The Application Of Color Doppler Ultrasonography In The Process Of Microsurgery For Supratentorial Gliomas

ObjectivesGliomas are the most popular tumor in intracranial tumors. About 75% occurred supratentorially, and about 25% occurred under the tentorium. In adults, gliomas often occurred in the telencephalon. The average age was about 30. The tumor grew invasively; there are always no clear board line between the brain and the tumors. The texture was often very hard and the color often gray, about half of them accompanied with cyst formation. The nature of gloom is firstly astrocytoma, secondly glioblastoma,thirdly ependymoma. The main treatment for glioma is operation, post-operation radiotherapy would always be given, with these treatments, the patient could live longer. The recurrence time is about 2.5 years, the average survival time is about 3 years, the 5 years survival rate is about 14-31 percents. The extent of surgical resection is the decisive factor. If the tumor was completely resected and the patient had comprehensive treatment system, he could work in good condition and have a long-term survival. But because there often have no clear broad line between the brain and the tumors, and the tumor grew invasively, the tumor was hard to be resected completely. Neuronavigation could solve this problem better, but it was so expensive that only some big hospital can use it. Some important factors as the stretch of brain tissue in the operation can have impact on the accuracy of navigation easily. The real-time MRI in operation may be accurate ,it can solve the problem of brain shift and get accurate position ,but the operating room should be completely shield from the magnetic field, and the equipments such as surgical instruments, microscope should be special materials magnetic compatible, it will be very expensive. To most hospitals in our country, it is necessary to find one technology .It can get accurate position with little cost. So this research is to evaluate the effect of color Doppler ultrasonography in the process of microsurgery for supratentorial gliomas.MethodsCases of supratentorial gliomas were chosen according to the CT and MRI, conventional craniotomy was performed, the dural was exposed, before resecting the tumor under the microscope, color Doppler ultrasonography was used to locate the right position of tumor epidurally or subdurally and to choose the operation path. When we had resected the tumor completely under microscope, color Doppler ultrasonography was used secondly to evaluate the range of resection. If the tumor was not completely resected, we could do further resection according to color Doppler ultrasonography imaging. Post-operation CT or MRI will be repeated, so we can compare the imaging data and evaluate the effect of the intraoperative ultrosonography.Results:The imaging data of pre- and post-operation showed that tumors were accurately positioned in all 36 cases. 16 cases in this group had total resection under microscope, 12 cases had subtotal resection, and 8 cases had partial resection. Neurological impairment aggravated in 4 cases after the operation, hemiparalysis aggravated and recovered later in 3 cases and motor aphasia aggravated in 1 case in short term, the other cases remained fine.Conclusions1 .The application of intraoperative color Doppler ultrasonography can localize the accurate position of tumor epidurally or subdurally and is helpful in choosing the operation approach. We can observe the range and the extent of resection in real-time. This technology can improve the rate of total tumor resection and decrease the side-effect to the largest extent. For this we can improve the prognosis of patients.2.The technology of intraoperative color Doppler ultrasonography have some advantages such as simple, fast, non-invasive, secure, repeatable, cheap, time saving. It has possible clinical value in the process of microsurgery of supratentorial gliomas.3. The technology of color Doppler ultrasonography can show the intracranial tumors accurately and cheaply, it is suitable for application in grass-roots level hospitals .