Habib Ahmed, Jovanovich Nicolina, Hoppe Meagan, Hameed N U Farrukh, Edwards Lincoln, Zinn Pascal
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Surg Neurol Int. 2022 Aug 12;13:356. doi: 10.25259/SNI_469_2022. eCollection 2022.
The crux in high-grade glioma surgery remains maximizing resection without affecting eloquent brain areas. Toward this, a myriad of adjunct tools and techniques has been employed to enhance surgical safety and efficacy. Despite intraoperative MRI and advanced neuronavigational techniques, as well as augmented reality, to date, the only true real-time visualization tool remains the ultrasound (US). Neuroultrasonography is a cost-efficient imaging modality that offers instant, real-time information about the changing anatomical landscape intraoperatively. Recent advances in technology now allow for the integration of intraoperative US with neuronavigation.
In this report, we present the resection technique for three cases of high-grade gliomas (two glioblastomas and one anaplastic astrocytoma). The patient presented with a variable clinical spectrum. All three cases have been performed using the Brainlab neuronavigation system (BrainLAB, Munich, Germany) and the bk5000 US Machine (BK Medical, Analogic Corporation, Peabody, Massachusetts, USA).
Gross total resection was achieved in all three cases. The use of 3D navigated US was a reliable adjunct surgical tool in achieving favorable resection outcomes in these patients.
高级别胶质瘤手术的关键仍然是在不影响明确脑区的情况下实现最大程度的切除。为此，人们采用了大量辅助工具和技术来提高手术安全性和疗效。尽管有术中磁共振成像、先进的神经导航技术以及增强现实技术，但迄今为止，唯一真正的实时可视化工具仍然是超声（US）。神经超声检查是一种经济高效的成像方式，可在术中提供有关不断变化的解剖结构的即时、实时信息。目前技术的最新进展使得术中超声能够与神经导航相结合。
在本报告中，我们介绍了三例高级别胶质瘤（两例胶质母细胞瘤和一例间变性星形细胞瘤）的切除技术。患者表现出不同的临床症状。所有三例手术均使用了Brainlab神经导航系统（德国慕尼黑的BrainLAB公司）和bk5000超声仪（美国马萨诸塞州皮博迪的Analogic公司旗下的BK Medical公司生产）。
所有三例均实现了大体全切。在这些患者中，使用三维导航超声是实现良好切除效果的可靠辅助手术工具。
