Rohde Veit, Coenen Volker A
Department of Neurosurgery, Georg-August-University Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany.
Acta Neurochir Suppl. 2011;109:187-90. doi: 10.1007/978-3-211-99651-5_29.
The amount of resection is closely related to survival in brain tumours. To enhance resection, especially intraoperative magnetic resonance imaging (MRI) has been applied. The aim of this prospective, randomized study was to test if intraoperative 3-D ultrasound likewise can be used for resection control.
16 patients, who underwent surgery for intraaxial tumours in non-eloquent brain areas, were initially included into this prospective study. In two patients, the small size of the craniotomy hindered intraoperative ultrasound imaging. In 14 patients, 3-D ultrasound images were obtained before and after opening of the dura, during tumour removal, prior to evaluation by a blinded investigator for identification of tumour remnants, and after dura closure. Seven patients were randomized to complete tumour removal according to the impression of the surgeon (group 1). Seven patients were randomized to incomplete tumour removal (tumour remnant <1cm) (group 2); in these patients, the neurosurgeon intentionally left a tumour remnant prior to evaluation by the blinded investigator. The tumour remnant was then removed. It was tested if 3-D ultrasound can correctly identify complete and incomplete tumour resection. All patients underwent early postoperative MRI.
In two patients (one each of the two groups) the image quality was too poor for a meaningful intraoperative evaluation. In the six patients randomized for incomplete tumour removal, 3-D ultrasound correctly identified tumour remnants in four patients (67%). In six patients randomized for complete tumour removal, 3-D ultrasound confirmed complete tumour resection in three patients. In addition, 3-D ultrasound identified correctly one tumour remnant in a patient randomized for complete tumour removal. Thus, the sensitivity for tumour remnant detection increased to 71% (five of seven patients) and that of confirmation of complete tumour removal was 60 % (three of five patients).
The number of investigated patients is still to low to allow definite conclusions. However, the study results suggest, that 3-D ultrasound is especially helpful for detection of overseen brain tumour tissue.
脑肿瘤的切除量与生存率密切相关。为了提高切除率，尤其是术中磁共振成像（MRI）已被应用。这项前瞻性随机研究的目的是测试术中三维超声是否同样可用于切除控制。
16例在非功能区脑内肿瘤接受手术的患者最初被纳入这项前瞻性研究。2例患者因开颅切口过小阻碍了术中超声成像。14例患者在硬脑膜打开前后、肿瘤切除过程中、由一名不知情的研究者进行肿瘤残余识别评估之前以及硬脑膜关闭后均获得了三维超声图像。7例患者根据外科医生的判断随机进行完整肿瘤切除（第1组）。7例患者随机进行不完整肿瘤切除（肿瘤残余<1cm）（第2组）；在这些患者中，神经外科医生在不知情的研究者评估之前有意留下肿瘤残余。然后切除肿瘤残余。测试三维超声能否正确识别完整和不完整的肿瘤切除。所有患者均接受术后早期MRI检查。
2例患者（两组各1例）图像质量太差，无法进行有意义的术中评估。在随机进行不完整肿瘤切除的6例患者中，三维超声在4例患者（67%）中正确识别出肿瘤残余。在随机进行完整肿瘤切除的6例患者中，三维超声在3例患者中确认了完整肿瘤切除。此外，三维超声在1例随机进行完整肿瘤切除的患者中正确识别出一个肿瘤残余。因此，肿瘤残余检测的敏感性提高到71%（7例患者中的5例），完整肿瘤切除确认的敏感性为60%（5例患者中的3例）。
研究的患者数量仍然太少，无法得出明确结论。然而，研究结果表明，三维超声对检测遗漏的脑肿瘤组织特别有帮助。
