residual volume detected by the IOUS and the postoperative MRI brain. Principal surgeon reported overall great impression of the IOUS in 18/23 (78%) of cases. Mean total additional time of usage of the IOUS was 27min. IOUS was found to be valuable in localization of the lesions, differentiating solid and cystic parts and detection of the residual volume in the posterior fossa intra axial tumors.
Neuro-navigation, Intra-operative Ultrasound, IOUS, Intraoperative MRI, Posterior Fossa, Intra-axial Lesions
To cite this article
Ahmed Nagaty, Ahmad Elsabaa, Hisham Anwer, Efficacy of Intraoperative Ultrasound in Resection of Posterior Fossa Lesions, International Journal of Neurosurgery. Vol. 3, No. 2, 2019, pp. 13-20. doi: 10.11648/j.ijn.20190302.11
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ius T, Isola M, Budai R, Pauletto G, Tomasino B, Fadiga L, et al. Low-grade glioma surgery in eloquent areas: volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients. J Neurosurg. 2012; 117 (6): 1039–52.
Maugeri R, Villa A, Pino M, Imperato A, Giammalva GR, Costantino G, et al. With a little help from my friends: The role of intraoperative fluorescent dyes in the surgical management of high-grade gliomas. Brain Sci. 2018; 8 (2): 31.
Pino MA, Imperato A, Musca I, Maugeri R, Giammalva GR, Costantino G, et al. New hope in brain glioma surgery: The role of intraoperative ultrasound. A review. Brain Sci. 2018; 8 (11): 202.
El Beltagy MA, Aggag M, Kamal M. Role of intraoperative ultrasound in resection of pediatric brain tumors. Child’s Nerv Syst. 2010; 26 (9): 1189–93.
Karnofsky DA. The clinical evaluation of chemotherapeutic agents in cancer. Eval Chemother agents. 1949; 191–205.
Ailon T, Dunham C, Carret A-S, Tabori U, Mcneely PD, Zelcer S, et al. The role of resection alone in select children with intracranial ependymoma: the Canadian Pediatric Brain Tumour Consortium experience. Child’s Nerv Syst. 2015; 31 (1): 57–65.
Zhang N, Ouyang T, Kang H, Long W, Thomas B, Zhu S. Adult medulloblastoma: clinical characters, prognostic factors, outcomes and patterns of relapse. J Neurooncol. 2015; 124 (2): 255–64.
Hammoud MA, Ligon BL, Elsouki R, Shi WM, Schomer DF, Sawaya R. Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurg. 1996; 84 (5): 737–41.
Gerganov VM, Samii A, Akbarian A, Stieglitz L, Samii M, Fahlbusch R. Reliability of intraoperative high-resolution 2D ultrasound as an alternative to high–field strength MR imaging for tumor resection control: a prospective comparative study. J Neurosurg. 2009; 111 (3): 512–9.
Tronnier VM, Bonsanto MM, Staubert A, Knauth M, Kunze S, Wirtz CR. Comparison of intraoperative MR imaging and 3D-navigated ultrasonography in the detection and resection control of lesions. Neurosurg Focus. 2001; 10 (2): 1–5.
Chacko AG, Kumar NKS, Chacko G, Athyal R, Rajshekhar V. Intraoperative ultrasound in determining the extent of resection of parenchymal brain tumours–a comparative study with computed tomography and histopathology. Acta Neurochir (Wien). 2003; 145 (9): 743–8.
Wang Y, Wang Y, Wang Y, Taniguchi N, Chen X-C. Intraoperative real-time contrast-enhanced ultrasound angiography: a new adjunct in the surgical treatment of arteriovenous malformations. J Neurosurg. 2007; 107 (5): 959–64.
Woydt M, Krone A, Soerensen N, Roosen K. Ultrasound-guided neuronavigation of deep-seated cavernous haemangiomas: clinical results and navigation techniques. Br J Neurosurg. 2001; 15 (6): 485–95.
LeRoux PD, Berger MS, Ojemann GA, Wang K, Mack LA. Correlation of intraoperative ultrasound tumor volumes and margins with preoperative computerized tomography scans: An intraoperative method to enhance tumor resection. J Neurosurg. 1989; 71 (5): 691–8.
Barone DG, Lawrie TA, Hart MG. Image guided surgery for the resection of brain tumours. Cochrane Database Syst Rev. 2014; (1).
Roder C, Bisdas S, Ebner FH, Honegger J, Nägele T, Ernemann U, et al. Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: high-field iMRI versus conventional and 5-ALA-assisted surgery. Eur J Surg Oncol. 2014; 40 (3): 297–304.
Schulder M, Carmel PW. Intraoperative magnetic resonance imaging: impact on brain tumor surgery. Cancer Control. 2003; 10 (2): 115–24.
Puppa A Della, Ciccarino P, Lombardi G, Rolma G, Cecchin D, Rossetto M. 5-Aminolevulinic acid fluorescence in high grade glioma surgery: surgical outcome, intraoperative findings, and fluorescence patterns. Biomed Res Int. 2014; 2014.
Hill DLG, Maurer CR, Maciunas RJ, Maciunas RJ, Barwise JA, Fitzpatrick JM, et al. Measurement of intraoperative brain surface deformation under a craniotomy. Neurosurgery. 1998; 43 (3): 514–26.
Letteboer MMJ, Willems PWA, Viergever MA, Niessen WJ. Brain shift estimation in image-guided neurosurgery using 3-D ultrasound. IEEE Trans Biomed Eng. 2005; 52 (2): 268–76.
Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R. Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery. 2000; 47 (5): 1070–80.
Makary M, Chiocca EA, Erminy N, Antor M, Bergese SD, Abdel‐Rasoul M, et al. Clinical and economic outcomes of low‐field intraoperative MRI‐guided tumor resection neurosurgery. J Magn Reson imaging. 2011; 34 (5): 1022–30.
Samdani AF, Schulder M, Catrambone JE, Carmel PW. Use of a compact intraoperative low-field magnetic imager in pediatric neurosurgery. Child’s Nerv Syst. 2005; 21 (2): 108–13.
Schulder M. Intracranial surgery with a compact, low-field-strength magnetic resonance imager. Top Magn Reson Imaging. 2008; 19 (4): 179–89.
Schulder M, Salas S, Brimacombe M, Fine P, Catrambone J, Maniker AH, et al. Cranial surgery with an expanded compact intraoperative magnetic resonance imager. J Neurosurg. 2006; 104 (4): 611–7.
Schulder M, Azmi H, Biswal B. Functional magnetic resonance imaging in a low-field intraoperative scanner. Stereotact Funct Neurosurg. 2003; 80 (1–4): 125–31.
Comeau RM, Sadikot AF, Fenster A, Peters TM. Intraoperative ultrasound for guidance and tissue shift correction in image‐guided neurosurgery. Med Phys. 2000; 27 (4): 787–800.
Lindseth F, Ommedal S, Bang J, Unsgård G, Hernes TAN. Image fusion of ultrasound and MRI as an aid for assessing anatomical shifts and improving overview and interpretation in ultrasound-guided neurosurgery. In: International Congress Series. Elsevier; 2001. p. 254–60.
Unsgaard G, Rygh OM, Selbekk T, Müller TB, Kolstad F, Lindseth F, et al. Intra-operative 3D ultrasound in neurosurgery. Acta Neurochir (Wien). 2006; 148 (3): 235–53.
Tirakotai W, Miller D, Heinze S, Benes L, Bertalanffy H, Sure U. A novel platform for image-guided ultrasound. Neurosurgery. 2006; 58 (4): 710–8.
Prada F, Perin A, Martegani A, Aiani L, Solbiati L, Lamperti M, et al. Intraoperative contrast-enhanced ultrasound for brain tumor surgery. Neurosurgery. 2014; 74 (5): 542–52.
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