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  • Three-dimensional Intraoperative Ultrasound-based Frameless Navigation with Neuromonitoring and 5-ala Assistance in Patients with Astrocytoma Grade IV WHO

    Final Number:

    Vsevolod Shurkhay

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    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


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