Application Of Intraoperative Ultrasound In Resection Of Intracranial Subcortical Space Occupying Lesions

Objective: Intraoperative ultrasound was used to obtain the images of subcortical space-occupying lesions from different views to determine their location and morphological characteristics.The imaging characteristics of i US(Intraoperative ultrasound)were summarized,to evaluate the value of i US in localization and monitoring of subcortical mass resection.Methods: The study included patients with subcortical space-occupying lesions in the Neurosurgery Department of the first affiliated hospital of Dalian Medical University from October 2020 to December 2022.According to the inclusion criteria: 1.Older than 18;2.Complete imaging data were obtained before operation,and enhanced MRI showed subcortical space occupying lesion.2.According to the imaging data,the lesion was located under the cortex,that is,the distance from the cortex to the center of the lesion was greater than the radius of the lesion.4.If the lesion is located in the functional area,intraoperative electrophysiological monitoring.A total of 67 patients with subcortical lesions were collected.All patients were operated and managed by the same treatment group,and were divided into study group and traditional group according to the use of i US.The basic information of the patients,such as the diameter of the lesion,the distance from the cortex to the lesion,and the degree of brain edema,were collected before the operation,the location,the characteristics of ultrasound images,the extent of resection,the amount of blood loss,the time of resection and the degree of postoperative brain edema were collected during the operation.Quantitative data were compared between the two groups using t-test,qualitative data using chi-square test,ordinal categorical variables data were compared using Wilcoxon rank-sum test.Results: There was no significant difference between the two groups(P > 0.05).All the subcortical lesions in the study group could be displayed by ultrasound,the detection rate of ultrasound was 100%,which could locate the lesion,provide the size of the lesion,and the image was clear.The imaging findings of gliomas were correlated with their pathological grades.Most of the low grade gliomas were solid,a few were cystic solid,and were hyperechoic,the edema was small and the blood flow signal was not abundant in the tumor.High-grade gliomas were all solid,heterogeneous and hyperechoic,with irregular shape and indistinct border,obvious edema around the tumor and large area,and abundant blood flow signals in the tumor.Metastatic tumor:the shape is regular and round,the boundary is clear,it is hyperechoic,a few are accompanied by cystic change or necrosis,the echo is more even without cystic change inside,it does not exceed the blood flow signal,the periphery of the tumor has large-scale patchy edema,the echo is slightly lower than the tumor.Cavernous Hemangioma: a round strong echo,internal echo is not uniform,internal blood flow signal is not exceeded,there is no obvious edema around.Lymphoma: the shape is regular and round like hyperechoic,the internal echo is even,the boundary is clear,the periphery of the tumor can be detected edema,not beyond the blood flow signal.The total resection rate was 83.9% in the study group and 61.1% in the traditional group,with a significant difference between the two groups(z =-2.00,p < 0.05).The amount of intraoperative bleeding was(410.81 ± 111.95)ml in the study group and(464.58 ±105.13)ml in the traditional group,with significant difference between the two groups(t = 2.03,p < 0.05).The resection time was(53.39 ± 13.83)min in the study group and(60.69 ± 10.96)min in the traditional group,with a significant difference between the two groups(t = 2.41,p < 0.05).The proportion of I and II degree brain water was80.7% in the study group and 55.5% in the traditional group.There was significant difference between the two groups(z =-2.27,p < 0.05).The length of stay in ICU was(48.32 ± 10.17)h in the study group and(49.75 ± 8.43)h in the traditional group.There was no significant difference between the two groups(t = 0.63,P > 0.05).Conclusion:1.1.The application of i US can clearly display the location,size,boundary and surrounding brain tissue of the space-occupying lesion under the intracranial cortex,improve the resection rate,reduce the amount of blood loss during the operation and shorten the resection time.2.IUS has the characteristics of accuracy,real-time,portability and safety,and has a broad prospect in the application of neurosurgery at all levels of hospitals.