Kaushal-Deep Singh Mathuria, Bhat Abdul Rashid, Fayaz Mohsin, Scalia Gianluca, Robbani Irfan, Wani Muhammed Afzal, Lodhi Mehershree, Chaurasia Bipin
Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, Soura, 190011, India.
Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy.
Neurosurg Rev. 2024 Dec 28;48(1):9. doi: 10.1007/s10143-024-03157-7.
Intraoperative assessment of tumor margins can be challenging; as neoplastic cells may extend beyond the margins seen on preoperative imaging. Real-time intraoperative ultrasonography (IOUS) has emerged as a valuable tool for delineating tumor boundaries during surgery. However, concerns remain regarding its ability to accurately distinguish between tumor margins, peritumoral edema, and normal brain tissue. Preoperative contrast-enhanced MRI (CEMRI) and contrast-enhanced CT (CECT) were performed to assess tumor dimensions, and IOUS was used intraoperatively to further evaluate tumor characteristics. Tumor volume was estimated using the prolate ellipsoid formula. Statistical analysis was conducted to compare tumor dimensions between imaging modalities and assess tumor expansion post-craniotomy. Our study included 51 patients with intracranial tumors. IOUS revealed larger tumor dimensions compared to preoperative CEMRI and CECT, with significant differences observed in surface area and volume. Tumors exhibited varied echogenicity on IOUS, with most showing mixed echogenicity. Histopathological analysis revealed a range of tumor grades, with gliomas being the most common. Statistical analysis indicated significant differences in tumor dimensions between imaging modalities, with tumor expansion observed post-craniotomy. Tumor type and grade were predictive factors for tumor volume expansion. Tumors exhibit expansion after craniotomy, with both tumor volume and surface area increasing. This expansion phenomenon, not solely attributed to tumor edema, underscores the importance of considering tumor mass expansion during surgical planning and intraoperative decision-making. These findings highlight the utility of IOUS in accurately delineating tumor boundaries and optimizing surgical outcomes in the management of intracranial tumors.
术中评估肿瘤边界可能具有挑战性；因为肿瘤细胞可能延伸至术前影像学检查所见的边界之外。实时术中超声检查（IOUS）已成为手术中描绘肿瘤边界的一种有价值的工具。然而，对于其准确区分肿瘤边界、瘤周水肿和正常脑组织的能力仍存在担忧。术前行对比增强磁共振成像（CEMRI）和对比增强计算机断层扫描（CECT）以评估肿瘤大小，术中使用IOUS进一步评估肿瘤特征。使用长椭球体公式估算肿瘤体积。进行统计分析以比较不同成像方式下的肿瘤大小，并评估开颅术后肿瘤的扩展情况。我们的研究纳入了51例颅内肿瘤患者。与术前CEMRI和CECT相比，IOUS显示的肿瘤尺寸更大，在表面积和体积方面观察到显著差异。肿瘤在IOUS上表现出不同的回声性，大多数显示混合回声性。组织病理学分析显示肿瘤分级范围广泛，其中胶质瘤最为常见。统计分析表明不同成像方式下肿瘤大小存在显著差异，开颅术后观察到肿瘤扩展。肿瘤类型和分级是肿瘤体积扩展的预测因素。肿瘤在开颅术后会出现扩展，肿瘤体积和表面积均增加。这种扩展现象并非仅归因于肿瘤水肿，强调了在手术规划和术中决策过程中考虑肿瘤体积扩展的重要性。这些发现突出了IOUS在准确描绘颅内肿瘤边界和优化手术结果方面的实用性。
