Pedro Maria Teresa, Antoniadis Gregor, Scheuerle Angelika, Pham Mirko, Wirtz Christian Rainer, Koenig Ralph W
Departments of 1 Neurosurgery and.
Neuropathology, University of Ulm, Guenzburg; and.
Neurosurg Focus. 2015 Sep;39(3):E5. doi: 10.3171/2015.6.FOCUS15218.
The diagnostic workup and surgical therapy for peripheral nerve tumors and tumorlike lesions are challenging. Magnetic resonance imaging is the standard diagnostic tool in the preoperative workup. However, even with advanced pulse sequences such as diffusion tensor imaging for MR neurography, the ability to differentiate tumor entities based on histological features remains limited. In particular, rare tumor entities different from schwannomas and neurofibromas are difficult to anticipate before surgical exploration and histological confirmation. High-resolution ultrasound (HRU) has become another important tool in the preoperative evaluation of peripheral nerves. Ongoing software and technical developments with transducers of up to 17-18 MHz enable high spatial resolution with tissue-differentiating properties. Unfortunately, high-frequency ultrasound provides low tissue penetration. The authors developed a setting in which intraoperative HRU was used and in which the direct sterile contact between the ultrasound transducer and the surgically exposed nerve pathology was enabled to increase structural resolution and contrast. In a case-guided fashion, the authors report the sonographic characteristics of rare tumor entities shown by intraoperative HRU and contrast-enhanced ultrasound.
周围神经肿瘤及肿瘤样病变的诊断检查和外科治疗颇具挑战性。磁共振成像（MRI）是术前检查的标准诊断工具。然而，即便采用先进的脉冲序列，如用于磁共振神经成像的扩散张量成像，基于组织学特征区分肿瘤实体的能力依然有限。特别是，不同于神经鞘瘤和神经纤维瘤的罕见肿瘤实体，在手术探查和组织学确诊前很难预判。高分辨率超声（HRU）已成为周围神经术前评估的另一重要工具。随着换能器不断发展，高达17 - 18 MHz的软件和技术进步实现了具有组织分辨特性的高空间分辨率。遗憾的是，高频超声的组织穿透性较低。作者开发了一种术中使用HRU的方法，使超声换能器与手术暴露的神经病变直接进行无菌接触，以提高结构分辨率和对比度。作者以病例指导的方式报告了术中HRU及对比增强超声显示的罕见肿瘤实体的超声特征。
