====== Intraoperative Ultrasound for Brain Tumor Surgery ======

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[[Intraoperative ultrasound]] (IOUS) is an increasingly valuable tool in the surgical management of brain tumors. It provides real-time imaging during surgery, enabling neurosurgeons to localize tumors, monitor resection progress, and identify residual tumor tissue with minimal delay.

==== Applications in Brain Tumor Surgery ====
  - **Tumor Localization**:
    * Identifies tumor margins and their relationship to surrounding brain structures.
    * Particularly useful for low-grade gliomas, metastases, and cystic tumors.
  - **Guidance During Resection**:
    * Real-time imaging aids in navigating tumor boundaries, especially in deep-seated or eloquent areas.
    * Facilitates maximal safe resection by distinguishing tumor tissue from normal brain parenchyma.
  - **Assessment of Residual Tumor**:
    * Helps evaluate the extent of resection intraoperatively, reducing the need for postoperative imaging.
  - **Functional Preservation**:
    * In combination with neurophysiological monitoring, IOUS helps avoid damage to critical structures.

==== Advantages ====
  - **Real-Time Feedback**:
    * Provides immediate visualization without interrupting surgical flow.
  - **Cost-Effective**:
    * More affordable than alternatives like intraoperative MRI (iMRI) or CT.
  - **Portable and Versatile**:
    * Compact and easy to use, with minimal setup required.
  - **Enhanced Safety**:
    * Reduces the likelihood of leaving residual tumor tissue, potentially improving patient outcomes.
  - **Adaptability**:
    * Can be used in conjunction with other technologies like neuronavigation and fluorescein imaging.

==== Challenges and Limitations ====
  - **Operator Dependency**:
    * Image acquisition and interpretation require significant experience and training.
  - **Limited Resolution**:
    * IOUS may have difficulty distinguishing between edema, gliosis, and tumor tissue in some cases.
  - **Acoustic Artifacts**:
    * Bone and air can interfere with image quality, necessitating careful positioning and gel application.
  - **Learning Curve**:
    * Surgeons must familiarize themselves with the nuances of IOUS imaging.

==== Techniques for Optimization ====
  - **Contrast-Enhanced Ultrasound (CEUS)**:
    * Improves tumor delineation by enhancing vascular structures.
  - **Integration with Neuronavigation**:
    * Enhances accuracy and correlation with preoperative imaging.
  - **Training and Simulation**:
    * Regular use and simulation training can improve proficiency and interpretation skills.


==== Clinical Evidence ====
Studies have demonstrated that IOUS significantly improves the extent of resection (EOR) in glioma surgeries. For metastatic tumors, IOUS is effective in identifying small residuals and ensuring completeness of resection.

==== Future Directions ====
  - **Advanced Imaging Techniques**:
    * Development of high-frequency probes for better resolution.
    * Integration with 3D reconstruction and artificial intelligence for enhanced interpretation.
  - **Wider Adoption**:
    * As costs decrease and training improves, IOUS may become a standard part of neurosurgical workflows.

Intraoperative ultrasound has revolutionized brain tumor surgery by providing real-time, dynamic imaging. With ongoing advancements in technology and training, its utility and accuracy are likely to continue improving, benefiting patient outcomes worldwide.

===== Intraoperative ultrasound in intracranial meningioma =====

[[Intraoperative ultrasound in intracranial meningioma]]

===== Intraoperative ultrasound in glioma surgery =====

[[Intraoperative ultrasound in glioma surgery]].

===== BraTioUS =====

[[BraTioUS]]