title: Real-Time Ultrasound-Guided Catheter Navigation for Approaching Deep-Seated Brain Lesions: Role of Intraoperative Neurosonography with and without Fusion with Magnetic Resonance Imaging.
abstract: OBJECTIVE
  Brain shift during the exposure of cranial lesions may reduce the accuracy of frameless stereotaxy. We describe a rapid, safe, and effective method to approach deep-seated brain lesions using real-time intraoperative ultrasound placement of a catheter to mark the dissection trajectory to the lesion.
  
  
  METHODS
  With Institutional Review Board approval, we retrospectively reviewed the radiographic, pathologic, and intraoperative data of 11 pediatric patients who underwent excision of 12 lesions by means of this technique.
  
  
  RESULTS
  Full data sets were available for 12 lesions in 11 patients. Ten lesions were tumors and 2 were cavernous malformations. Lesion locations included the thalamus (n = 4), trigone (n = 3), mesial temporal lobe (n = 3), and deep white matter (n = 2). Catheter placement was successful in all patients, and the median time required for the procedure was 3 min (range 2-5 min). There were no complications related to catheter placement. The median diameter of surgical corridors on postresection magnetic resonance imaging was 6.6 mm (range 3.0-12.1 mm).
  
  
  CONCLUSIONS
  Use of real-time ultrasound guidance to place a catheter to aid in the dissection to reach a deep-seated brain lesion provides advantages complementary to existing techniques, such as frameless stereotaxy. The catheter insertion technique described here provides a quick, accurate, and safe method for reaching deep-seated lesions.
authors.affiliation: Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.forename: Aditya
authors.initials: A
authors.lastname: Karhade
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D038361:Neuronavigation; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D055815:Young Adult