title: Usefulness of three-dimensional navigable intraoperative ultrasound in resection of brain tumors with a special emphasis on malignant gliomas.
abstract: BACKGROUND
  Intraoperative imaging is increasingly being used in resection of brain tumors. Navigable three-dimensional (3D)-ultrasound is a novel tool for planning and guiding such resections. We review our experience with this system and analyze our initial results, especially with respect to malignant gliomas.
  
  
  METHODS
  A prospective database for all patients undergoing sononavigation-guided surgery at our center since this surgery's introduction in June 2011 was queried to retrieve clinical data and technical parameters. Imaging was reviewed to categorize tumors based on enhancement and resectability. Extent of resection was also assessed.
  
  
  RESULTS
  Ninety cases were operated and included in this analysis, 75 % being gliomas. The 3D ultrasound mode was used in 87 % cases (alone in 40, and combined in 38 cases). Use of combined mode function [ultrasound (US) with magnetic resonance (MR) images] facilitated orientation of anatomical data. Intraoperative power Doppler angiography was used in one-third of the cases, and was extremely beneficial in delineating the vascular anatomy in real-time. Mean duration of surgery was 4.4 hours. Image resolution was good or moderate in about 88 % cases. The use of the intraoperative imaging prompted further resection in 59 % cases. In the malignant gliomas (51 cases), gross-total resection was achieved in 47 % cases, increasing to 88 % in the "resectable" subgroup.
  
  
  CONCLUSIONS
  Navigable 3D US is a versatile, useful and reliable intraoperative imaging tool in resection of brain tumors, especially in resource-constrained settings where Intraoperative MR (IOMR) is not available. It has multiple functionalities that can be tailored to suit the procedure and the experience of the surgeon.
authors.affiliation: Division of Neurosurgery, PS 245, ACTREC and TMH, Tata Memorial Centre, Kharghar, Navi Mumbai, 410210, India, aliasgar.moiyadi@gmail.com.
authors.forename: Aliasgar V
authors.initials: AV
authors.lastname: Moiyadi
authors.forename: Prakash M
authors.initials: PM
authors.lastname: Shetty
authors.forename: Abhishek
authors.initials: A
authors.lastname: Mahajan
authors.forename: Amar
authors.initials: A
authors.lastname: Udare
authors.forename: Epari
authors.initials: E
authors.lastname: Sridhar
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D014463:Ultrasonography