title: A simple, safe and effective surface marking and targeting method combined with intraoperative ultrasonography for small subcortical intracranial lesions.
abstract: BACKGROUND
  Accurately locating small subcortical brain lesions is very important for maximal surgical resection with minimal neurological damage. Intraoperative MRI has proved to be more precise than ultrasound, it is relatively expensive and is not available in all centers. Herein we describe a new, simple, safe and effective method for determining a small skin incision and craniotomy via skin staples combined with intraoperative ultrasonography to determine the margins, vascularity and residue of the lesion.
  
  
  METHODS
  Thirty-three patients with small subcortical lesions were admitted into the study. The maximum diameter of the lesions ranged between 18 and 30 mm. The depth of the lesion was described as the distance between the cortical surface and most outer point of the lesion. The mean of the depth of the lesions was 10.56 mm ranging between 3.3 and 18.7 mm. Multiple skin staples were used as irremovable skin markers. Before and after dural incision, ultrasound was used to assess the lesion size and location, its relationship with the surrounding tissue and the Doppler function to reveal the blood supply to the lesion.
  
  
  RESULTS
  In this study mean craniotomy diameter was 44 mm ranging between 32-55 mm. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation.
  
  
  CONCLUSIONS
  We describe a simple, safe and effective method for determining a small skin incision and craniotomy combined with intraoperative ultrasound for small subcortical intracranial lesions for health center that does not have intraoperative MRI and navigation systems.
authors.affiliation: Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey - atillakazanci@gmail.com.
authors.forename: Atilla
authors.initials: A
authors.lastname: Kazanci
authors.affiliation: Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Gurcan
authors.affiliation: Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gurcay
authors.affiliation: Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Bozkurt
authors.affiliation: Department of Radiology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Algin
authors.affiliation: Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Turkoglu
authors.affiliation: Department of Neurosurgery, School of Medicine, Yildirim Beyazit University, Ankara, Turkey.
authors.forename: Murad
authors.initials: M
authors.lastname: Bavbek
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D059906:Neuroimaging / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*