Department of Neurological Surgery, Germans Trias I Pujol University Hospital, Ctra del Canyet Sn, 08916, Barcelona, CP, Spain.
Acta Neurochir (Wien). 2024 Aug 14;166(1):337. doi: 10.1007/s00701-024-06228-2.
Intraoperative ultrasound (IOUS) is a profitable tool for neurosurgical procedures' assistance, especially in neuro-oncology. It is a rapid, ergonomic and reproducible technique. However, its known handicap is a steep learning curve for neurosurgeons. Here, we describe an interesting postoperative analysis that provides extra feedback after surgery, accelerating the learning process.
We conducted a descriptive retrospective unicenter study including patients operated from intra-axial brain tumors using neuronavigation (Curve, Brainlab) and IOUS (BK-5000, BK medical) guidance. All patients had preoperative Magnetic Resonance Imaging (MRI) prior to tumor resection. During surgery, 3D neuronavigated IOUS studies (n3DUS) were obtained through craniotomy N13C5 transducer's integration to the neuronavigation system. At least two n3DUS studies were obtained: prior to tumor resection and at the resection conclusion. A postoperative MRI was performed within 48 h. MRI and n3DUS studies were posteriorly fused and analyzed with Elements (Brainlab) planning software, permitting two comparative analyses: preoperative MRI compared to pre-resection n3DUS and postoperative MRI to post-resection n3DUS. Cases with incomplete MRI or n3DUS studies were withdrawn from the study.
From April 2022 to March 2024, 73 patients were operated assisted by IOUS. From them, 39 were included in the study. Analyses comparing preoperative MRI and pre-resection n3DUS showed great concordance of tumor volume (p < 0,001) between both modalities. Analysis comparing postoperative MRI and post-resection n3DUS also showed good concordance in residual tumor volume (RTV) in cases where gross total resection (GTR) was not achieved (p < 0,001). In two cases, RTV detected on MRI that was not detected intra-operatively with IOUS could be reviewed in detail to recheck its appearance.
Post-operative comparative analyses between IOUS and MRI is a valuable tool for novel ultrasound users, as it enhances the amount of feedback provided by cases and could accelerate the learning process, flattening this technique's learning curve.
术中超声（IOUS）是神经外科手术辅助的有利工具，尤其是在神经肿瘤学方面。它是一种快速、符合人体工程学且可重复的技术。然而，其已知的缺点是神经外科医生需要陡峭的学习曲线。在这里，我们描述了一种有趣的术后分析，它提供了手术后的额外反馈，加速了学习过程。
我们进行了一项描述性回顾性单中心研究，纳入了使用神经导航（Curve，Brainlab）和 IOUS（BK-5000，BK medical）引导进行脑内肿瘤切除的患者。所有患者在肿瘤切除前均行术前磁共振成像（MRI）检查。手术过程中，通过开颅 N13C5 换能器与神经导航系统集成，获得三维神经导航 IOUS 研究（n3DUS）。至少获得两次 n3DUS 研究：肿瘤切除前和切除结束时。术后 48 小时内行 MRI 检查。将 MRI 和 n3DUS 研究进行后融合，并使用 Elements（Brainlab）规划软件进行分析，允许进行两次比较分析：术前 MRI 与术前 n3DUS 比较，术后 MRI 与术后 n3DUS 比较。有不完整 MRI 或 n3DUS 研究的病例被排除在研究之外。
从 2022 年 4 月至 2024 年 3 月，共有 73 例患者接受 IOUS 辅助手术。其中 39 例纳入研究。比较术前 MRI 和术前 n3DUS 的分析显示，两种模态之间的肿瘤体积具有高度一致性（p<0.001）。比较术后 MRI 和术后 n3DUS 的分析也显示，在未达到全切除（GTR）的情况下，残留肿瘤体积（RTV）具有良好的一致性（p<0.001）。在 2 例病例中，MRI 检测到而 IOUS 术中未检测到的 RTV 可以进行详细复查以重新检查其外观。
IOUS 和 MRI 之间的术后比较分析是新超声使用者的一种有价值的工具，因为它增加了病例提供的反馈量，并可能加速学习过程，使该技术的学习曲线变平。
