Resection of Pediatric Intracerebral Tumors with the Aid of Intraoperative Real-Time-3-D Ultrasound

Purpose: Intraoperative ultrasound (IOUS) became a useful tool in the daily work of neurosurgical procedures. In pediatric patients IOUS offers a radiation-free and safe imaging method. This study aims to evaluate the use of new real-time three-dimensional intraoperative ultrasound (rt-3-D-IOUS) in our pediatric patient cohort.

Material and Methods: Rt-3-D-IOUS was performed in 22 pediatric patients (8 girls and 14 boys) with various brain tumors within 24 months. These lesions were localized by a standard navigation system followed by analyzes before, intermittently, and after neurosurgical resection using the ultrasound-system iU22 (Philips, Bothell, WA, USA) connected to the rt-3-D probe (X7-2).

Results: In all 22 patients rt-3-D-IOUS images of the lesions could be obtained during neurosurgical resection. Based on this imaging method, fast orientation in the surgical field and the approach for the resection could be planned in all patients. In 18 patients (82%) rt-3-D-IOUS revealed gross total resection with favorable neurological outcome.

Conclusion: Rt-3-D-IOUS provides the surgeon with advanced orientation at the tumor site by immediate live two-plane imaging. However, rt-3-D-IOUS in combination with a navigation system is still missing, which would further improve intraoperative localization.