Ultrasonography.  2019 Apr;38(2):156-165. 10.14366/usg.18032.

Non-enhancing gliomas: does intraoperative ultrasonography improve resections?

Affiliations
  • 1Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India. aliasgar.moiyadi@gmail.com

Abstract

PURPOSE
Non-enhancing diffuse gliomas are a challenging surgical proposition. Delineation of tumor extent on preoperative imaging and intraoperative visualization are often difficult.
METHODS
We retrospectively analyzed all cases of non-enhancing gliomas that were operated on using navigated 3-dimensional ultrasonography (US). tumor delineation (good, moderate, or poor) on preoperative magnetic resonance imaging (MRI) and intraoperative US was compared. Post-resection US findings with respect to residual tumor status were compared to the postoperative imaging findings. The extent of resection was calculated and recorded.
RESULTS
There were 55 gliomas (43 high-grade, 12 low-grade). Forty were close to eloquent areas. The pre-resection concordance of MRI with US was 56%, with US defining more tumors as well-delineated (n=26) than MRI (n=13). US was used for resection control in 50 cases. Gross tumor resection was achieved in 24 cases (51%). US correctly predicted the residual tumor status in 78% of cases. The use of US led to radical resections even in some tumors preoperatively deemed to be unresectable. However, eloquent location was the only independent predictor of the extent of resection.
CONCLUSION
Intraoperative US is a useful tool for guiding resection of non-enhancing gliomas. It may be better than MRI for delineating these tumors, and may thereby facilitate improved resection of these otherwise poorly delineated tumors. However, functional boundaries remain the main limiting factor for achieving complete resection of non-enhancing gliomas.

Keyword

Intraoperative ultrasound; Navigated ultrasound; Non-enhancing gliomas; Predictive value

MeSH Terms

Glioma*
Magnetic Resonance Imaging
Neoplasm, Residual
Retrospective Studies
Ultrasonography*
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