title: Neurosurgical tools to extend tumor resection in hemispheric low-grade gliomas: conventional and contrast enhanced ultrasonography.
abstract: OBJECTIVE
  Pediatric low-grade gliomas (LGGs) are the most frequent solid tumor in childhood. Based on an increasing number of literature reports, maximal safe resection is recommended as the first line of treatment whenever possible. However, distinguishing tumor tissue from the surrounding normal brain is often challenging with infiltrating neoplasms, even with the assistance of intraoperative, microscopic and conventional neuronavigation systems. Therefore, any technique that enhances the detection and visualization of LGGs intraoperatively is certainly desirable.
  
  
  METHODS
  In this paper, we reviewed the role of intraoperative conventional ultrasound and contrast-enhanced ultrasound (CEUS) as a tool for extending tumor resection in LGGs. Moreover, our experience with this technology is reported and discussed.
  
  
  RESULTS
  Both B-mode and CEUS are helpful in highlighting LGGs, detecting tumor margins and providing additional information such as vascularization, thus improving the safety of a more radical resection.
  
  
  CONCLUSIONS
  Although the full potentialities of the method are yet to be explored, intraoperative ultrasound is a promising tool in oncologic surgery and LGG surgery.
authors.affiliation: Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy. luca.mattei@fastwebnet.it.
authors.forename: Luca
authors.identifier: http://orcid.org/0000-0002-7330-502X
authors.initials: L
authors.lastname: Mattei
authors.affiliation: Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.affiliation: Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.
authors.forename: Federico Giuseppe
authors.initials: FG
authors.lastname: Legnani
authors.affiliation: Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perin
authors.affiliation: Istituto di Neurochirurgia, Fondazione Policlinico Universitario "A. Gemelli" Università Cattolica e del Sacro Cuore, Largo A. Gemelli 8, 00186, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.affiliation: Neurochirurgia I, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Giovanni Celoria 11, 20133, Milan, Italy.|Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, 21218, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D005910:Glioma / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: CEUS; Low-grade glioma; Pediatric brain tumor; Ultrasound; Ultrasound contrast-agent