Division of Neurosurgery, PS 245, ACTREC and TMH, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India,
Acta Neurochir (Wien). 2013 Dec;155(12):2217-25. doi: 10.1007/s00701-013-1881-z. Epub 2013 Sep 14.
Intraoperative imaging is increasingly being used in resection of brain tumors. Navigable three-dimensional (3D)-ultrasound is a novel tool for planning and guiding such resections. We review our experience with this system and analyze our initial results, especially with respect to malignant gliomas.
A prospective database for all patients undergoing sononavigation-guided surgery at our center since this surgery's introduction in June 2011 was queried to retrieve clinical data and technical parameters. Imaging was reviewed to categorize tumors based on enhancement and resectability. Extent of resection was also assessed.
Ninety cases were operated and included in this analysis, 75 % being gliomas. The 3D ultrasound mode was used in 87 % cases (alone in 40, and combined in 38 cases). Use of combined mode function [ultrasound (US) with magnetic resonance (MR) images] facilitated orientation of anatomical data. Intraoperative power Doppler angiography was used in one-third of the cases, and was extremely beneficial in delineating the vascular anatomy in real-time. Mean duration of surgery was 4.4 hours. Image resolution was good or moderate in about 88 % cases. The use of the intraoperative imaging prompted further resection in 59 % cases. In the malignant gliomas (51 cases), gross-total resection was achieved in 47 % cases, increasing to 88 % in the "resectable" subgroup.
Navigable 3D US is a versatile, useful and reliable intraoperative imaging tool in resection of brain tumors, especially in resource-constrained settings where Intraoperative MR (IOMR) is not available. It has multiple functionalities that can be tailored to suit the procedure and the experience of the surgeon.
术中成像在脑肿瘤切除术中的应用越来越广泛。可导航的三维（3D）超声是规划和指导此类切除的一种新工具。我们回顾了使用该系统的经验，并分析了我们的初步结果，尤其是在恶性胶质瘤方面。
自 2011 年 6 月该手术引入以来，我们对中心所有接受 sononavigation 引导手术的患者的前瞻性数据库进行了查询，以检索临床数据和技术参数。通过成像对肿瘤进行分类，根据增强和可切除性进行分类。还评估了切除范围。
90 例患者接受了手术并纳入本分析，其中 75%为胶质瘤。87%的病例（单独使用 40 例，联合使用 38 例）使用 3D 超声模式。联合模式功能（超声（US）与磁共振（MR）图像）的使用有助于定位解剖数据。三分之一的病例使用术中功率多普勒血管造影术，实时描绘血管解剖结构非常有益。手术平均持续时间为 4.4 小时。约 88%的病例图像分辨率良好或中等。术中成像的使用促使 59%的病例进一步切除。在恶性胶质瘤（51 例）中，有 47%的病例实现了大体全切除，在“可切除”亚组中增加到 88%。
可导航 3D US 是脑肿瘤切除术中一种多功能、有用且可靠的术中成像工具，特别是在资源有限的情况下，无法进行术中磁共振成像（IOMR）。它具有多种功能，可以根据手术和外科医生的经验进行定制。
