Neoplasms

Nervous System Diseases

All Conditions

Heart and Blood Diseases

Diseases and Abnormalities at or Before Birth

Symptoms and General Pathology

Blood and Lymph Conditions

Brain Neoplasms

Arteriovenous Malformations

Congenital Abnormalities

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Hemangioma, Cavernous

Hemangioma

Hemorrhage

Vascular Malformations

Cardiovascular Abnormalities

Vascular Diseases

Neoplasms, Vascular Tissue

Neoplasms by Histologic Type

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

Syndrome

Hemostatic Disorders

Blood Coagulation Disorders

Hemorrhagic Disorders

Hematologic Diseases

Intracranial Hemorrhages

Cerebrovascular Disorders

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

Rare Diseases

Glioma

Neoplasms, Neuroepithelial

Neuroectodermal Tumors

Neuroectodermal Tumors, Primitive

Neoplasms, Germ Cell and Embryonal

Neoplasms, Glandular and Epithelial

Neoplasms, Nerve Tissue

Neuroepithelioma

Glioma resection with intraoperative sonography

Glioma resection without intraoperative sonography

ultrasound scanning of brain to search tumor remnants

Intraoperative sonography

The purpose of the study is to determine whether intraoperative ultrasound guided resection of glioma without contrast enhancement in magnetic resonance imaging can achieve higher extent of resection than surgery without intraoperative sonography

Gliomas, not enhancing contrast agent in magnetic resonance imaging (MRI), are usually low-grade gliomas. They rarely show intraoperative fluorescence using 5-aminolevulinic acid or fluorescein. Intraoperative high-field MRI, sonography and navigation are the only ways to assess extent of their resection during surgery. MRI is the gold standard, but interrupts surgical workflow and only few hospitals are equipped with device like that. Navigation eventually looses it's precision due to brainshift. Ultrasound allows assess tumor remnants in real time but has worse imaging quality. Currently no randomized trials published their results about efficiency of intraoperative sonography in removing low-grade gliomas.

Objective of the study is to determine whether intraoperative ultrasound guided resection of non-enhancing gliomas can achieve higher extent of resection than surgery without intraoperative sonography.

Participants of the study will be randomly operated with and without intraoperative ultrasound. Extent of resection will be assessed in postoperative MRI by blinded radiologists.

Glioma extent of resection will be assessed by radiologists blinded for the treatment arm

Intraoperative Sonographically Guided Resection of Non-enhancing Gliomas

Intraoperative Sonographically Guided Resection of Gliomas Not Enhancing Contrast Agent in Magnetic Resonance Imaging: a Randomised, Controlled Trial

Gross total resection is a total removal of tumor (or 100 percents extent of resection)

Motor function is assessed in Medical Research Council scale

Speech function is assessed in Hendrix scale (2017)

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 Sonographically Guided Resection of Non-enhancing Gliomas	NCT05470374	Non-enhancing C...	Intraoperative ...	18 Years - 79 Years	Sklifosovsky Institute of Emergency Care

Spots Global Cancer Trial Database for intraoperative sonography