Pino Maria Angela, Imperato Alessia, Musca Irene, Maugeri Rosario, Giammalva Giuseppe Roberto, Costantino Gabriele, Graziano Francesca, Meli Francesco, Francaviglia Natale, Iacopino Domenico Gerardo, Villa Alessandro
Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, AOUP "Paolo Giaccone", 90100 Palermo, Italy.
Division of Neurosurgery, IRCCS Neuromed, 86077 Pozzilli, Italy.
Brain Sci. 2018 Nov 19;8(11):202. doi: 10.3390/brainsci8110202.
Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival.
最大安全切除是恶性脑肿瘤手术的金标准。对于全切除而言，需要准确的肿瘤定位和精确的肿瘤边界勾画。术中诊断成像（术中磁共振成像-IOMR、术中计算机断层扫描-IOCT、术中超声-IOUS）和染料（荧光）在脑肿瘤手术中变得至关重要，可实现更彻底、更安全的肿瘤切除。IOUS在脑肿瘤手术中的引导在区分肿瘤与正常脑实质方面是准确的，并且能实现术中实时可视化。我们旨在评估IOUS在胶质瘤手术中的作用，并概述最大化其疗效的具体策略。我们通过PubMed数据库进行文献研究，筛选了过去15年（2003年至2018年）发表的每一篇聚焦于IOUS在脑肿瘤手术，特别是胶质瘤手术中应用的文章。我们选取了39篇关于IOUS在包括胶质瘤在内的脑肿瘤手术中应用的论文。IOUS因其成本低、对手术流程干扰小且无辐射暴露而具有显著吸引力。我们的文献综述表明，在脑肿瘤手术中增加超声的使用可实现更彻底的切除，从而提高生存率。
