Usefulness of ultrasound-guided microsurgery in cavernous angiomas removal.

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Usefulness of ultrasound-guided microsurgery in cavernous angiomas removal.

World Neurosurg. 2018 May 08;:

Authors: Barzaghi LR, Capitanio JF, Giudice L, Panni P, Acerno S, Mortini P

Abstract
OBJECT: Primary steps in the cavernous angiomas (CAs) surgery are a precise lesion identification and an optimal trajectory definition. Doing so, navigation techniques allow better results compared to microsurgery alone. In this paper we define the benefits of Intra-Operative Ultra-Sound (IOUS) use in addition to standard localization systems.
METHODS: We retrospectively analyzed 59 CAs comparing two groups: 34 cases of frame-based and frameless navigation-assisted microsurgery (no-IOUS group) versus 25 cases of IOUS-guided microsurgery associated with these techniques (IOUS group).
RESULTS: IOUS did not increase the surgery time (172 ± 1.7 minutes in IOUS group and 192.6 ± 11.5 in no-IOUS group; p = 0.08). In all 25 cases IOUS allowed an easy identification of CA as a hyper-echoic mass. At the last follow-up (mean 41.7 ± 3.5 months), the modified Rankin Scale was 0-1 and the Extended Glasgow Outcome Scale 7-8 in 95.2% of IOUS group and in 80.8% of no-IOUS (p = 0.2), whereas the frequency of patients included in Engel's Outcome Scale class IA was 100% and 64%, respectively (p = 0.006). Complete removal, confirmed on postoperative MRI, was achieved in all cases of IOUS-guided group and in almost all (97.1%, p = 0.4) patients of no-IOUS group.
CONCLUSIONS: IOUS is a valid tool for the intraoperative identification of CAs. Implementation of standard localization methods with IOUS was associated with complete resection in all cases, without increasing surgical time. The long-term functional outcomes showed a better trend and the epilepsy free rate was significantly higher compared with no-IOUS-guided microsurgery.

PMID: 29751184 [PubMed - as supplied by publisher]

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