الفهرس 
EPIDEMIOLOGYOnly 14 pages are availabe for public view
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Abstract
Background
Astrocytomas are the most common primary brain tumors with glioblastoma being the most frequent and most aggressive among them. Surgical resection remains the only surgeon modifiable determinant of outcome in patients harboring astrocytomas. Maximum safe resection has shown to improve outcome by extending survival and relieving tumor pressure. Multiple intraoperative aids have been introduced over the last two decades to help surgeons achieve maximum safe resection. In this study we compared the use of intraoperative ultrasound guidance to conventional surgery. Ultrasonography is a cheaper alternative to intraoperative magnetic resonance imaging and is more suitable for limited resources neurosurgical practice.
Patients and methods
We conducted a cohort study comparing ultrasound guided resection with conventional surgery. We included patients with high and low grade supratentorial astrocytoma that is amenable to gross total resection. The primary outcome was the degree of cytoreduction measured by both a conventional categorical method as well as three-dimensional volumetric analysis. Other outcomes included the postoperative functional status and the rate of operative complications.
Results
There were 17 patients in the ultrasound group and 13 patients in the control group. The extent of resection was significantly better in the ultrasound group with both the conventional categorical method (P=0.01) and the volumetric method (P=0.03). Patients in the ultrasound group had a significantly better postoperative performance score (P=0.01). The general rate of complications was low to draw conclusions. It was not possible to measure survival trends due to high attrition rate.
Discussion
Ultrasound was superior in the control of resection. This was seen through its ability to detect small residual tumor and help its subsequent resection. Intraoperative High-grade and focal low-grade gliomas were both well localized and well defined with ultrasound while this was less clear with diffuse low grade gliomas. Ultrasonography guided resection also appears to be safer than non-image guided surgery, probably due to better localization of the tumor.
Conclusion
We recommend the use of ultrasound in surgical resection of high-grade and focal low-grade gliomas to achieve a higher and safer extent of resection. Further studies are needed to compare ultrasonographic guidance to neuronavigation and intraoperative magnetic resonance imaging.