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Intraoperative ultrasonography of brain tumors: Semiological analysis of a series of 56 consecutive cases
Author(s): ,
I. Zemmoura
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
,
A. Amelot
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France; Groupe Hospitalier Pitié-Salpétrière, APHP, Department of Neurosurgery, Paris, France
,
G. Kerdiles
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France
,
L.-M. Terrier
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
,
P. Francois
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France
S. Velut
Affiliations:
CHRU de Tours, Department of Neurosurgery, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
EANS Academy. Zemmoura I. Oct 21, 2018; 226039; EP3098
Assoc. Prof. Ilyess Zemmoura
Assoc. Prof. Ilyess Zemmoura
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Abstract
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Introduction
Ultrasonography (US) is a well-known but not widely used tool in neurosurgical practice for assisting the resection of intracerebral tumors. Compared to MRI, it is thought to be a more complex tool to tame for the neurosurgeon. The aim of this work was to study the intraoperative semiological symptomatology of hemispheric brain tumors.

Material and method :
Fifty-six consecutive cases of patients, operated by the same surgeon (IZ) from a hemispheric tumor, from November 24, 2016 to January 12, 2018, were included. An intraoperative US (Philips HD11-XE, L15-7io probe) was performed systematically. One or more images and/or videos have been archived for each case. US semiology was compared with MRI (echogenic and MRI signal contrast were quantified) and histopathological data. Intraoperative technical difficulties were collected.

Results:
Fifty-three out of the 56 mass lesions were hyperechogenic. In all cases, the tumor was hyperechogenic when the MRI lesion was either hyperintense in FLAIR or contrast-enhanced after Gadolinium injection, regardless of histological type; necrosis and cystic fluid were hypoechogenic; the tumor could be identified, allowing not to use neuronavigation. During or at the end of the resection, US identified deep anatomical limits (distance from the insula, ventricle, falx or tentorium). The analysis of the banks of the operative cavity was limited by blood deposits. For the 2 cases of cerebral radionecrosis in our series, the US signal was very different from the MRI signal.

Conclusion:
Detailing the semiology of intraoperative US is a major point for this device to obtain neurosurgeons´ approval. Our series confirms the interest and feasibility of intraoperative US in brain tumor surgery. US is an interesting alternative to neuronavigation for surgery of shallow and bulky hemisphere tumors. Other US modalities such as elastography or ultrasensitive Doppler should be explored to aid intraoperative diagnosis of tumor residue or radionecrosis.
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