Journal Information
Vol. 19. Issue 6.
Pages 530-536 (January 2008)
Share
Share
Download PDF
More article options
Vol. 19. Issue 6.
Pages 530-536 (January 2008)
Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial
Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours
Visits
2161
F. López-Hernández, J.F. Martínez-Lage
Servicios de Neurocirugía, Anestesiología. Hospital Universitario Virgen de la Arrixaca. El Palmar. Murcia
J. Hernández-Palazón*,
, M. Reus-Pintado**, J.I. Garrido-Gómez*
* Servicios de Reanimación. Hospital Universitario Virgen de la Arrixaca. El Palmar. Murcia
** Servicios de Radiología. Hospital Universitario Virgen de la Arrixaca. El Palmar. Murcia
This item has received
Article information
Resumen
Objetivos

El objetivo de este estudio descriptivo es presentar nuestra experiencia clínica durante un año sobre la utilización de la ultrasonografía bidimensional (2-D) en tiempo-real para la exéresis de tumor supratentorial de localización cerebral profunda.

Material y métodos

Durante el año 2006 realizamos craneotomía guiada por ultrasonografía 2-D en pacientes sometidos a cirugía para exéresis de tumor supratentorial, confirmado por anatomía patológica y de localización subcortical. Para la realización de la ultrasonografía se utilizaron los modelos de ultrasonidos M 2410 A ultrasounds HP y Phillips HDI 3500 ATL. Se utilizó en primer lugar un transductor de 3Mhz para localizar estructuras anatómicas, seguido de un transductor de 5MHz para la identificación del tumor cerebral. Se consiguieron cortes en el plano sagital y coronal durante la craneotomía parietal o temporal y en el plano axial y sagital en la craneotomía frontal. Tras la exéresis del tumor, se realizó una nueva ultrasonografía tras irrigar la cavidad con suero salino para la visualización de remanentes tumorales. Se realizó una tomografía computarizada (TC) craneal postoperatoria para verificar la exéresis total del tumor.

Resultados

Se incluyeron en el estudio 30 pacientes de edades comprendidas entre 28 y 82 años. El tiempo requerido para la localización de la lesión fue de 17,5 (±1,9)min. Se realizaron 8 craneotomías temporales, 7 parietooccipitales, 8 parietales, 2 frontoparietales y 5 parietotemporales. La lesión fue localizada a una profundidad media de 5,3 (±1,6)cm. El estudio histológico reveló 17 gliomas de alto grado, 3 gliomas de bajo grado, 8 lesiones metastásicas y 2 oligoastrocitomas. Los gliomas de alto grado mostraron mayor ecogenidad que los gliomas de bajo grado y el edema cerebral. No se detectaron restos del tumor al final de la cirugía, excepto en dos pacientes debido a la proximidad a áreas elocuentes del cerebro. La TC craneal postoperatoria confirmó la exéresis total del tumor en los pacientes incluidos en el estudio.

Conclusiones

La ultrasonografía 2-D en tiempo-real proporciona una imagen de calidad aceptable para la realización de craneotomía guiada para exéresis de tumores supratentoriales, ya que permite su localización de manera fiable y segura, sobre todo de tumores localizados en zonas del cerebro con gran importancia anatómica y funcional, así como identificar restos de tumor una vez finalizada la cirugía.

Palabras clave:
Tumor cerebral
Neurocirugía
Ultrasonidos bidimensional
Cirugía guiada por imagen
Summary
Objectives

With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours.

Material and methods

During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3MHz probe and then a 5MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery.

Results

The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (±1.9)min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (±1.6)cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocitomas, 8 metastatic lesions and 2 oligo-astrocytomas. Highgrade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds.

Conclusions

Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms.

Key words:
Brain tumour
Neurosurgery
Bidimensional ultrasonography
Image-guided surgery
Glioma
Brain metastasis

Article

These are the options to access the full texts of the publication Neurocirugía (English edition)
Member
Member of the Sociedad Española de Neurocirugía

If it is the first time you have accessed you can obtain your credentials by contacting Elsevier Spain in suscripciones@elsevier.com or by calling our Customer Service at902 88 87 40 if you are calling from Spain or at +34 932 418 800 (from 9 to 18h., GMT + 1) if you are calling outside of Spain.

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option ¿I have forgotten my password¿.

Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Neurocirugía (English edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Email
Idiomas
Neurocirugía (English edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?