Moiyadi Aliasgar, Shetty Prakash
Department of Neurosurgery, Tata Memorial Centre, Mumbai, India.
J Neurol Surg A Cent Eur Neurosurg. 2017 Mar;78(2):105-112. doi: 10.1055/s-0036-1584512. Epub 2016 Jul 1.
Optimal resection of tumors in eloquent locations requires a combination of intraoperative imaging and functional monitoring during surgery. Combining awake surgery with intraoperative magnetic resonanceis logistically challenging. Navigable ultrasound (US) is a useful alternative in such cases. A total of 22 subjects with eloquent tumors were operated on (1 intended biopsy and 21 intended radical resections) using combined modality three-dimensional (3D) US and awake craniotomy with intraoperative clinical monitoring. We describe the technical details for these cases specifically addressing the feasibility of combining the two modalities. US was used for resection control in 18 cases. There were technical limitations in three cases. Transient intraoperative worsening was encountered in eight, necessitating premature termination of the procedure. All patients tolerated the awake procedure well. Mean duration of the surgery was 3.2 hours. Radical resections were obtained in 14 of 18 where this was intended and in 12 of the 13 where there was no adverse intraoperative monitoring event prompting premature termination of the resection. Combining awake surgery with 3DUS is feasible and beneficial. It does not entail any additional surgical workflow modification or patient discomfort. This combined modality intraoperative monitoring can be beneficial for eloquent region tumors.
在明确功能区进行肿瘤的最佳切除需要术中成像和手术期间功能监测相结合。将清醒手术与术中磁共振成像相结合在后勤保障方面具有挑战性。在这种情况下，可导航超声（US）是一种有用的替代方法。共有22例明确功能区肿瘤患者接受了联合三维（3D）超声和清醒开颅手术并术中进行临床监测的手术（1例为活检，21例为根治性切除）。我们描述了这些病例的技术细节，特别讨论了两种方式联合应用的可行性。18例手术中使用超声进行切除控制。3例存在技术限制。8例术中出现短暂病情恶化，需要提前终止手术。所有患者对清醒手术耐受性良好。手术平均时长为3.2小时。18例计划进行根治性切除的患者中有14例实现了根治性切除，13例术中无不良监测事件提示提前终止切除的患者中有12例实现了根治性切除。将清醒手术与3D超声相结合是可行且有益的。它无需对手术流程进行任何额外修改，也不会给患者带来不适。这种联合方式的术中监测对明确功能区肿瘤可能有益。
