The role of intraoperative ultrasound in intracranial tumor surgery
Main Article Content
Abstract
This study evaluated the role and supportive value of intraoperative ultrasound (IOUS) for localization, margin assessment, and residual tumor detection in intracranial tumor surgery, using early postoperative MRI as the reference standard. A descriptive retrospective-prospective study included 34 patients treated with IOUS at Saint Paul General Hospital from January 2021 to March 2026. Early postoperative MRI within 48 hours was the reference standard. IOUS localized all tumors correctly. Gross total resection on postoperative MRI was achieved in 25/34 patients (73.5%). For residual tumor detection, IOUS showed sensitivity 55.6%, specificity 100%, positive predictive value 100%, negative predictive value 86.2%, and accuracy 88.2%. False-negative cases were mainly small, deep-seated, or ill-defined residual lesions at the resection cavity margin. IOUS is a useful, real-time, and cost-effective adjunct that supports surgical orientation and resection control. It should be combined with postoperative MRI and other adjuncts, particularly for infiltrative intra-axial tumors.
Article Details
Keywords
Intraoperative ultrasound, intracranial tumor, magnetic resonance imaging, extent of resection, residual tumor
References
2. Brown TJ, Brennan MC, Li M, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016; 2(11): 1460-1469. doi:10.1001/jamaoncol.2016.1373.
3. Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R. Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery. 2000; 47(5): 1070-1080. doi:10.1097/00006123-200011000-00008.
4. Trevisi G, Barbone P, Treglia G, Mattoli MV, Mangiola A. Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis. Neurosurg Rev. 2020; 43(5): 1221-1233. doi:10.1007/s10143-019-01160-x.
5. Dixon L, Lim A, Grech-Sollars M, Nandi D, Camp S. Intraoperative ultrasound in brain tumor surgery: a review and implementation guide. Neurosurg Rev. 2022; 45(4): 2503-2515. doi:10.1007/s10143-022-01778-4.
6. Wu H, Wang L, Hu P, He Z. Progress in the application of ultrasound in glioma surgery. Front Med (Lausanne). 2024; 11: 1388728. doi:10.3389/fmed.2024.1388728.
7. Erdoğan N, Tucer B, Mavili E, Menkü A, Kurtsoy A. Ultrasound guidance in intracranial tumor resection: correlation with postoperative magnetic resonance findings. Acta Radiol. 2005; 46(7): 743-749. doi:10.1080/02841850500223208.
8. Albert FK, Forsting M, Sartor K, Adams HP, Kunze S. Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery. 1994; 34(1): 45-61. doi:10.1227/00006123-199401000-00008.
9. Solheim O, Selbekk T, Jakola AS, Unsgård G. Ultrasound-guided operations in unselected high-grade gliomas-overall results, impact of image quality and patient selection. Acta Neurochir (Wien). 2010; 152(11): 1873-1886. doi:10.1007/s00701-010-0731-5.
10. Prada F, Del Bene M, Fornaro R, et al. Identification of residual tumor with intraoperative contrast-enhanced ultrasound during glioblastoma resection. Neurosurg Focus. 2016; 40(3): E7. doi:10.3171/2015.11.FOCUS15573.
11. Sweeney JF, Smith H, Taplin A, Perloff E, Adamo MA. Efficacy of intraoperative ultrasonography in neurosurgical tumor resection. J Neurosurg Pediatr. 2018; 21(5): 504-510. doi:10.3171/2017.11.PEDS17473.
12. Mosteiro A, Di Somma A, Ramos PR, et al. Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis. Front Oncol. 2022; 12:1016264. doi:10.3389/fonc.2022.1016264.
13. Fang Q, Hou Q, Liu X, Ma L, Jiang G, He Z. Enhancing the extent of resection in glioma surgery through the integration of intraoperative contrast-enhanced ultrasound and fluorescein sodium. World Neurosurg. 2024; 186: e662-e672. doi:10.1016/j.wneu.2024.04.027.
14. Sirbu OM, Chirtes A, Gorgan MR, Mitrica M. 2D intraoperative ultrasound in brain metastasis resection: a matched cohort analysis from a single-center experience. Cancers (Basel). 2025; 17(14): 2272. doi:10.3390/cancers17142272.
15. Ferreira MY, Cardoso LJC, Huda S, Ben-Shalom N. Intraoperative contrast-enhanced ultrasound-assisted resection of brain tumors: a systematic review and meta-analysis. Neurochirurgie. 2026; 72(2): 101774. doi:10.1016/j.neuchi.2026.101774.