General-Purpose B-Mode Intraoperative Ultrasonography in Perirolandic Brain Metastasis Surgery: Practical Value and Limitations

Résumé fourni par la source

Background/Objectives: Perirolandic brain metastases are challenging to resect because small deviations from the surgical corridor may cause sensorimotor deficits. This study evaluated the stage-specific value and limitations of general-purpose, non-navigated B-mode intraoperative ultrasonography (iUS) with MRI-based frameless neuronavigation in a consecutive surgical cohort of perirolandic metastases. Methods: In this single-center, single-surgeon retrospective case series, 15 consecutive adults underwent microsurgical resection of perirolandic brain metastases using MRI-based frameless neuronavigation and a general-purpose B-mode ultrasound system, without functional mapping or neurophysiological monitoring. Extent of resection was assessed on contrast-enhanced MRI obtained 24 to 36 h after surgery, and post-resection cavity iUS findings were compared descriptively with early postoperative MRI. Results: Gross-total resection was achieved in 13 patients (86.7%). iUS modified intraoperative targeting in 6 of 15 patients: the entry point was repositioned after findings consistent with intraoperative brain shift in 4, and the lesion was localized in interhemispheric corridors in 2. Post-resection iUS suspected residual tissue in 7 of 14 patients, but only 1 corresponded to residual tumor on MRI; a thin remnant on the motor cortex was not identified as suspicious for residual tumor on iUS. A new or worsened motor deficit occurred in 2 patients (13.3%); at follow-up, this was persistent at 20 months in 1 and partially improved in the other. No patient required reoperation, and there was no 30-day mortality. Conclusions: General-purpose B-mode iUS aided exposure confirmation and trajectory refinement but had limited value for excluding thin residual tumor. When functional mapping or neurophysiological monitoring is unavailable, it may provide accessible real-time anatomical guidance; however, because it lacks functional information, it should not be considered an alternative to these functional adjuncts.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.