Ultrasonography.  2017 Jan;36(1):60-65. 10.14366/usg.16015.

The value of intraoperative ultrasonography during the resection of relapsed irradiated malignant gliomas in the brain

• Mursch K
• Scholz M
• Brück W
• Behnke-Mursch J

• KMID: 2365577
• DOI: http://doi.org/10.14366/usg.16015

Abstract

PURPOSE
The aim of this study was to investigate whether intraoperative ultrasonography (IOUS) helped the surgeon navigate towards the tumor as seen in preoperative magnetic resonance imaging and whether IOUS was able to distinguish between tumor margins and the surrounding tissue.
METHODS
Twenty-five patients suffering from high-grade gliomas who were previously treated by surgery and radiotherapy were included. Intraoperatively, two histopathologic samples were obtained a sample of unequivocal tumor tissue (according to anatomical landmarks and the surgeon's visual and tactile impressions) and a small tissue sample obtained using a navigated needle when the surgeon decided to stop the resection. This specimen was considered to be a boundary specimen, where no tumor tissue was apparent. The decision to take the second sample was not influenced by IOUS. The effect of IOUS was analyzed semi-quantitatively.
RESULTS
All 25 samples of unequivocal tumor tissue were histopathologically classified as tumor tissue and were hyperechoic on IOUS. Of the boundary specimens, eight were hypoechoic. Only one harbored tumor tissue (P=0.150). Seventeen boundaries were moderately hyperechoic, and these samples contained all possible histological results (i.e., tumor, infiltration, or no tumor).
CONCLUSION
During surgery performed on relapsed, irradiated, high-grade gliomas, IOUS provided a reliable method of navigating towards the core of the tumor. At borders, it did not reliably distinguish between remnants or tumor-free tissue, but hypoechoic areas seldom contained tumor tissue.

Keyword

Glioblastoma; Glioma; Interventional ultrasonography; Neoplasms, residual; Neurosurgical procedure

MeSH Terms

Brain*
Glioblastoma
Glioma*
Humans
Magnetic Resonance Imaging
Methods
Needles
Neoplasm, Residual
Neurosurgical Procedures
Radiotherapy
Ultrasonography*
Ultrasonography, Interventional