Pattern of use of intraoperative ultrasound in surgery for brain tumors influences outcomes in glial tumors.

IF 1 4区医学 Q4 CLINICAL NEUROLOGY British Journal of Neurosurgery Pub Date : 2024-10-01 Epub Date: 2021-12-20 DOI:10.1080/02688697.2021.2016619

Ujwal Yeole, Prakash Shetty, Vikas Singh, Aliasgar Moiyadi

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Abstract

Background: Intraoperative ultrasound (iUS) imaging has emerged as a promising adjunct in glioma surgery with both, 2-dimensional (2D) as well as navigated 3-dimensional (n3D), modes increasingly being used.

Methods: We analyzed our decade-long experience of 1075 brain tumor (807, 75% gliomas) cases operated using iUS. A retrospective chart and electronic records review was performed. The primary aim was to understand the patterns of use of iUS mode and its purpose of application (as a localizing tool or as a resection control modality) as well as to evaluate its impact on the extent of resection.

Results: The use of iUS increased over time, especially with the introduction of n3DUS though 2DUS remained the more commonly used mode (63%) overall during this period. For biopsies (156 cases), both 2D, as well as n3D iUS, were used as a localizing tool only. Lesion localization was the major purpose for use of iUS even for tumor resections (61%). Resection control was performed more often for gliomas (46.5% compared to 16.5% in non-glial tumors). n3DUS was the preferred modality as a resection control tool irrespective of histological class. GTR (gross total resection) was achieved in 53.1% cases overall, while in glial and non-glial tumors it was 44.7% and 80.7%, respectively. GTR was higher when iUS was used as a resection control modality. The US and MR defined EOR (extent of resection) showed substantial agreement (κ = 0.678) with high diagnostic accuracy of 84% for glial tumors. In glial tumors, iUS was used more often in eloquent tumors and GTR rates were slightly higher than when iUS was not used.

Conclusion: iUS is a versatile tool and is a useful surgical adjunct for glioma surgeons. Besides its proven benefit as a localizing tool, when used as a tool for resection control it improves the resection rates. n3DUS may offer benefits over 2DUS as a resection control modality, though the evidence is still evolving.

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在脑肿瘤手术中使用术中超声波的模式会影响胶质瘤的治疗效果。

背景：术中超声（iUS）成像已成为胶质瘤手术中一种前景广阔的辅助手段，二维（2D）和导航三维（n3D）成像模式的应用日益广泛：我们对十年来使用 iUS 进行手术的 1075 例脑肿瘤（807 例，75% 为胶质瘤）病例进行了分析。我们对病历和电子记录进行了回顾性分析。主要目的是了解 iUS 模式的使用模式及其应用目的（作为定位工具或切除控制方式），并评估其对切除范围的影响：结果：随着时间的推移，iUS的使用有所增加，特别是随着n3DUS的引入，尽管在此期间2DUS仍然是最常用的模式（63%）。在活组织检查（156 例）中，2D 和 n3D iUS 都只用作定位工具。即使在肿瘤切除术中，病灶定位也是使用 iUS 的主要目的（61%）。无论组织学分类如何，n3DUS 都是首选的切除控制工具。53.1%的病例实现了GTR（全切除），而在胶质瘤和非胶质瘤中，这一比例分别为44.7%和80.7%。当使用 iUS 作为切除控制模式时，GTR 更高。US 和 MR 界定的 EOR（切除范围）显示出很大的一致性（κ = 0.678），对胶质瘤的诊断准确率高达 84%。结论：iUS 是一种多功能工具，对于胶质瘤外科医生来说是一种有用的手术辅助手段。n3DUS 作为一种切除控制模式可能比 2DUS 更有优势，但相关证据仍在不断发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.