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Image-guided ultrasonography for recurrent cystic gliomas

  • Clinical Article
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Summary

Background. Long-term survival of patients with recurrent gliomas depends on the extent of resection. Thus, the desirability of an intra-operative imaging modality that can augment the resection extension without affecting vital surrounding structures is more than obvious. It was the aim of the present study to evaluate a possible benefit of image-guided intra-operative ultrasonography for the surgery of recurrent gliomas.

Method. The authors performed ultrasonography-assisted image-guided resection of recurrent gliomas in 16 patients. An ultrasound device (IGSonic) was integrated into the VectorVision2 navigation system (BrainLAB, Heimstetten, Germany). The IGSonic Probe 10V5 was connected to the VectorVision Navigation station via an IGSonic Device Box. Following patient registration, MRI based neuronavigation was used to determine the skin incision and the bone flap. Before opening the dura, the underlying structures were explored by ultrasound combined with the corresponding MR images. The navigated ultrasound displayed the sonographic image of the intracranial anatomy on the navigation screen in a composed overlay fashion.

Findings. The integration of intra-operative ultrasound into neuronavigation system offered quick and helpful intra-operative images in all 16 procedures. Due to the specific ultrasonic characteristics of the solid and the cystic parts, our technique created highly useful images in 10 patients with cystic recurrences. In these, user friendly images were obtained that were easy to understand even for neurosurgeons without major experience in intra-operative ultrasound.

Conclusions. Neurosonography is a time- and cost-effective technology offering intra-operative imaging. The improved orientation and visualization of tumour remnants, adjacent ventricles, and the enhanced intra- and peri-tumoural vasculature is one of the main advantages of ultrasonography-assisted image-guided surgery, which is most obvious during surgery for cystic gliomas.

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References

  • B Albayrak AF Samdani PM Black (2004) ArticleTitleIntra-operative magnetic resonance imaging in neurosurgery Acta Neurochir (Wien) 146 543–557 Occurrence Handle1:STN:280:DC%2BD2c3mslSlsw%3D%3D Occurrence Handle10.1007/s00701-004-0229-0

    Article  CAS  Google Scholar 

  • LM Auer V van Velthoven (1990) ArticleTitleIntra-operative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT Acta Neurochir (Wien) 104 84–95 Occurrence Handle1:STN:280:DyaK3M%2FmvVKhsA%3D%3D Occurrence Handle10.1007/BF01842825

    Article  CAS  Google Scholar 

  • G Barnett (1999) ArticleTitleThe role of image-guided technology in the surgical planning and resection of gliomas J Neurooncol 42 247–258 Occurrence Handle10433108 Occurrence Handle1:STN:280:DyaK1MzmtVCqsg%3D%3D Occurrence Handle10.1023/A:1006138609201

    Article  PubMed  CAS  Google Scholar 

  • RL Bernays (2003) ArticleTitleIntra-operative imaging in neurosurgery. MRI, CT, ultrasound. Introduction Acta Neurochir [Suppl] 85 1–3 Occurrence Handle1:STN:280:DC%2BD3s%2FlvFOrtA%3D%3D

    CAS  Google Scholar 

  • H Bertalanffy L Benes T Miyazawa O Alberti AM Siegel U Sure (2002) ArticleTitleCerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients Neurosurg Rev 25 1–53 Occurrence Handle11954761 Occurrence Handle10.1007/s101430100179

    Article  PubMed  Google Scholar 

  • MM Bonsanto A Staubert CR Wirtz V Tronnier S Kunze (2001) ArticleTitleInitial experience with an ultrasound-integrated single-rack neuronavigation system Acta Neurochir (Wien) 143 1127–1132 Occurrence Handle1:STN:280:DC%2BD3MnosVelsQ%3D%3D Occurrence Handle10.1007/s007010100003

    Article  CAS  Google Scholar 

  • G Broggi P Ferroli A Franzini I Dones C Marras M Marchetti E Maccagnano (2003) ArticleTitleCT-guided neurosurgery: preliminary experience Acta Neurochir [Suppl] 85 101–104 Occurrence Handle1:STN:280:DC%2BD3s%2FlvFOquw%3D%3D

    CAS  Google Scholar 

  • R Buchholz C Sturm J Henderson (1996) ArticleTitleDetection of brain shift with an image guided ultrasound device Acta Neurochir (Wien) 138 627

    Google Scholar 

  • VA Coenen T Krings L Mayfrank RS Polin MHT Reinges A Thron JM Gilsbach (2001) ArticleTitleThree-dimensional visualization of the pyramidal tract in a neuronavigation system during brain tumor surgery: First experiences and technical note Neurosurgery 49 86–93 Occurrence Handle11440464 Occurrence Handle1:STN:280:DC%2BD3MzosFymtw%3D%3D Occurrence Handle10.1097/00006123-200107000-00013

    Article  PubMed  CAS  Google Scholar 

  • RM Comeau AF Sadikot A Fenster TM Peters (2000) ArticleTitleIntra-operative ultrasound for guidance and tissue shift correction in image-guided neurosurgery Med Phys 27 787–800 Occurrence Handle10798702 Occurrence Handle1:STN:280:DC%2BD3c3ls1Glsg%3D%3D Occurrence Handle10.1118/1.598942

    Article  PubMed  CAS  Google Scholar 

  • NL Dorward O Alberti B Velani FA Gerritsen WFJ Harkness ND Kitchen DGT Thomas (1998) ArticleTitlePostimaging brain distortion: magnitude, correlates, and impact on neuronavigation J Neurosurg 88 656–662 Occurrence Handle9525711 Occurrence Handle1:STN:280:DyaK1c7osVKhtg%3D%3D

    PubMed  CAS  Google Scholar 

  • NL Dorward O Alberti JD Palmer ND Kitchen DGT Thomas (1999) ArticleTitleAccuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note J Neurosurg 90 160–168 Occurrence Handle10413173 Occurrence Handle1:STN:280:DyaK1MzjvFGiug%3D%3D

    PubMed  CAS  Google Scholar 

  • JG Golfinos BC Fitzpatrick LR Smith RF Spetzler (1995) ArticleTitleClinical use of a frameless stereotactic arm: results of 325 cases J Neurosurg 83 197–205 Occurrence Handle7616261 Occurrence Handle1:STN:280:DyaK2MzktFensg%3D%3D

    PubMed  CAS  Google Scholar 

  • A Gronningsaeter A Kleven S Ommedal TE Aarseth T Lie F Lindseth T Lango G Unsgard (2000) ArticleTitleSonoWand, an ultrasound-based neuronavigation system Neurosurgery 47 1373–1380 Occurrence Handle11126908 Occurrence Handle1:STN:280:DC%2BD3M7gtl2ntw%3D%3D Occurrence Handle10.1097/00006123-200012000-00021

    Article  PubMed  CAS  Google Scholar 

  • HK Gumprecht DC Widenka CB Lumenta (1999) ArticleTitleBrainLab VectorVision neuronavigation system: technology and clinical experience in 131 cases Neurosurgery 44 97–105 Occurrence Handle9894969 Occurrence Handle1:STN:280:DyaK1M7htValsg%3D%3D Occurrence Handle10.1097/00006123-199901000-00056

    Article  PubMed  CAS  Google Scholar 

  • M Hadani R Spiegelman Z Feldman H Berkenstadt Z Ram (2001) ArticleTitleNovel, compact, intra-operative magnetic resonance imaging guided system for conventional neurosurgical operating rooms Neurosurgery 48 799–809 Occurrence Handle11322440 Occurrence Handle1:STN:280:DC%2BD3M3ivFSjtw%3D%3D Occurrence Handle10.1097/00006123-200104000-00021

    Article  PubMed  CAS  Google Scholar 

  • MA Hammoud BL Ligon R elSouki et al. (1996) ArticleTitleUse of intra-operative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging J Neurosurg 84 737–741 Occurrence Handle8622145 Occurrence Handle1:STN:280:DyaK287pvVyqtA%3D%3D Occurrence Handle10.3171/jns.1996.84.5.0737

    Article  PubMed  CAS  Google Scholar 

  • N Hata T Dohi H Iseki K Takakura (1997) ArticleTitleDevelopment of a frameless and armless stereotactic neuronavigation system with ultrasonographic registration Neurosurgery 41 608–614 Occurrence Handle9310978 Occurrence Handle1:STN:280:DyaK2svlslSgtw%3D%3D Occurrence Handle10.1097/00006123-199709000-00020

    Article  PubMed  CAS  Google Scholar 

  • N Hata A Nabavi WM Wells SuffixIII SK Warfield R Kikinis PM Black FA Jolesz (2000) ArticleTitleThree-dimensional optical flow method for measurement of volumetric brain deformation from intra-operative MR images. Technical note J Comput Assist Tomogr 24 531–538 Occurrence Handle10966182 Occurrence Handle1:STN:280:DC%2BD3cvivVKgsg%3D%3D Occurrence Handle10.1097/00004728-200007000-00004

    Article  PubMed  CAS  Google Scholar 

  • DLG Hill CR Maurer SuffixJr RJ Maciunas JA Barwise JM Fitzpatrick MY Wang (1998) ArticleTitleMeasurement of intra-operative brain surface deformation under a craniotomy Neurosurgery 43 514–528 Occurrence Handle9733307 Occurrence Handle1:STN:280:DyaK1cvgt1WnsQ%3D%3D Occurrence Handle10.1097/00006123-199809000-00066

    Article  PubMed  CAS  Google Scholar 

  • A Jödicke W Deinsberger H Erbe A Kriete D-K Böker (1998) ArticleTitleIntra-operative three-dimensional ultrasonography: An approach to register brain shift using multidimensional image processing Minim Invas Neurosurg 41 13–19

    Google Scholar 

  • A Jödicke T Springer D-K Böker (2004) ArticleTitleReal-time integration of ultrasound into neuronavigation: technical accuracy using a light-emitting-diode-based navigation system Acta Neurochir (Wien) 146 1211–1220 Occurrence Handle10.1007/s00701-004-0352-y

    Article  Google Scholar 

  • H Kanno Y Ozawa K Sakata H Sato Y Tanabe N Shimizu (2005) ArticleTitleIntra-operative power Doppler ultrasonography with a contrast enhancing agent for intracranial tumors J Neurosurg 102 295–301 Occurrence Handle15739558

    PubMed  Google Scholar 

  • M Kaus R Steinmeier T Sporer O Ganslandt R Fahlbusch (1997) ArticleTitleTechnical accuracy of a neuronavigation system measured with a high-precision mechanical micromanipulator Neurosurgery 41 1431–1437 Occurrence Handle9402599 Occurrence Handle1:STN:280:DyaK1c%2Fms1aiuw%3D%3D Occurrence Handle10.1097/00006123-199712000-00046

    Article  PubMed  CAS  Google Scholar 

  • J Koivukangas Y Louhisalmi J Alakuijala J Oikarinen (1993) ArticleTitleUltrasound-controlled neuronavigator-guided brain surgery J Neurosurg 79 36–42 Occurrence Handle8315467 Occurrence Handle1:STN:280:DyaK3szgtFOjuw%3D%3D

    PubMed  CAS  Google Scholar 

  • T Koyama H Okudera S Kobayashi (1999) ArticleTitleComputer-generated surgical simulation of morphological changes in microstructures: concepts of “virtual retractor”. Technical note J Neurosurg 90 780–785 Occurrence Handle10193627 Occurrence Handle1:STN:280:DyaK1M3gsl2ksg%3D%3D

    PubMed  CAS  Google Scholar 

  • F Lindseth T Lango J Bang TA Nagelhus Hernes (2002) ArticleTitleAccuracy evaluation of a 3D ultrasound-based neuronavigation system Comput Aided Surg 7 197–222 Occurrence Handle12454892 Occurrence Handle10.1002/igs.10046

    Article  PubMed  Google Scholar 

  • MI Miga KD Paulsen JM Lemery SD Eisner A Hartov FE Kennedy DW Roberts (1999) ArticleTitleModel-updated image guidance: initial clinical experiences with gravity-induced brain deformation IEEE Trans Med Imaging 18 866–874 Occurrence Handle10628946 Occurrence Handle1:STN:280:DC%2BD3c%2Fpt1Glug%3D%3D Occurrence Handle10.1109/42.811265

    Article  PubMed  CAS  Google Scholar 

  • MI Miga DW Roberts FE Kennedy LA Platenik A Hartov KE Lunn KD Paulsen (2001) ArticleTitleModeling of retraction and resection for intra-operative updating of images Neurosurgery 49 75–85 Occurrence Handle11440463 Occurrence Handle1:STN:280:DC%2BD3MzosFymtg%3D%3D Occurrence Handle10.1097/00006123-200107000-00012

    Article  PubMed  CAS  Google Scholar 

  • A Nabavi PMcL Black DT Gering C-F Westin V Mehta RS Pergolizzi SuffixJr M Ferrant SK Warfield N Hata RB Schwartz WM Wells SuffixIII R Kikinis FA Jolesz (2001) ArticleTitleSerial intra-operative magnetic resonance imaging of brain shift Neurosurgery 48 787–798 Occurrence Handle11322439 Occurrence Handle1:STN:280:DC%2BD3M3ivFSjtg%3D%3D Occurrence Handle10.1097/00006123-200104000-00019

    Article  PubMed  CAS  Google Scholar 

  • Nikas DC, Hartov A, Lunn K, Rick K, Paulsen K, Roberts DW (2003) Coregistered intra-operative ultrasonography in resection of malignant glioma. Neurosurg Focus 14(2): Article 6

  • C Nimsky O Ganslandt S Cerny P Hastreiter G Greiner R Fahlbusch (2000) ArticleTitleQuantification of, visualization of, and compensation for brain shift using intra-operative magnetic resonance imaging Neurosurgery 47 1070–1080 Occurrence Handle11063099 Occurrence Handle1:STN:280:DC%2BD3crgvFOmsw%3D%3D Occurrence Handle10.1097/00006123-200011000-00008

    Article  PubMed  CAS  Google Scholar 

  • C Nimsky O Ganslandt H Kober M Buchfelder R Fahlbusch (2001) ArticleTitleIntra-operative magnetic resonance imaging combined with neuronavigation: a new concept Neurosurgery 48 1082–1091 Occurrence Handle11334275 Occurrence Handle1:STN:280:DC%2BD3M3jvVequg%3D%3D Occurrence Handle10.1097/00006123-200105000-00023

    Article  PubMed  CAS  Google Scholar 

  • KD Paulsen MI Miga FE Kennedy PJ Hoopes A Hartov DW Roberts (1999) ArticleTitleA computational model for tracking subsurface tissue deformation during stereotactic neurosurgery IEEE Trans Biomed Eng 46 213–225 Occurrence Handle9932343 Occurrence Handle1:STN:280:DyaK1M7jtFWgtw%3D%3D Occurrence Handle10.1109/10.740884

    Article  PubMed  CAS  Google Scholar 

  • PC Reinacher V van Velthoven (2003) ArticleTitleIntra-operative ultrasound imaging: practical applicability as a real-time navigation system Acta Neurochir [Suppl] 85 89–93 Occurrence Handle1:STN:280:DC%2BD3s%2FlvFOqtQ%3D%3D

    CAS  Google Scholar 

  • MHT Reinges U Spetzger V Rohde L Adams JM Gilsbach (1998) ArticleTitleExperience with a new multifunctional articulated instrument holder in minimally invasive navigated neurosurgery Minim Invas Neurosurg 41 149–151 Occurrence Handle1:STN:280:DyaK1M%2FhvVyntQ%3D%3D Occurrence Handle10.1055/s-2008-1052032

    Article  CAS  Google Scholar 

  • DW Roberts A Hartov FE Kennedy MI Miga KD Paulsen (1998) ArticleTitleIntra-operative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases Neurosurgery 43 749–760 Occurrence Handle9766300 Occurrence Handle1:STN:280:DyaK1cvjslKqsg%3D%3D Occurrence Handle10.1097/00006123-199810000-00010

    Article  PubMed  CAS  Google Scholar 

  • DW Roberts MI Miga A Hartov S Eisner JM Lemery FE Kennedy KD Paulsen (1999) ArticleTitleIntra-operative updated neuroimaging using brain modeling and sparse data Neurosurgery 45 1199–1207 Occurrence Handle10549938 Occurrence Handle1:STN:280:DC%2BD3c%2Fhs1Wgsw%3D%3D Occurrence Handle10.1097/00006123-199911000-00037

    Article  PubMed  CAS  Google Scholar 

  • M Salcman (1999) ArticleTitleHistorical development of surgery for glial tumors J Neurooncol 42 195–204 Occurrence Handle10433103 Occurrence Handle1:STN:280:DyaK1MzmtVCrtw%3D%3D Occurrence Handle10.1023/A:1006169701990

    Article  PubMed  CAS  Google Scholar 

  • JR Schlaier J Warnat U Dorenbeck M Proescholdt KM Schebesch A Brawanski (2004) ArticleTitleImage fusion of MR images and real-time ultrasonography: evaluation of fusion accuracy combining two commercial instruments, a neuronavigation system and a ultrasound system Acta Neurochir (Wien) 146 271–277 Occurrence Handle1:STN:280:DC%2BD2c7itFOrug%3D%3D Occurrence Handle10.1007/s00701-003-0155-6

    Article  CAS  Google Scholar 

  • M Schulder D Liang PW Carmel (2001) ArticleTitleCranial surgery navigation aided by a compact intra-operative magnetic resonance imager J Neurosurg 94 936–945 Occurrence Handle11409523 Occurrence Handle1:STN:280:DC%2BD3Mzks12ksQ%3D%3D Occurrence Handle10.3171/jns.2001.94.6.0936

    Article  PubMed  CAS  Google Scholar 

  • U Sure O Alberti M Petermeyer R Becker H Bertalanffy (2000) ArticleTitleAdvanced image-guided skull base surgey Surg Neurol 53 563–572 Occurrence Handle10940424 Occurrence Handle1:STN:280:DC%2BD3cvitlWltA%3D%3D Occurrence Handle10.1016/S0090-3019(00)00243-3

    Article  PubMed  CAS  Google Scholar 

  • U Sure S Gatscher O Alberti J Witte H Bertalanffy (2000) ArticleTitleImage-guided duplex and Doppler ultrasound for microsurgery of cerebral AVMs Zentralbl Neurochir 61 IssueID[Suppl] 1 47–48

    Google Scholar 

  • U Sure L Benes T Riegel DM Schulte H Bertalanffy (2002) ArticleTitleImage fusion for skull base neuronavigation. Technical note Neurol Med-Chir 42 458–462 Occurrence Handle10.2176/nmc.42.458

    Article  Google Scholar 

  • U Sure L Benes O Bozinov M Woydt W Tirakotai H Bertalanffy (2005) ArticleTitleIntra-operative landmarking of vascular anatomy by integration of duplex and Doppler ultrasonography in image guided surgery. Technical note Surg Neurol 63 133–142 Occurrence Handle15680653 Occurrence Handle10.1016/j.surneu.2004.08.040

    Article  PubMed  Google Scholar 

  • W Tirakotai D Miller S Heinze L Benes H Bertalanffy U Sure (2006) ArticleTitleA novel platform for image-guided ultrasound Neurosurgery 58 710–718 Occurrence Handle16575335 Occurrence Handle10.1227/01.NEU.0000204454.52414.7A

    Article  PubMed  Google Scholar 

  • Tronnier VM, Bonsanto MM, Staubert A et al (2001) Comparison of intra-operative MR imaging and 3D-navigated ultrasonography in the detection and resection control of lesions. Neurosurg Focus 10(2): Article 3

  • G Unsgaard S Ommedal T Muller A Gronningsaeter TA Nagelhus Hernes (2002) ArticleTitleNeuronavigation by intra-operative three-dimensional ultrasound: initial experience during brain tumor resection Neurosurgery 50 804–812 Occurrence Handle11904032 Occurrence Handle10.1097/00006123-200204000-00022

    Article  PubMed  Google Scholar 

  • G Unsgaard GM Rygh T Selbekk et al. (2006) ArticleTitleIntra-operative 3D ultrasound in neurosurgery Acta Neurochir (Wien) 148 235–254 Occurrence Handle1:STN:280:DC%2BD287itlaqsw%3D%3D Occurrence Handle10.1007/s00701-005-0688-y

    Article  CAS  Google Scholar 

  • V van Velthoven (2003) ArticleTitleIntra-operative ultrasound imaging: comparison of pathomorphological findings in US versus CT, MRI and intra-operative findings Acta Neurochir [Suppl] 85 95–99 Occurrence Handle1:STN:280:DC%2BD3s%2FlvFOqug%3D%3D

    CAS  Google Scholar 

  • G Vince M Woydt J Witte A Horowski K Roosen A Krone (1999) ArticleTitleReal-time ultrasound fusion in CT/MR image-guided surgery J Neurosurg 90 422

    Google Scholar 

  • CR Wirtz MM Bonsanto M Knauth VM Tronnier FK Albert A Staubert S Kunze (1997) ArticleTitleIntra-operative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience Comp Aid Surg 2 172–179 Occurrence Handle1:STN:280:DyaK1c%2FhvVWmtQ%3D%3D Occurrence Handle10.1002/(SICI)1097-0150(1997)2:3/4<172::AID-IGS4>3.0.CO;2-T

    Article  CAS  Google Scholar 

  • CR Wirtz VM Tronnier MM Bonsanto M Knauth A Staubert FK Albert S Kunze (1997) ArticleTitleImage-guided neurosurgery with intra-operative MRI: Update of frameless stereotaxy and radicality control Stereotact Funct Neurosurg 68 39–43 Occurrence Handle9711693 Occurrence Handle1:STN:280:DyaK1cznslGksA%3D%3D

    PubMed  CAS  Google Scholar 

  • M Woydt J Perez J Meixensberger A Krone N Soerensen K Roosen (1998) ArticleTitleIntra-operative colour-duplex-sonography in the surgical management of cerebral AV-malformations Acta Neurochir (Wien) 140 689–698 Occurrence Handle1:STN:280:DyaK1cvlsVGlug%3D%3D Occurrence Handle10.1007/s007010050164

    Article  CAS  Google Scholar 

  • M Zimmermann V Seifert C Trantakis A Raabe (2001) ArticleTitleOpen MRI-guided microsurgery of intracranial tumours in or near eloquent brain areas Acta Neurochir (Wien) 143 327–337 Occurrence Handle1:STN:280:DC%2BD38%2Fhs1yqtg%3D%3D Occurrence Handle10.1007/s007010170086

    Article  CAS  Google Scholar 

  • SJ Zinreich SA Tebo DM Long H Brem DE Mattox ME Loury CA Vander Kolk WM Koch DW Kennedy RN Bryan (1993) ArticleTitleFrameless stereotaxic integration of CT imaging data: accuracy and initial applications Radiology 188 735–742 Occurrence Handle8351341 Occurrence Handle1:STN:280:DyaK3szlsFSjtQ%3D%3D

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Philipps University, Marburg, Germany

    Y. Enchev, O. Bozinov, D. Miller, W. Tirakotai, S. Heinze, L. Benes, H. Bertalanffy & U. Sure

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  1. Y. Enchev
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  2. O. Bozinov
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  3. D. Miller
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  4. W. Tirakotai
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  5. S. Heinze
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  6. L. Benes
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  7. H. Bertalanffy
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  8. U. Sure
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The first and second authors contributed equally to the paper.

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Enchev, Y., Bozinov, O., Miller, D. et al. Image-guided ultrasonography for recurrent cystic gliomas. Acta Neurochir (Wien) 148, 1053–1063 (2006). https://doi.org/10.1007/s00701-006-0858-6

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