The Application Of Intraoperative Ultrasound In Supratentorial Glioma Resection

Objective: gliomas are the most common primary tumor diseases in the central nervous system,which belong to the category of malignant tumors.The World Health Organization(WHO)divides it into four grades(I-IV),of which grade I-II is low-grade glioma(LGG),and grade III-IV is high-grade glioma(HGG).Because glioma has the characteristics of malignant tumor,and it is easy to cause neurological injury or even life-threatening adverse consequences,which brings heavy pressure and burden to society and individuals.At present,there are more and more basic and clinical researches on gliomas,but the specific pathogenesis is still unclear,which makes the radical treatment of the disease faced with great difficulties and challenges.Therefore,the global treatment methods for gliomas are based on surgical resection,assisted by radiation,chemicals and targeted treatment,and other comprehensive treatment strategies,including surgical objectives Including biopsy or resection of tumor tissue to achieve a clear diagnosis and improve patients' symptoms and prognosis.More and more studies show that the resection range of gliomas is significantly related to the survival time and prognosis of patients.Although the extended resection of tumor may bring better prognosis for patients,too much resection may also cause or aggravate the nerve function defect of patients and cause limb paralysis,long-term plant survival status and even death.Therefore,how to achieve the visualization of tumor in operation to achieve the maximum range of safe tumor resection is a huge problem in neurosurgery.Now a variety of imaging techniques have been applied to assist surgeons in tumor location,boundary determination,functional area protection and residual tumor identification,and achieved satisfactory results.Therefore,the study of intraoperative imaging techniques to improve the visual dilemma of intraoperative tumors and achieve the maximum safe resection of gliomas is of great significance.Among them,intraoperative ultrasound(IOUS)is a popular intraoperative imaging assistant technology,which has the advantages of real-time,noninvasive,repeatable,low cost and easy operation.It can judge the residual tumor tissue which can not be found under the microscope,and provide real-time operation guidance and more accurate residual tumor judgment for the operator.Therefore,we attempted to analyze the value of intraoperative ultrasound in guiding the resection of glioma;To explore the diagnostic sensitivity,specificity and predictive value of intraoperative ultrasound versus early postoperative MRI for residual tumors,as well as the factors associated with complete resection of glioma.Methods: a prospective cohort study was conducted to collect the clinical data of 55 patients who underwent supratentorial brain parenchymal tumor surgery in neurosurgery department of our hospital from November 2018 to December2019.After admission,they were randomly divided into two groups.One group was operated on the basis of traditional microsurgical methods supplemented by intraoperative ultrasound,while the other group was operated on the basis of traditional microsurgical methods.The two groups of patients decided whether to use intraoperative navigation assistance according to whether the tumor was located in the functional area,while other intraoperative fluorescence and brain function monitoring devices were not used.The general data,preoperative and postoperative MRI results,preoperative and postoperative KPS scores,intraoperative ultrasound use and tumor resection range of patients in the two groups were statistically analyzed.Results: after statistical analysis of the data collected above,we found that:(1)the total cutting rate of the ultrasound group was higher than that of the control group;(2)the residual tumor volume in the ultrasound group was smaller than that in the control group and the difference was statistically significant(P <0.05).(3)there was no significant difference in preoperative and postoperative KPS scores between the two groups showing no statistical significance(P >0.05).(4)intraoperative ultrasound showed a diagnostic sensitivity of 0.50,specificity of 0.857,negative predictive value of 0.571,and positive predictive value of 0.818 for residual tumor.(5)The tumor size and whether it is located in the functional area is a significant predictor of the total resection rate of glioma.Conclusions: intraoperative ultrasound is superior to traditional microsurgery in the sensitivity and specificity of residual tumors,which can significantly reduce the volume of residual tumors and improve the total resection rate of gliomas;intraoperative ultrasound does not increase the risk of neurological damage,which is conducive to safe extended resection;intraoperative ultrasound is not a significant predictor of tumor total resection,tumor volume Size and location of functional area are the only predictors of total resection.