Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
World Neurosurg. 2021 Jun;150:140-143. doi: 10.1016/j.wneu.2021.03.138. Epub 2021 Apr 2.
While benefits of neurosurgical intraoperative ultrasound (IOUS) are reported frequently, this method still has some significant pitfalls, which are described less often. However, sufficient knowledge on dealing with IOUS drawbacks, particularly various image artifacts, is important for successful surgery. We report a case of failed IOUS-guided pediatric cerebellar pilocytic astrocytoma resection, incorrectly evaluated as gross total resection according to IOUS. A large tumor residuum was left in place. Successful IOUS-guided reoperation using new IOUS technology and appropriate ultrasound imaging technique are described. The most probable reasons for initial resection failure and crucial points of reoperation, predominantly dealing with IOUS artifacts, are discussed. Neurosurgeons should be aware of IOUS limitations and have sufficient knowledge about how to overcome them before adopting routine use of this intraoperative imaging modality.
虽然神经外科术中超声（IOUS）的益处经常被报道，但该方法仍存在一些重大缺陷，这些缺陷描述得较少。然而，充分了解处理 IOUS 缺陷的方法，特别是各种图像伪影，对于手术的成功至关重要。我们报告了一例 IOUS 引导下小儿小脑毛细胞星形细胞瘤切除失败的病例，根据 IOUS 错误地评估为大体全切除。大量肿瘤残留在原处。成功地使用新的 IOUS 技术和适当的超声成像技术进行了 IOUS 引导下的再次手术，对此进行了描述。讨论了最初切除失败的最可能原因和再手术的关键点，主要涉及 IOUS 伪影的问题。神经外科医生应该意识到 IOUS 的局限性，并在采用这种术中成像方式之前，充分了解如何克服这些局限性。
