Introduction: Accuracy of intraoperative orientation is one of the
factors that significantly affect both the success of neurosurgical
intervention and long-term outcome. “Brain shift” phenomena that
occurs during surgery really disturbs orientation of a surgeon
and can lead to serious functional complications (especially in eloquent and
near-eloquent brain areas).
Methods: Intraoperative three-dimensional ultrasound-based
frameless navigation (SonoWand Invite) in combination with 5-ALA
fluorescence imaging and intraoperative neuromonitoring was used in 36 patients with GBM between July-October, 2012. In all cases we use different types of probes according to tumor depth and size.
Results: Intraoperative 3D ultrasound has shown sufficient sensitivity
in delineating tumor border from normal brain tissue before removal and during procedure. We find that ultrasound characteristics cannot be easily interpreted according to histological properties of the tissue. 5-ALA is a valuable method for additional verification of tumor tissue and in combination with ultrasound and intraoperative neuromonitoring (MEP and SSEP) it helps to perform gross-total resection in more safety and easy way
Conclusions: Modern 3D ultrasound-based frameless intraoperative
navigation combined with neuromonitoring and molecular imaging with 5-ALA can be used as a faster, cheaper and very promising method to achieve extended and safe
resection in GBM patients.
Patient Care: This study demonstrates that in GBM patients intraoperative imaging is extremely important and GTR can be achieved even in eloquent brain areas due to anatomical and metabolic-based neuronavigation
Learning Objectives: By the conclusion of this section, participant should be able to: 1) describe the importance of intraoperative visualization including 3D ultrasound and metabolic navigation
2) Estimate role of intraoperative imaging such as ultrasound in the treatment plan of patinets wish glioblastoma
3) Limitations of ultrasound use and possibilities offered by metabolic imaging