Velho Vernon, Kharosekar Hrushikesh Umakant, Bhople Laxmikant, Domkundwar Shilpa
Department of Neurosurgery, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India.
Department of Radiology, Grant Medical College, Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2020 Dec 21;15(4):983-988. doi: 10.4103/ajns.AJNS_332_20. eCollection 2020 Oct-Dec.
Over the past decade, the use of intraoperative image guidance in neurosurgery has gradually gained in importance. Apart from some sophisticated and very expensive techniques, intraoperative ultrasound (IOUS) is a simple and economical technique that allows the surgeon to localize deep-seated lesions under a real-time ultrasonic image display without dissection. The purpose of this study was to present our own preliminary experiences in various (n=1250) neurosurgical procedures carried out at our tertiary care centre in a developing country.
A Prospective study was carried out in our department of neurosurgery at Grant Medical College and Sir J J Group of hospitals from January 2010 to May 2019. IOUS was used during various elective neurosurgical procedures done during this period as given in table no below. A total of 1250 patients, 850 supratentorial lesion, 290 infratentorial lesion and 110 spinal lesion, were included in this study. All studies were performed using an ultrasound machine with variable 3.5~7.5 MHz sector transducers. The echogenicity and pathomorphology between IOUS and computed tomography/magnetic resonance imaging (CT/MRI) of various disease entities were compared.
Intracranial structures could be well demonstrated by ultrasound once the skull was opened. Most of the intracranial lesions were hyperechoic, except those with a cystic component. IOUS was more sensitive in demonstrating non-enhanced solid lesions and lesions with a cystic component than was preoperative CT/MRI. The border between the tumor and healthy brain was better delineated on IOUS in all cases aiding in tumor resection.
High-resolution real-time IOUS is a convenient and user-friendly method for identifying, localizing, and characterizing the pathological focus during an operation. Such information is very important and can enhance surgical results.
在过去十年中，术中图像引导在神经外科手术中的应用逐渐变得重要。除了一些复杂且非常昂贵的技术外，术中超声（IOUS）是一种简单且经济的技术，它能使外科医生在实时超声图像显示下定位深部病变，而无需进行解剖。本研究的目的是介绍我们在一个发展中国家的三级医疗中心进行的各种（n = 1250）神经外科手术中的初步经验。
2010年1月至2019年5月，在格兰特医学院和J J爵士医院集团的神经外科进行了一项前瞻性研究。在此期间，在各种择期神经外科手术中使用了术中超声，如下表所示。本研究共纳入1250例患者，其中幕上病变850例，幕下病变290例，脊柱病变110例。所有研究均使用配备3.5~7.5 MHz可变扇扫探头的超声仪进行。比较了各种疾病实体的术中超声与计算机断层扫描/磁共振成像（CT/MRI）之间的回声性和病理形态学。
一旦打开颅骨，颅内结构就能通过超声很好地显示出来。除了那些有囊性成分的病变外，大多数颅内病变为高回声。与术前CT/MRI相比，术中超声在显示非强化实性病变和有囊性成分的病变方面更敏感。在所有病例中，术中超声能更好地勾勒出肿瘤与健康脑组织之间的边界，有助于肿瘤切除。
高分辨率实时术中超声是一种在手术中识别、定位和表征病理病灶的方便且用户友好的方法。此类信息非常重要，可提高手术效果。
