Ultrasound-guided versus traditional surgical resection of supratentorial gliomas in a limited-resources neurosurgical setting

[摘要] Intraoperative ultrasonography (IOUS) represents a cheap and safe alternative to the more expensive intraoperative guidance modalities. In this study, we investigate the impact of introducing IOUS in the surgical management of supratentorial gliomas and compare its use objectively to unguided surgery. We conducted a prospective cohort study comparing two groups of patients with supratentorial gliomas amenable to gross total resection. One group was operated using intraoperative ultrasound guidance while the other group was operated using a more traditional approach with no intraoperative image guidance. The main outcomes assessed were the extent of tumor resection (EOR) based on early postoperative MRI, the postoperative Karnofsky performance score (KPS), and the rate of complications. There were 17 patients in the ultrasound group and 13 in the control group. EOR was significantly better in the IOUS group. Gross total (GTR) and near-total (NTR) resection were achieved in 29% and 24% respectively in the IOUS group, while 0% and 8% respectively in the control group. The mean volumetric EOR was 83% and 66% in the IOUS and the control groups respectively. Ultrasound was able to detect residual tumor after surgeon perceived GTR in 76% of cases. Postoperative KPS was significantly better in the IOUS group. IOUS guidance is superior to non-guided surgery in terms of EOR. Higher tumor resection confers a survival benefit according to previously published literature. This is particularly useful in a limited-resource setting, where neuronavigation and intraoperative MRI are not available.

[学科分类] 神经科学

[关键词] Astrocytoma;Glioblastoma;Ultrasound;Extent of resection