Ultrasound-based navigation during intracranial burr hole procedures: experience in a series of 100 cases.
BACKGROUND
To establish a rational basis for intraoperative ultrasound guidance in neurosurgical procedures via a single burr hole approach based on the experience of one hundred cases.


METHODS
The single burr hole approach is carried out using a bayonet-shaped ultrasound transducer with a tip dimension of 8 x 8 mm. The ultrasound probe with a mounted puncture adapter fits a standard burr hole and allows real-time imaging of the ongoing surgical steps.


RESULTS
One hundred cases with five indications have been operated on so far: tapping of the ventricular system (46 patients), tapping of intracranial cysts (23 patients), biopsy of intracranial tumors (15 patients), evacuation of intracranial abscesses (9 patients), and evacuation of intracerebral hematomas (7 patients). Depending on their size, the ventricles could be clearly visualized in 34 of 46 patients. In the remaining patients the free margin of the falx served as orientation. Two ventricles could neither be visualized nor entered. Visualization and puncture of intracranial cysts were easy to achieve throughout, as was the case with abscesses. Tumor biopsy was unsuccessful in two patients harboring lymphomas at distances of more than 50 mm from probe to target. Intracerebral hematomas were easily visualized but, due to the presence of clots, aspiration was impossible in two patients. One patient with a giant glioblastoma died the day after the uneventful biopsy due to increased cerebral edema. No other complications occurred.


CONCLUSIONS
The presented method of ultrasound-based neuronavigation is an easy-to-use, fast, and safe technique of real-time imaging for free-hand single burr hole procedures.
Strowitzki
M
M
Department of Neurosurgery, Saarland University Medical School, Homburg, Germany.
Moringlane
J R
JR
Steudel
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000601:surgery; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003560:Cysts / Q000000981:diagnostic imaging / Q000601:surgery; D004453:Echoencephalography / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014159:Transducers; D014207:Trephining / Q000295:instrumentation*; D014696:Ventriculostomy / Q000295:instrumentation