title: Applications of Ultrasound in the Resection of Brain Tumors.
abstract: Neurosurgery makes use of preoperative imaging to visualize pathology, inform surgical planning, and evaluate the safety of selected approaches. The utility of preoperative imaging for neuronavigation, however, is diminished by the well-characterized phenomenon of brain shift, in which the brain deforms intraoperatively as a result of craniotomy, swelling, gravity, tumor resection, cerebrospinal fluid (CSF) drainage, and many other factors. As such, there is a need for updated intraoperative information that accurately reflects intraoperative conditions. Since 1982, intraoperative ultrasound has allowed neurosurgeons to craft and update operative plans without ionizing radiation exposure or major workflow interruption. Continued evolution of ultrasound technology since its introduction has resulted in superior imaging quality, smaller probes, and more seamless integration with neuronavigation systems. Furthermore, the introduction of related imaging modalities, such as 3-dimensional ultrasound, contrast-enhanced ultrasound, high-frequency ultrasound, and ultrasound elastography, has dramatically expanded the options available to the neurosurgeon intraoperatively. In the context of these advances, we review the current state, potential, and challenges of intraoperative ultrasound for brain tumor resection. We begin by evaluating these ultrasound technologies and their relative advantages and disadvantages. We then review three specific applications of these ultrasound technologies to brain tumor resection: (1) intraoperative navigation, (2) assessment of extent of resection, and (3) brain shift monitoring and compensation. We conclude by identifying opportunities for future directions in the development of ultrasound technologies.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Sastry
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Wenya Linda
authors.initials: WL
authors.lastname: Bi
authors.affiliation: Isomics, Inc, Cambridge, MA.
authors.forename: Steve
authors.initials: S
authors.lastname: Pieper
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Frisken
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Tina
authors.initials: T
authors.lastname: Kapur
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: William
authors.initials: W
authors.lastname: Wells
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.|Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007432:Intraoperative Period; D038361:Neuronavigation / Q000379:methods; D014463:Ultrasonography / Q000009:adverse effects / Q000379:methods*
keywords: Ultrasound; brain shift; brain tumor resection; intraoperative imaging; neurosurgery