Ultrasonography Monitoring with Superb Microvascular Imaging Technique in Brain Tumor Surgery

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• 作者：Mami Ishikawa¹ ; ² ; ^{m.ishikawa@edogawa.or.jp} ; Yasushi Ota³ ; Mutsumi Nagai⁴ ; Gen Kusaka² ; Yuichi Tanaka² ; Heiji Naritaka¹
• 关键词：Intraoperative monitoring ; Microvascular imaging ; Tumor vessels ; Ultrasonography
• 刊名：World Neurosurgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：97
• 期：Complete
• 页码：749.e11-749.e20
• 全文大小：4264 K
• 卷排序：97

文摘

Neuronavigation based on preoperative magnetic resonance imaging has been developed as a useful tool to improve visibility of the surgical site in the operative field. Ultrasonography (US) monitoring has also been used as a reliable imaging technique, providing real-time information during neurosurgical operations. We combined the latest innovative imaging technique for detecting very low-flow components, Superb Microvascular Imaging (SMI), with US monitoring during brain tumor surgery.Case DescriptionFifteen patients diagnosed with brain tumor (8 malignant and 7 benign) underwent neurosurgery with US monitoring using an Aplio 400/500 US system with the new SMI technique (imaging frequency, 10–12 MHz; frame rate, 28–31 Hz). Features of the SMI images in the gray scale mode include 1) visualization of low-velocity flow with minimal motion artifact, 2) high resolution of images, and 3) high frame rates. The tumors, tumor vessels, compressed and shifted healthy vessels, and cistern were clearly visualized on the SMI images in the gray scale mode, detailing the characteristics of healthy brain tissue (vertically penetrating, fine, straight vessels), glioblastoma (rounding, dilating, and bending vessels), low-grade glioma (fine and straight vessels), meningioma (many large and branching vessels), and lymphoma (less vascular, low echoic tumor) and demonstrating the tumor-defined border. We also performed biopsies under US monitoring with SMI.ConclusionsWe combined SMI technique with US monitoring during brain tumor surgery and observed healthy and tumor vessels. Further research is important for the development of a more precise and reliable neurosurgery.