State of Mexico and Municipalities

Estado de México, México

State of Mexico and Municipalities

Estado de México, México

dr.martinezanda@gmail.com

https://orcid.org/0009-0007-6892-2983

Neurosurgery Service

Arturo Montiel Rojas Medical Center

Social Security Institute

State of Mexico and Municipalities

davidberrio-@hotmail.com

https://orcid.org/0000-0002-8178-0955

Neurosurgery Service

Arturo Montiel Rojas Medical Center

Social Security Institute

State of Mexico and Municipalities

hsvtorres@gmail.com

https://orcid.org/0009-0008-7374-7259

Background: preoperative MRI data has been the gold standard for the diagnosis and therapy of

malignant gliomas for decades, and operative ultrasonography for the management of patients with

neurological pathologies that require surgical treatment has been also used for many years as it provides

additional image guidance for surgical procedure to neuronavigation techniques. The main objective of

IV astrocytoma. Operative USG + NNV was used in 17 patients and a subtotal or total resection was

achieved in 75% of the patients, with a significantly lower postoperative volumetry in patients operated

on by NNV + USG (5.6mm3 + 2.5), compared to NNV alone (8mm3 + 2.8) However, these results did

not affect tumor-free time, which was comparable between both groups. Conclusions: Surgical

treatment of brain gliomas with USG + NNV has a good degree of tumor resection compared to those

treated with NNV only, but the main factor affecting survival is the hystophatological grade of the

tumor.

Keywords: brain glioma, operative image, ultrasound

Antecedentes: los datos preoperatorios de resonancia magnética han sido el patrón oro para el

diagnóstico y tratamiento de los gliomas malignos durante décadas, y la ultrasonografía operatoria para

utilizado durante muchos años, ya que proporciona una guía de imagen para el procedimiento quirúrgico

adicional a las técnicas de neuronavegación. El objetivo principal de este estudio es averiguar si el uso

de la ultrasonografía operatoria en la cirugía del glioma puede aportar un mayor beneficio en la

resección total de los gliomas cerebrales y cómo influye la mejora del grado de resección neoplásica en

significativamente menor en los pacientes intervenidos mediante NNV + USG (5,6mm3 + 2,5), en

comparación con la NNV sola (8mm3 + 2,8) Sin embargo, estos resultados no afectaron al tiempo libre

de tumor, que fue comparable entre ambos grupos. Conclusiones: El tratamiento quirúrgico de los

gliomas cerebrales con USG + NNV tiene un buen grado de resección tumoral en comparación con los

tratados sólo con NNV, pero el principal factor que afecta a la supervivencia es el grado histofatológico

del tumor.

Palabras clave: glioma cerebral, imagen operatoria, ecografía

for decades, and intraoperative MRI-guided neurosurgery navigation is limited by its complex

patients with neurological pathologies that require surgical treatment has been also used for many years;

One of them is the bone covering that the brain has, formed by the cranial vault, so that this makes free

access to brain exploration with ultrasound difficult. Another important point that limits ultrasound is

the sensitivity of the brain to pressure; however, this sensitivity to pressure can be easily controlled by

In the last decade, the advance in image processing and improvements in image quality have taken

ultrasonography to another level; nowadays, it can be used for surgical navigation of deep brain lesions,

Rojas Medical Center, of patients with a histopathological diagnosis of cerebral glioma treated by the

neurosurgery service in the period between January 2018 and December 2020. The present study was

approved by the ethics and research committee of the institution (UEeIM 144/22) and to perform the

procedure, informed consent specially designed for this study, was signed by the patients, or the

relatives of the patients.

Surgical cases were selected from a series of patients with neoplastic lesions and a pathological

diagnosis of gliomas. Radiological and operative clinical information was collected. As well as

histopathological results, postoperative complications and follow-up data from the hospital information

system. The inclusion criteria were the following: 1) patients > 18 years of age with a histopathological

with coordinated sequence induction for patient airway management. Neuronavigation (Brand:

Medtronic; Model: Stealthstation S8; Manufacture: United States) and intraoperative ultrasound

(Brand: Sonosite; Model: M – turbo; Manufacture: United States) were used for the procedure in a

conventional manner. In the patients were transoperative USG was used, the transducer was placed

epidurally centered on the lesion with the support of vascular USG Doppler, and the presence of

“bright” hyperechogenic borders delimited by ultrasound in contrast to brain tissue was defined as a

tumor. “healthy”, defined as the “dark” halo, moderately hyperechogenic and hypoechogenic (Figures

1 and 2). In addition, the anatomical relationships observed in the preoperative imaging study, such as

the ventricles, when they are hypoechoic in relation to the brain parenchyma or the tumor capsule, both

showing greater echogenicity. The use of vascular USG Doppler was used to determine tumor and

with a preoperative volumetry of 32.7cm3 (+ 9.2) vs. postoperative volumetry of 6.7cm3 (+ 2.8)

respectively, with a statistically significant difference (p= <0.0001). All patients received Fractionated

Stereotactic Radiosurgery (FSRT) with linear accelerator (LINAC, Brand: Elekta; Model: Sinergy;

Manufactured: United States), with an average dose of 43.8Gy (+ 14.7) and Temozolamide as

postoperative chemotherapy treatment (Table 1).

Post-operative complications occurred in 12.5% of the patients: 2 with neurological deficit, 1

hemorrhage, 1 with CSF (cerebrospinal fluid) fistula. There was a surgical mortality of 3.1% (1 patient).

The post-operative Karnofsky was 79.3, with 28.2% of the patients with a value >90, with a statistically

significant difference with respect to the preoperative state (p=0.003, (table 1). According to the WHO

in patients operated on by NNV + USG (5.6mm3 + 2.5), compared to NNV alone (8mm3 + 2.8) (Figure

4B). This result went hand by hand with a statistically significant higher degree of resection in patients

operated with NNV + USG as an auxiliary compared to patients operated with NNV alone (Figure 4C).

However, these results did not affect tumor-free time, which was comparable between both groups

(USG + NNV = 27.2 months vs. NNV alone = 22.4 months, p= 0.8) (Figure 4D). It also did not influence

final survival (USG = 23.5 months vs. 32.3 months, p= 0.22) (Figure 4E). Final mortality was also not

influenced by the surgical results with both auxiliaries (USG + NNV = 70.5% vs. NNV alone = 50%,

p= 0.1) (Figure 4F), the main factor influencing final survival and mortality being the degree of the

resected lesion.

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