Unsgaard Geirmund, Ommedal Steinar, Muller Tomm, Gronningsaeter Aage, Nagelhus Hernes Toril A
Department of Neurosurgery, University Hospital of Trondheim, Trondheim, Norway.
Neurosurgery. 2002 Apr;50(4):804-12; discussion 812. doi: 10.1097/00006123-200204000-00022.
Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection.
Patients were selected for inclusion in the study on the basis of the size and location of their lesion. Preoperative 3-D MRI data were registered and used for planning as in other conventional neuronavigation systems. Intraoperative 3-D ultrasound images were acquired three to six times, and tumor resection was guided on the basis of these updated 3-D images.
Intraoperative 3-D ultrasound represents a good solution to the problem of brain shift in neuronavigation because it easily provides an updated, and hence more accurate, map of the patient's true anatomy in all phases of the operation. Ultrasound makes it possible to follow the progression of the operation, and it improves the radicality of tumor resection by detecting tumor tissue that would remain if the imaging technology had not been used (in 53% of the cases). Integration of 3-D ultrasound with navigation technology solves the orientation problem experienced previously with two-dimensional ultrasound in neurosurgery. The technology makes it possible to directly compare intraoperative ultrasound and MRI data regarding visualization of the lesion. Ultrasound image quality is useful for guiding surgical procedures.
Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.
三维（3-D）超声是一种术中成像方式，在神经导航中用作磁共振成像（MRI）的替代方法。本文总结了将术中3-D超声集成到神经导航中用于脑肿瘤切除指导的4年临床经验。
根据病变的大小和位置选择患者纳入研究。术前3-D MRI数据进行配准，并像在其他传统神经导航系统中一样用于手术规划。术中获取3-D超声图像三到六次，并根据这些更新后的3-D图像指导肿瘤切除。
术中3-D超声是解决神经导航中脑移位问题的一个好办法，因为它能在手术的各个阶段轻松提供患者真实解剖结构的更新且更准确的图谱。超声能够跟踪手术进程，并且通过检测若未使用成像技术将会残留的肿瘤组织（在53%的病例中）提高了肿瘤切除的彻底性。3-D超声与导航技术的整合解决了神经外科手术中二维超声以前存在的定位问题。该技术能够直接比较术中超声和MRI数据关于病变的可视化情况。超声图像质量对指导手术操作很有用。
术中3-D超声似乎提供了一种经济高效的方式来更新神经导航中使用的高质量3-D图谱。
