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  • Ultrasound & Neuronavigation in-one - a more superior option in tumour surgery?

    Final Number:

    mohammed a awad MBBS, MSc, BSc; Kevin S. O'Neill

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Sonowand is a neuronavigation console with real-time 3D intra-operative ultrasound. We have studied the volume of tumour resected in patients with high grade glioma using this operative aid.

    Methods: We have used the sonowand extensively wihtin our unit for high-grade tumour resection, amongst many other tumour types. A pre-operative and post-operative MRI was obtained on 20 patients operated with the aid of Sonowand Vs 20 patients operated with an alternative standard neuronavigation module without ultrasound integration.

    Results: The groups were matched for age, sex & histology. In our data, we found that when pre and post operative volumes were examined for both groups, the sonowand group had better, more complete volume resections than the group operated with standard neuronavigation. There was no significant difference in operative times or complication rates.

    Conclusions: The use of neuronavigation has proved invaluable over the last decade in Neurosurgery and intra-operative ultrasound is increasingly proving fashionable too. Intra-operative ultra-sound is a very useful adjunct in neuro-oncological surgery, moreso in this case with the use of the Sonowand module as it is optomised with the integration of neuronavigation and provides the ability to up-date the 'road-map' intra-operatively. We have shown through volumteric MRI analysis that you can achive better resection volumes which may lead to increased survival time. There is however a learning curve to aquire operater experience with ultrasound. Also image quality may also be degraded by blood in the cavity; and slightly larger craniotomies maybe required to allow for probe size.

    Patient Care: Preliminary analysis has also shown that sonowand resected patient have an increased life expectancy. We are working on increasing the number of patients in this early study and hopefully confirm this early finding and also analyse potential causes for this finding if it is proven. If this is the case then the benefit of more extensive tumour resection using intra-operative ultra-sound will, to patients with high-grade (operable) lesions, be exceptional

    Learning Objectives: By the conclusion of this session, participants should be able to 1) appreciate the use of intra-operative ultrasound amd see how tumours look under the probe in comparison to pre-operative MRI. 2)Appreciate the alternative options for Neuronavigation 3)Discuss the possibility that more extensive high-grade tumour resection may allow for increased life-span.


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