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Ultrasound-guided resection of brain tumors, vascular malformations and hematomas

Surgeon detects brain mass lesion and assesses extent of it's resection with sonography

Sonography

Alexander Dmitriev, MD

Objective of the study is to determine possibilities of intraoperative sonography in detecting of various brain mass lesions, assessing extent of their resection and define indications to use ultrasound-guided needle or ultrasound wire-guided port.

Intraoperative sonography is usially used in neurooncology to detect brain tumors and exclude their remnants. A few studies describe it's usage while removing hematomas or vascular malformations. Ultrasound is the only method allowing to observe brain tissue in real time. It is chip and doesn't violate surgical workflow. Main disadvantages of sonography are lengthy learning curve and poorer image quality compared to magnetic resonance imaging. Novel acoustic coupling fluid, contrast-enhanced ultrasound and elastography expanded it's effectiveness. Meanwhile problems of locating of isoechogenic lesions with poor margins and elimination of artefacts are steel actual.

Objective of the study is to determine possibilities of intraoperative sonography in detecting of various brain mass lesions, assessing extent of their resection and define indications to use ultrasound-guided needle or ultrasound wire-guided port.

A surgeon will intraoperatively locate mass lesion and assess extent of it's resection with sonography. Ultrasound scanning will be performed through the same surgical approach or at a distance through enlarged craniotomy, periodically or permanently. To facilitate approach to subcortical and deep small mass lesions ultrasound-guided needle or ultrasound wire-guided port will be used.

Sonography-guided Resection of Brain Mass Lesions

Sonography-guided Resection of Brain Mass Lesions: a Prospective, Single Arm Clinical Trial

Assessment of target visibility, echogenicity, homogeneity and border demarcation in sonography and their comparison to preoperative computed tomography and magnetic resonance imaging

Sensitivity = true detection of mass lesion / (true detection of mass lesion + inability to detect mass lesion) x 100

Sensitivity = true detection of residual mass lesion / (true detection of residual mass lesion + inability to detect residual mass lesion) x 100

Specificity = true absence of residual mass lesion / (true absence of residual mass lesion + false detection of residual mass lesion) x 100

Positive predictive value = true detection of residual mass lesion / (true detection of residual mass lesion + false detection of residual mass lesion) x 100

Negative predictive value = true absence of residual mass lesion / (true absence of residual mass lesion + inability to detect residual mass lesion) x 100

Accuracy = (true detection of residual mass lesion + true absence of residual mass lesion) / (true detection of residual mass lesion + true absence of residual mass lesion + false detection of residual mass lesion + inability to detect residual mass lesion) x 100

How long did in take to remove mass lesion from starting of it's dissection till final evacuation

Extent of resection = (preoperative tumor volume - postoperative tumor volume) / preoperative tumor volume x 100

Possibility of ultrasound differentiation between artefacts and residual lesion

Only for subcortical or deep-seated mass lesions. How long did in take to reach margin of mass lesion after dural incision using ultrasound-guided needle or ultrasound wire-guided port

Assessment of patients' possibilities to self-service in Karnofsky Performance Status scale

Which cerebral complications arose after surgery

Sklifosovsky Institute of Emergency Care

Principal Investigator

Removing different brain lesions using neuronavigation

Surgeon removes brain lesions and assesses brain shift with neuronavigation

Navigation-guided surgery

The purpose of the study is to calculate magnitude, type of intraoperative brain shift and assess possibility of it's prediction.

Brain shift is the main natural cause of major navigation imprecision. Despite numerous attempts no trials showed a possibility to calculate and predict it's value although some patterns were found. Some modern navigational features allow to partially resolve this problem. Manual shift correction allows to displace brain structures but can only be used if brain shift is linear. Intraoperative computed tomography (CT) and magnetic resonance imaging (MRI) allow to update navigational data but violate surgical workflow and cannot display brain tissue in real time. Intraoperative sonography has poorer quality, limited observe volume and lengthy learning curve.

The purpose of the study is to calculate magnitude, type of intraoperative brain shift and assess possibility of it's prediction.

For each patient a surgeon intraoperatively will assess location of brain surface, various intracranial structures and lesion margins during surgery. Postoperatively these data will be compared to lesion's characteristics, patient's state and intraoperative features.

Intraoperative Brain Shift Calculation Study

Intraoperative Brain Shift Calculation Study: a Prospective, Single Arm Clinical Trial

Maximal difference between disposition of different brain structures in preoperative scans and it's real intraoperative location

Assesses patients' possibilities to self-service

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Sonography-guided Resection of Brain Mass Lesions	NCT05484245	Tumor, Brain Arteriovenous M... Cavernoma Intracerebral H...	Sonography	18 Years - 100 Years	Sklifosovsky Institute of Emergency Care
Sonography-guided Resection of Brain Mass Lesions	NCT05484245	Tumor, Brain Arteriovenous M... Cavernoma Intracerebral H...	Sonography	18 Years - 100 Years	Sklifosovsky Institute of Emergency Care
Intraoperative Brain Shift Calculation Study	NCT05477680	Tumor, Brain Cavernoma Arteriovenous M... Intracerebral H...	Navigation-guid...	18 Years - 100 Years	Sklifosovsky Institute of Emergency Care

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