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

ABSTRACT

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.