Strategy of indocyanine green fluorescence staining and ultrasound application in laparos-copic anatomical liver segmentectomy / 中华消化外科杂志

With the deeper understanding of liver anatomy and the use of fluorescent laparoscopic equipment, laparoscopic anatomical liver resection has become the first choice for the treatment of liver cancer, and achieved good short-term and long-term results. Indocyanine green (ICG) fluorescence staining and intraoperative ultrasound are the two most commonly used tech-niques for real-time imaging guidance in laparoscopic anatomical liver resection, especially for the identification of three-dimensional interface between liver segments and the guidance of hepatic parenchyma dissection. Based on latest research progress, and combined with clinical practice, the authors elaborate on the selection of ICG fluorescence staining method and the application of intra-operative ultrasound in laparoscopic anatomical liver segmentectomy.

Application of laparoscopic ultrasound in retroperitoneal radical nephrectomy for renal cell carcinoma with Type II inferior vena cava tumor thrombectomy

Background: The aim of this study was to investigate the application value of laparoscopic ultrasound (LU) in retroperitoneal radical nephrectomy for renal cell carcinoma with Type II inferior vena cava tumor thrombectomy (RRN-RCC-TII-IVCTT). Methods: The clinical data (operative time, length of tumor thrombus, tumor length, intraoperative bleeding, clinical stage, histological type, residual tumor tissue, and postoperative follow-up) of 6 patients who underwent LU-guided RRN-RCC-TII-IVCTT were retrospectively analyzed, and the intraoperative experience of LU was also summarized. Results: All 6 patients recovered well with liver and kidney functions returning to normal, and no tumor recurrence, metastasis, or vena cava tumor thrombus. Conclusions: LU-guided RRN-RCC-TII-IVCTT is a feasible treatment option, which locates the tumor accurately by retroperitoneal approach and provides the additional benefit of reduced intraoperative bleeding and shortened operative time, also achieving the much sought-after goal of precision.

Surgical strategy and procedure of adrenocortical carcinoma with retrohepatic inferior vena cava tumor thrombus with intraoperative ultrasound guidance / 中华肝胆外科杂志

Adrenocortical carcinoma (ACC) with inferior vena cava thrombosis is rare and has a poor prognosis, and the current literature overwhelmingly supports aggressive surgical intervention. This article summarizes the management of a patient with ACC with inferior vena cava thrombosis, and discusses the feasibility of detailed preoperative imaging data and intraoperative ultrasound to assess the superior and inferior boundaries of ACC with inferior vena cava thrombosis, while describing the intraoperative ultrasound-guided surgical planning and procedure for ACC with retrohepatic inferior vena cava tumor thrombus. Furthermore, it also demonstrates that it is feasible to accurately assess the superior and inferior boundaries of ACC with inferior vena cava thrombosis by preoperative multimodal imaging and intraoperative ultrasound, determine the mode of flow blockage during the operation, and obtain radical resection of the tumor.

Utility of Intraoperative Ultrasound in Neurosurgery

Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected,with 5 cases, followed by the parietal lobe,with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.

O volume de fluxo e a velocidade de pico sistólico ao ultrassom vascular com Doppler intraoperatório como preditores de perviedade precoce na fístula arteriovenosa autógena para hemodiálise / Intraoperative vascular Doppler ultrasound blood flow and peak systolic velocity predict early patency in hemodialysis arteriovenous fistula

Resumo Contexto A insuficiência renal crônica é um problema de saúde pública mundial. A hemodiálise é a principal terapia renal substitutiva. As fístulas arteriovenosas (FAV) são uma possível escolha, mas apresentam altas taxas de falência. Objetivos Este estudo tem como objetivo avaliar a relação entre as variáveis hemodinâmicas ao ultrassom vascular com Doppler no intraoperatório e a perviedade precoce da FAV para hemodiálise. Métodos Tratou-se de um estudo prospectivo observacional. Os pacientes consecutivos foram submetidos a FAV com ultrassonografia vascular com Doppler em intraoperatório nos dias 1, 7, 30 e 60. Eles foram divididos em grupos quanto à presença ou não de perviedade primária e secundária, e o volume de fluxo (VF) e a velocidade de pico sistólico (VPS) foram comparados. Foram realizadas curvas receiver operating characteristic (ROC), com definição de valores de VPS e VF com sensibilidade (S) e especificidade (E). Resultados Foram analisados 47 pacientes, os quais preencheram os critérios de inclusão. Os valores de VPS e VF intraoperatório foram maiores nos pacientes com perviedade primária e secundária comparados àqueles com falência. Os seguintes valores apresentaram maiores sensibilidade e especificidade para predizer perviedade primária aos 30 dias: 106 cm/s para VPS venoso, S: 75%, E: 71,4%; e 290,5 mL/min para VF arterial, S: 80,6%, E: 85,7%. Para perviedade secundária aos 30 dias, foram observados: 106 cm/s para VPS arterial, S: 72,7%, E: 100%; e 230 mL/min para VF venoso, com S: 86,4%, E: 100%. Para a perviedade primária no 60º dia, foram observados: 106 cm/s para VPS venoso, S: 74,4%, E: 62,5%; e 290,5 mL/min para VF arterial, S: 80%, E: 75%. Conclusões A velocidade de pico sistólico e o VF ao ultrassom vascular com Doppler intraoperatório são preditores de perviedade precoce na FAV para hemodiálise.

Abstract Background Chronic kidney disease is a major public health problem. Hemodialysis is the most common renal replacement therapy. Arteriovenous fistulas (AVF) are a possible access option, but early failure rates remain high. Objectives to investigate the value of intraoperative vascular Doppler ultrasound for predicting early AVF patency. Methods Prospective observational study. Consecutive patients undergoing AVF were assessed with vascular Doppler ultrasonography intraoperatively and on days 1, 7, 30, and 60. Patients were divided into groups according to presence or absence of primary and secondary patency. Blood flow (BF) and peak systolic velocity (PSV) were compared. ROC curves were plotted and used to define the PSV and BF values that yielded greatest sensitivity (Sens) and specificity (Spec). Results 47 patients met the inclusion criteria and were analyzed. Higher intraoperative PSV and BF values were observed in patients who had primary and secondary patency than in patients with access failure. The values with greatest sensitivity and specificity for predicting 30-day primary patency were 106 cm/s for venous PSV (Sens: 75% and Spec: 71.4%) and 290.5 ml/min for arterial blood flow (Sens: 80.6% and Spec 85.7%). Values for 30-day secondary patency were 106 cm/s for arterial PSV (Sens: 72.7%, Spec: 100%) and 230 ml/min for venous blood flow (Sens: 86.4%, Spec100%). Values for 60-day primary patency were 106 cm/s for venous PSV (Sens: 74.4%, Spec: 62.5%) and 290.5 ml/min for arterial blood flow (Sens: 80%, Spec: 75%). Conclusions Peak systolic velocity and blood flow measured using intraoperative vascular Doppler ultrasound can predict early patency of hemodialysis arteriovenous fistulas.

Intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations / 中华神经医学杂志

Objective To analyze the application value and clinical experience of intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations.Methods From March 2018 to March 2019,31 patients with supratentorial cavernous malformations were operated with assistance of intraoperative ultrasound in our hospital.Intraoperative ultrasound could clearly show the locations and sizes of the lesions,and relations of lesions with surrounding structures to choose appropriate surgical routes.The degrees of resection were judged and complications were recorded.The patients were followed up for 3-6 months,and modified Rankin scale (mRS) was used to evaluate the prognoses.Results In these 31 patients,35 cavernous hemangiomas were diagnosed by MR imaging before surgery;33 lesions were removed surgically,and the other two lesions located in the contralateral side of the operative field were not removed.The accuracy of intraoperative ultrasound guiding the lesions was up to 100％.There were no postoperative infections or deaths.During follow-up,mRS score of 28 patients was 0;the other 3 patients with postoperative neurological impairment recovered partially during follow-up.Conclusion With the help of real-time monitoring of intraoperative ultrasound and location technique of small pieces of hemostatic yam,patients with supratentorial cavernous malformations could acquire satisfactory prognosis through meticulous microsurgery.

Technology of intraoperative ultrasound in peripheral intracranial aneurysm clipping / 中风与神经疾病杂志

@#Objective　To evaluate the clinical significance of intraoperative ultrasound assisted clipping of peripheral intracranial aneurysms.Methods　The clinical data of 14 patients with distal intracranial aneurysms treated by craniotomy and clipping with intraoperative ultrasound-assisted technique were retrospectively analyzed as experimental group.The clinical data of 13 patients with distal intracranial aneurysms (without intraoperative ultrasound-assisted technique) treated by craniotomy and clipping were compared between the two groups.Results　The average operation time and hospitalization days of 14 patients in the experimental group were shorter than those of 13 patients in the control group;the incidence of complications of 14 patients in the experimental group was lower than that of 13 patients in the control group;the average GOS prognosis score of 14 patients in the experimental group was higher than that of 13 patients in the control group,the statistics were all P<0.05.Conclusion　Intraoperative ultrasound-assisted clipping of distal intracranial aneurysms can guide the accurate localization of lesions,shorten the operation time and hospitalization days,reduce injury and postoperative complications,and improve the prognosis of patients.

Útilidad de la ecografía intraoperatoria en la exéresis de las lesiones no palpables de la mama: experiencia y revisión de conjunto / Usefulness of intraoperative ultrasound in excision of non-lesions palpable of the breast: experience and overview

RESUMEN OBJETIVO: Presentar la experiencia de la unidad de mama de nuestro hospital con la utilización de la ecografía intraoperatoria en el tratamiento de las lesiones no palpables de mama. PACIENTES Y MÉTODO: Se incluyeron aquellas pacientes con lesiones no palpables de mama y ecovisibles. Intraoperatoriamente se localizó la lesión con la ecografía y se procedió a su exéresis, con comprobación ecográfica de su correcta extirpación con márgenes de seguridad. Se realizó estudio macroscópico en fresco de los márgenes marcados con tinta intraoperatoriamente. En caso de que los márgenes no fueran correctos se procedía a una ampliación de márgenes en el mismo acto quirúrgico. RESULTADOS: Desde el año 2012 se han intervenido 52 pacientes. En todas las pacientes se localizó la lesión con la ecografía. Se realizó tumorectomía a 24 pacientes y a 28 pacientes se les asoció la biopsia del ganglio centinela. El resultado patológico definitivo fue de 19 lesiones benignas y 33 lesiones malignas. A una paciente se le realizó mastectomía simple por presentar un carcinoma in situ extenso con microinfiltración no diagnosticado con las pruebas radiológicas preoperatorias. El resto de pacientes presentaron márgenes libres de tumor. CONCLUSIONES: La ecografía intraoperatoria es una técnica simple y fácil de desarrollar. Presenta una baja tasa de afectación de márgenes y es enteramente cirujano-controlada. Es confortable para el paciente y conlleva un bajo riesgo de complicaciones relacionadas con la técnica.

ABSTRACT OBJETIVE: To present the results of our hospital's experience with the utilization of intraoperative ultrasound in the treatment of non-palpable breast lesions. PATIENTS AND METHOD: We included those patients whose breast lesions were non-palpable yet simultaneously visible on ultrasound. The lesions were located intraoperatively with ultrasound and were removed with ultrasound verification of the proper security margins. An examination of the intraoperative macroscopic margins with ink was done. In cases with incorrect margins, a re-excision was done utilizing the same technique but with amplified margins. RESULTS: Dating from 2012, we have operated on 52 patients. In all cases, the lesions were discovered and localized by means of ultrasound. Lumpectomy was performed on 24 patients and we associated the sentinel node biopsy in 28 cases. Subsequent pathology reports determined that 19 lesions were benign and 33 lesions were malignant. There was one patient with a mastectomy because a long extensive ductal carcinoma in situ with microinfiltration that was not seeing during the preoperative study. CONCLUSIONS: Intraoperative ultrasound is an easy and simple technique that is entirely surgeon controlled and results in a low rate of positive margins. The procedure is comfortable for the patient and carries with it a low rate of complications.

Non-enhancing gliomas: does intraoperative ultrasonography improve resections?

PURPOSE: Non-enhancing diffuse gliomas are a challenging surgical proposition. Delineation of tumor extent on preoperative imaging and intraoperative visualization are often difficult. METHODS: We retrospectively analyzed all cases of non-enhancing gliomas that were operated on using navigated 3-dimensional ultrasonography (US). tumor delineation (good, moderate, or poor) on preoperative magnetic resonance imaging (MRI) and intraoperative US was compared. Post-resection US findings with respect to residual tumor status were compared to the postoperative imaging findings. The extent of resection was calculated and recorded. RESULTS: There were 55 gliomas (43 high-grade, 12 low-grade). Forty were close to eloquent areas. The pre-resection concordance of MRI with US was 56%, with US defining more tumors as well-delineated (n=26) than MRI (n=13). US was used for resection control in 50 cases. Gross tumor resection was achieved in 24 cases (51%). US correctly predicted the residual tumor status in 78% of cases. The use of US led to radical resections even in some tumors preoperatively deemed to be unresectable. However, eloquent location was the only independent predictor of the extent of resection. CONCLUSION: Intraoperative US is a useful tool for guiding resection of non-enhancing gliomas. It may be better than MRI for delineating these tumors, and may thereby facilitate improved resection of these otherwise poorly delineated tumors. However, functional boundaries remain the main limiting factor for achieving complete resection of non-enhancing gliomas.

Intracranial pressure monitoring in ventricular puncture by intraoperative ultrasonography in treatment of posttraumatic diffuse brain swelling / 中华神经医学杂志

Objective To investigate the clinical efficacy of intracranial pressure monitoring in ventricular puncture for patients with posttraumatic diffuse brain swelling under guidance of real-time intraoperative ultrasound. Methods Sixty-seven patients with posttraumatic diffuse brain swelling, admitted to and accepted intracranial pressure monitoring in ventricular puncture under real-time intraoperative ultrasound in our hospital from January 2015 to December 2017, were chosen as experimental group; and other 71 patients with posttraumatic diffuse brain swelling, admitted to and accepted traditional intracranial pressure monitoring in ventricular puncture in our hospital from January 2012 to June 2014, were chosen as control group. The clinical data were retrospectively analyzed, and the success rate of primary puncture and complications were compared between the two groups. Results The success rate of primary puncture in the experimental group was 100％ (67/67), and that in the control group was 77.5％ (55/71), with significant difference (P<0.05). No catheter-related infection was noted in either group. Only one patient in study group had puncture tract bleeding, while 9 patients in the control group had puncture tract bleeding; abnormal puncture location was noted in 8 patients of the control group, including 5 failing to be punctured in the ventricle, one puncturing to the contralateral ventricle, and two having excessive puncture depth; occurrence of postoperative complications in study group was significantly lower than that in control group (P<0.05). Conclusion Real-time intraoperative ultrasound-guided puncture ventricle drainage is superior to conventional bind-puncture in traumatic patients with diffuse brain swelling, and can be widely used in clinical practice.

Neuronavigation combined with intraoperative ultrasound-assisted microsurgery for the treatment of supratentorial intracranial arteriovenous malformations / 中国脑血管病杂志

Objective To investigate the clinical effect of neuronavigation combined with intraoperative ultrasound-assisted microsurgery for the treatment of supratentorial intracranial arteriovenous malformations (AVMs). Methods From March 2014 to February 2017,14 patients with supratentorial intracranial AVMs treated with neuronavigation combined with intraoperative ultrasound-assisted microsurgery at the Department of Neurosurgery,the Second Affiliated Hospital of Anhui Medical University were enrolled retrospectively.According to Spetzler-Martin (S-M)classification,there were 2 cases of grade Ⅰ,6 cases of grade Ⅱ,5 cases of grade Ⅲ,and 1 case of grade Ⅳ. The clinical data,surgical effects,and complications were analyzed. Results (1)The lesions of 13 patients were completely removed and 1 had residue. Four patients had preoperative limb hemiplegia and one had postoperative limb weakness. They were followed up for 1 to 4 years. The myodynamia was improved or returned to normal. (2)One patient had postoperative intracranial infection and was cured after anti-infective treatment. Of the 4 patients with preoperative epilepsy, 3 did not have postoperative recurrence and 1 was controlled. (3)The modified Rankin scale (mRS)scores at 3 months after operation were as follows:8 patients were 0,4 were 1,and 2 were 2. The clinical symptoms and imaging were followed up for 1-4 years,no vascular malformation recurrence and rebleeding were observed. Conclusion The preliminary observation showed that the neuronavigation and intraoperative ultrasound multimodality assisted microsurgical treatment of supratentorial AVMs had the characteristics of accurate location and high safety,and the clinical efficacy was satisfactory.

Correlation of intraoperative ultrasonography and immunohistochemical markers expression in glioma / 中国医学影像技术

Objective To investigate the correlation between intraoperative ultrasonographic features and expression of immunohistochemical markers in patients with glioma.Methods Totally 116 patients with glioma confirmed pathologically were collected.Ultrasonic features were observed,including the main site of the tumor,maximum diameter,border,cystic degeneration,calcification,the degree of peritumoral edema and CDFI blood flow classification,and the correlation between ultrasonographic features and immunohistochemical results such as Ki-67 and isocitrate dehydrogenase 1 (IDH1) was analyzed.Results Univariate analysis showed that the border,peritumoral edema and CDFI blood flow were significantly different between negative and positive Ki-67 expression patients (P＜ 0.01).The border,cystic degeneration and peritumoral edema were distinct between negative and positive IDH1 patients (P＜0.01).Multivariate analysis showed that gliomas with clear border,high degree of peritumoral edema and rich CDFI blood flow tended to show positive Ki-67 expression,while those with vague border,low degree of peritumoral edema were frequently accompanied by positive IDH1 expression.Conclusion The border of gliomas,peritumoral edema and blood flow showed on ultrasonography may predict the expression of Ki-67 and IDH1.It is of great significance for preliminary evaluation on biological behaviors and prognosis of the tumors before surgical operation.

Early microsurgical removal of 31 patients with low-grade (Spetzler-Martin Ⅰ-Ⅱ) bleeding arteriovenous malformations / 中华神经医学杂志

Objective To explore the safety and effectiveness of early microsurgical removal of low-grade (Spetzler-Martin Ⅰ-Ⅱ) bleeding arteriovenous malformations. Methods The clinical data of 31 patients with low-grade AVM by microsurgical treatment in our hospital from October 2009 to December 2015 were retrospectively reviewed in the acute stage of bleeding (within the first week after bleed). All patients showed a cerebral AVM on DSA or CTA at admission, 18 of whom underwent intraoperative ultrasound. Neurological outcomes were assessed with Glasgow outcome scale (GOS) after operation. According to the GOS scores, the patients were divided into good prognosis group (scores of 4-5) and poor prognosis group (scores of <4); the differences of preoperative clinical data between the two groups were compared. After operation, cerebral DSA or CTA was performed. According to the postoperative brain AVM with or without residual, the patients were divided into residual group and no-residue group; the differences of the clinical data and use of ultrasound in operation were analyzed statistically between the two groups. Results A favorable functional outcome was observed in 27 patients (87.1%); as compared with that in the poor prognosis group, the proportion of Glasgow coma scale (GCS) scores>8 and young patients in the good prognosis group was significantly higher (P<0.05). In 31 patients, there were 5 with residual brain AVM (total residual rate 16.1%); the proportion of patients with Spetzler-Martin grading (SMG) I in the residual group was significantly lower than that in the no-residue group (P<0.05). There was no statistically significant difference in the proportion of intraoperative ultrasound use between the two groups (P>0.05). Conclusions Early microsurgery for grade Ⅰ-Ⅱ bleeding AVMs is a safe and definitive treatment with intraoperative ultrasound, achieving both immediate cerebral decompression and protection against rebreeding, reducing hospital stays and allowing a more rapid rehabilitative course whenever necessary. Patients who are younger or with GCS scores>8 may have a better prognosis and high complete resection is achieved in those with SMG Ⅰ.

Laparoscopic ultrasound guided laparoscopic liver resection / 中华肝胆外科杂志

Objective To study the use of laparoscopic ultrasound (LUS) in laparoscopic liver resection (LLR).Methods Patients who underwent LLR in PLA General Hospital from Jan 2013 to Jan 2017 were retrospectively collected and analyzed.LUS detection was routinely performed to identify tumor and important vessels,determine the margin of liver resection and guide in parenchymal transection.Results 324 patients underwent LLR during the study period.The resections included 137 bisegmentectomies S2-3 (33.0％),62 segrnentectomies (19.1％),59 right or left hepatectomies (18.2％),45 wedge resections (13.9％) and 21 other types of bi-or tri-segmentectomies.The median duration of surgery was 3.3 h (1 ～ 10 h).The median operative blood loss was 125.0 ml (5 ～ 1 200 ml).Intraoperative complications were rare.The total conversion rate was 2.2％ (7 patients).Postoperative complications occurred in 23.7％ of patients,all grade 1 ～2 according to the Clavien-Dindo classification.No liver-related mortality occurred.The R0 resection rate of malignant tumors was 100％.The median postoperative hospital stay was 5.0 days (1 ～ 15 days).Conclusions The safety and efficacy of LLR were improved by the full-time and real-time use of intraoperative LUS.There is a need for intraoperative LUS training for liver surgeons.

Intraoperative ultrasound in liver surgery / 中华肝胆外科杂志

Intraoperative ultrasound (IOUS) should be routine in modem liver surgery.It can be divided into open and laparoscopic IOUS.The two types of IOUS differ not only in technique,but also in ultrasound probes.IOUS probes can further be classified as sector and linear probes.IOUS has a wide application in liver surgery.It improves intraoperative diagnosis and staging of tumour.As a consequence,it changes the preoperative surgical plan in 23％ to 51％ of patients.Under IOUS guidance,surgeons can carry out biopsy or treatment of liver nodules.It helps liver surgeons to localize tumours,to determine resection margins,to determine hepatic parenchymal transection planes,to guide and monitor transection planes and to find major vessels in order to protect or to ligate them.Proper IOUS requires special equipments and personnel.IOUS has a very wide application in modem liver surgery.Its widespread use would depend on the establishment of a proper training programme.

Image Guided Neurosurgery by Using Neuronavigation Integrated with Intraoperative Three-Dimensional Ultrasound.

Introduction: Intra-operative ultrasound provides low cost real time imaging that is simple and rapid to use. In recent years there has been a signifi cant improvement in the quality of ultrasound imaging. Ultrasound integrated neuronavigation can be used to optimize the approach, and achieving safe maximal resection, thereby improving outcomes for patients with diff erent localization and histology of brain tumors, vascular patology, spontaneous intra-cerebral hemorrhage. Material and Methods: Since 2007 till 2010, in the Institute of Neurology and Neurosurgery, 130 operations with application of 2D iUS have been performed. Starting from March till May 2012, 17 patients went under surgical treatment using the intraoperative ultrasound integrated neuronavigation system. Results: We applied ultrasound neuronavigation system in 17 cases on patients with diverse pathologies, including brain tumors (craniopharyngeoma, corpus callosum and intracerebral glioblastoma, intraaxial glioma), vascular patology (arteriovenous malformations, aneurysms), spontaneous intracerebral hemorrhage. Application of ultrasound neuronavigation system aids in improving postoperative outcomes for these patients. Conclusions: Th e integration of 3D US with neuronavigation technology created an effi cient and inexpensive tool for intraoperative imaging in neurosurgery. Th e technology has been applied to optimize surgery of brain tumors, but it has also been found to be useful in other procedures such as operations for aneurysms or arteriovenous malformations. iUS is easy to use and has a rapid learning curve which makes it a useful tool to the neurosurgeons intraoperative armamentarium.

Surgical treatment of functional glioma by neuronavigation with intraoperative ultrasound / 中国基层医药

Objective To investigate the operation process,extent of resection,protection function,the tumor recurrence and clicical value of neuronavigation with intraoperative ultrasound for treating functional glioma;signifi-cance of intraoperative ultrasound for correcting brain shift.Methods We analyzed the cliclical materical of 24 case of functional gliomas which were resected by neuronavigation with intraoperative ultrasound.Results The accuracy of localization of functional glioma was 100%.The distance of brain shift was 2 to 10mm,with an average 4.7mm.After 24 hours MRI confirmed that total removal of function glioma was achieved in 21 cases,subtotal in 3 cases.After oper-ation function improve was 20 cases,invalid of 2 cases,hemiplegia happened in 2 cases and no death in all the patients.Conclusion Neuronavigation with intraoperative ultrasound can correct brain shift and improve the accuracy of localization of functional glioma,to improve extent of function glioma and decrease dysfunction.Neuronavigation with intraoperative ultrasound is important to functional glioma.

Intraoperative ultrasound added with neuronavigation in resection of intracranial gliomas / 中华神经医学杂志

Objective To conclude the application experience of intraoperative ultrasound added with neuronavigation in resection of intracranial gliomas.Methods A retrospective analysis was performed on the clinical data of 60 patients with intracranial gliomas,performed resection in our hospital from January 2010 to June 2013 by intraoperative ultrasound added with neuronavigation; 32 of them had high-grade gliomas and 28 low-grade ones.Ultrasonoscopy of different grade gliomas was studied.Results The accuracy of localization was 100％ in 60 patients with intracranial gliomas.Ultrasonic image of high-grade gliomas enjoyed obvious hyperechogenicity and the boundaries were clear usually; ultrasonic image of low-grade ones were slightly hyperechogenic or isoechogenic and the boundaries were indistinct usually.Inhomogeneous hyperechogenic of the ultrasonoscopy of intracranial gliomas before resection and hypoechogenic of residual cavity after resection were noted,respectively.Total removal was achieved in 50 patients,subtotal resection in 6 and partial resection in 4.Brain swelling happened postoperatively in 1 and was remitted by decompressive craniectomy.Hemiplegia happened in 2,and no death occurred postoperatively.Conclusions Intraoperative ultrasound is important to the correct of brain shift,and has clear and important value to the choice of operation approach and incising cortex.Ultrasonic image of high-grade gliomas and calcified lesions enjoys the best view.Intraoperative ultrasound added with neuronavigation can raise resection rate of intracranial gliomas.

Intraoperative ultrasound assessment of carotid endarterectomy for the treatment of patients with subtotal or complete occlusion of carotid artery / 中国脑血管病杂志

Objective To analyze the correlations of vascular structure, hemodynamic changes and surgical recanalization of carotid endarterectomy ( CEA) for the treatment of subtotal or complete occlusion of carotid artery. Methods A total of 107 patients with carotid artery occlusive disease diagnosed at Beijing Xuanwu Hospital,Capital Medical University received CEA therapy from January 2005 to January 2014 and were enrolled retrospectively. According to the findings of introperative ultrasound,they were divided into either a recanalization group (n=86) or a non-recanalization group (n=21). Preoperative and intraoperative carotid artery diameter and blood flow velocity were compared and analyzed with carotid ultrasonography. Intraoperative detected vascular abnormalities, residual vascular stenosis rate, blood flow velocity and pulsatility index of the ipsilateral middle cerebral artery ( MCA) were documented. Results (1) The peak systolic velocity (PSV) (82 ± 32 cm/s and 60 ± 17 cm/s),mean velocity (MV) (50 ± 19 cm/s and 42 ±13cm/s),and pulsatility index (PI) (0. 97 ± 0. 25 and 0. 67 ± 0. 14) on the ipsilateral MCA in patients of carotid artery recanalization before and after procedure were significantly higher than those during the procedure. There were significant differences (all P=0. 000). In patients failed to recanalize,the intraoperative and preoperative PSV,EDV,and MV of MCA were 46 ± 20 cm/s and. 63 ± 21 cm/s,24 ± 13 cm/s and 34 ± 12 cm/s, and 32 ± 16 cm/s and 44 ± 15 cm/s,respectively. They were reduced more significantly during the procedure than those after procedure. There were significant differences ( all P=0. 000 ) . But there was no significant difference in PI (0. 70 ± 0. 18 and 0. 67 ± 0. 15) compared with that before procedure (P=0. 317). (2) The diseased vascular diameter of the recanalization group was significantly widened (0. 6 ± 0. 4 mm vs. 3. 4 ± 0. 9 mm,P=0. 000) compared with before procedure. The overall recanalization rate was 80. 4% (86/107). Intraoperative ultrasound revealed that 13 patients had mild abnormal vascular structures among the recanalized patients. The non-recanalized patients had significantly abnormal vascular structure. Conclusion Intraoperative carotid ultrasound in combination with transcranial Doppler (TCD) for monitoring cerebral blood flow may effectively identify the carotid structure and the degree of cerebral hemodynamic improvement,and timely guide the secondary repair.

Ultrasound-Guided Posterolateral Approach for Midline Calcified Thoracic Disc Herniation

OBJECTIVE: Symptomatic thoracic disc herniation often requires prompt surgical treatment to prevent neurological deterioration and permanent deficits. Anterior approaches offer direct visualization and access to the herniated disc and anterior dura but require access surgeons and are often associated with considerable postoperative pain and pulmonary complications. A disadvantage with using posterior approaches in the setting of central calcified thoracic disc herniation however, has been the limited visualization of anterior dura and difficulty to accurately assess the extent of decompression. METHODS: We report our experience with intraoperative ultrasound (US) guidance during a modified posterior transpedicular approach for removal of a central calcified thoracic disc herniation with a review of pertinent literature. RESULTS: The herniated thoracic disc was successfully removed with posterior approach with the aid of intraoperative US. The patient had significant neurological improvement at three months follow-up. CONCLUSION: Intraoperative ultrasound is a simple yet valuable tool for real-time imaging during transpedicular thoracic discectomy. Visualization provided by intraoperative US increases the safety profile of posterior approaches and may make thoracotomy unnecessary in a selected group of patients, especially when a patient has existing pulmonary disease or is otherwise not medically fit for the transthoracic approach.