title: The benefits of navigated intraoperative ultrasonography during resection of fourth ventricular tumors in children.
abstract: BACKGROUND
  Safe and radical excision of pediatric fourth ventricular tumors is by far the best line of management. Pediatric fourth ventricular tumor surgery is a challenge for neurosurgeons. The aim of the study is to present the authors' experience and to evaluate the possible benefits of neuro-navigated intraoperative ultrasonography (NIOUS) during the surgery of fourth ventricular tumors in children.
  
  
  METHODS
  Nonrandomized clinical trial study was conducted on 60 children with fourth ventricular tumors who were treated at Children's Cancer Hospital-Egypt. Mean age was 5.2 (±2.6) years. Thirty cases were operated upon utilizing the conventional microneurosurgical techniques. Another 30 cases were operated upon utilizing the NIOUS technique.
  
  
  RESULTS
  Total tumor excision was achieved in 29 cases (96.7%) of NIOUS group versus 24 cases (80%) in the conventional group. Mean operative time NIOUS group was 150 min [standard deviation (SD) = 18.28) versus 140.6 min (SD = 18.6) in the conventional group (p value = 0.055). The mean operative blood loss was 67.5 ml (SD = 17) in NIOUS group versus 71 ml (SD = 15.4) in the conventional group. Postoperative cerebellar mutism occurred in one case (3.3%) of NIOUS group versus in six cases (20%) of the conventional group.
  
  
  CONCLUSIONS
  Integration of navigated intraoperative ultrasonography in surgery of pediatric fourth ventricular tumors is a useful technology. It safely monitors maximum stepwise tumor excision. It is associated with less operative morbidity without significantly added operative time. It is a real-time, cost-effective, easily applicable, and easily interpretable tool that could substitute the use of intraoperative MRI especially in pediatric neurosurgery.
authors.affiliation: Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. beltagy_mohamed@hotmail.com.|Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt. beltagy_mohamed@hotmail.com.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El Beltagy
authors.affiliation: Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.|Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mostafa M E
authors.initials: MM
authors.lastname: Atteya
mesh_terms: D001254:Astrocytoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020546:Fourth Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D005910:Glioma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
keywords: Brain shift; Fourth ventricular tumors; IGSonic; Image guidance; Intraoperative ultrasonography; Neuro-navigation