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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Intraoperative 3-dimensional ultrasound for resection control during brain tumor removal: preliminary results of a prospective randomized study

Meeting Abstract

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  • N. Keric - Department of Neurosurgery, Georg-August-University Goettingen, Germany
  • H.C. Bock - Department of Neurosurgery, Georg-August-University Goettingen, Germany
  • A. Giese - Department of Neurosurgery, Georg-August-University Goettingen, Germany
  • V.A. Coenen - Department of Neurosurgery, Aachen University of Technology (RWTH), Germany; Department of Neurosurgery, University of Bonn, Germany
  • V. Rohde - Department of Neurosurgery, Georg-August-University Goettingen, Germany; Department of Neurosurgery, Aachen University of Technology (RWTH), Germany

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.04.06

doi: 10.3205/11dgnc014, urn:nbn:de:0183-11dgnc0144

Published: April 28, 2011

© 2011 Keric et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The amount of resection is closely related to survival in brain tumours. To enhance resection, especially intraoperative magnetic resonance imaging (MRI) has been applied. The aim of this prospective, randomized study was to test if intraoperative 3-D ultrasound likewise can be used for resection control.

Methods: 26 patients, who underwent surgery for intraaxial tumours in non-eloquent brain areas, were initially included into this prospective study. In 2 patients, the small size of the craniotomy hindered intraoperative ultrasound imaging. In 24 patients, 3-D ultrasound images were obtained before and after opening of the dura, during tumour removal, prior to evaluation by a blinded investigator for identification of tumour remnants, and after dura closure. 13 patients were randomized to complete tumour removal according to the impression of the surgeon (group 1). 13 patients were randomized to incomplete tumour removal (tumour remnant <1 cm) (group 2); in these patients, the neurosurgeon intentionally left a tumour remnant prior to evaluation by the blinded investigator. The tumour remnant was then removed. It was tested if 3-D ultrasound can correctly identify complete and incomplete tumour resection. All patients underwent early postoperative MRI.

Results: In 2 patients (one each of the two groups) the image quality was too poor for a meaningful intraoperative evaluation. In the 12 patients randomized for incomplete tumour removal, 3-D ultrasound correctly identified tumour remnants in 8 patients (67%). In 12 patients randomized for complete tumour removal, 3-D ultrasound confirmed complete tumour resection in 6 patients. In addition, 3-D ultrasound identified correctly tumour remnants in 2 patients randomized for complete tumour removal. Thus, the sensitivity for tumour remnant detection increased to 71% (8 of 12 patients) and that of confirmation of complete tumour removal was 60% (6 of 10 patients).

Conclusions: The number of investigated patients is still too low to allow definite conclusions. However, the study results suggest, that 3-D ultrasound is especially helpful for detection of overseen brain tumour tissue.