Korean J Radiol.  2011 Oct;12(5):541-546. 10.3348/kjr.2011.12.5.541.

Application of Intraoperative Ultrasonography for Guiding Microneurosurgical Resection of Small Subcortical Lesions

• Wang J
• Duan YY
• Liu X
• Wang Y
• Gao GD
• Qin HZ
• Wang L

• KMID: 1116438
• DOI: http://doi.org/10.3348/kjr.2011.12.5.541

Abstract

OBJECTIVE
We wanted to evaluate the clinical value of intraoperative ultrasonography for real-time guidance when performing microneurosurgical resection of small subcortical lesions.
MATERIALS AND METHODS
Fifty-two patients with small subcortical lesions were involved in this study. The pathological diagnoses were cavernous hemangioma in 25 cases, cerebral glioma in eight cases, abscess in eight cases, small inflammatory lesion in five cases, brain parasite infection in four cases and the presence of an intracranial foreign body in two cases. An ultrasonic probe was sterilized and lightly placed on the surface of the brain during the operation. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation.
RESULTS
All the lesions were located in the cortex and their mean size was 1.3 +/- 0.2 cm. Intraoperative ultrasonography accurately located all the small subcortical lesions, and so the neurosurgeon could provide appropriate treatment. Different lesion pathologies presented with different ultrasonic appearances. Cavernous hemangioma exhibited irregular shapes with distinct margins and it was mildly hyperechoic or hyperechoic. The majority of the cerebral gliomas displayed irregular shapes with indistinct margins, and they often showed cystic and solid mixed echoes. Postoperative imaging identified that the lesions had completely disappeared, and the original symptoms of all the patients were significantly alleviated.
CONCLUSION
Intraoperative ultrasonography can help accurately locate small subcortical lesions and it is helpful for selecting the proper approach and guiding thorough resection of these lesions.

Keyword

Intraoperative ultrasonography; Microneurosurgery; Subcortex

MeSH Terms

Adolescent
Adult
Aged
Brain Diseases/*surgery/ultrasonography
Brain Neoplasms/surgery/ultrasonography
Female
Glioma/surgery/ultrasonography
Hemangioma, Cavernous, Central Nervous System/surgery/ultrasonography
Humans
Male
*Microsurgery
Middle Aged
*Ultrasonography, Interventional
Young Adult

Figure

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  Fig. 1 Cavernous hemangioma. A. Intraoperative ultrasonic imaging of cavernous hemangioma (arrow). It shows hyperechoic characteristics with irregular shape and distinct margin. B. T2 sagittal MRI shows lesion (arrow) was located in frontal lobe.

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  Fig. 2 Cerebral glioma. A. Intraoperative ultrasonic imaging of one cerebral glioma (arrow). It demonstrates heterogeneous characteristics with irregular shape and indistinct margin. B. T1 sagittal MRI shows lesion (arrow) was located in frontal lobe.

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  Fig. 3 Mature abscess. A. Intraoperative ultrasonic imaging of mature abscess (arrow). It shows hypoechoic characteristics with regular margins and heterogeneous internal echo. B. Axial CT shows lesion (arrow) was located in parietal lobe.

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  Fig. 4 Inflammatory lesion. A. Intraoperative ultrasonic imaging of inflammation lesion (arrow). It demonstrates honeycomb-like hypoechoic characteristics with irregular shapes and indistinct margins (pathological diagnosis: infiltration of lymphocytes). B. T1 sagittal contrast enhanced MRI shows lesion (arrow) was located in cerebellum.

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  Fig. 5 Cerebral cysticercosis. A. Intraoperative ultrasonic imaging of cerebral cysticercosis lesion (arrow). Note hyperechoic scolex in multi-cysts. B. T1 axial MRI shows lesion was located at temporal lobe (arrow). Note there were multiple lesions shown on MRI.

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