3D Ultrasound-augmented image-guidance for surgery of high grade gliomas – A quantitative analysis focused on the extent of resection
Authors: Giulio Anichini (Corresponding author), Islam Shah FRCR, Dominic Edward Mahoney BSc, Neekhil Patel PhD, Lillie Pakzad-Shahabi BSc, Nelofer Syed PhD, Richard Perryman PhD, Adam Waldman PhD, Kevin O’Neill FRCS
Background: We have retrospectively reviewed our series of brain tumour patients operated using 3D lntraOperative Ultrasound (IOUS) to report technical advantages and areas of improvement.
Methods: Clinica l and radiolog ical data of patients with diagnosis of High-Grade Gl ioma IV (HGG-IV) operated with and without IOUS were retrieved and analysed. Results. We have found 391 patients operated using IOUS coupled with neuronavigation and 257 using neuronavigation stand-alone. We have selected a pool of 60 patients with diagnosis of GB, comparing two equally sized groups operated with and without IOUS, respectively. Average Extent of Resection (EOR) in the IOUS group was 93%, while in the control group it was 80%. IOUS was significantly associated with improved EOR (p < 0.0004), even when accounting for other factors affecting EOR. The average overall survival (OS) was 13.4 months, and the average progression-free survival (PFS) was 7.4 months. Cox Proportional hazard model showed an advantage in OS on patients operated using the IOUS. No statistically significant effect was observed on PFS.
Conclusion: lntraoperatlve ultrasound coupled with image guidance is associated with an improved EOR and possibly an improved OS. While we are aware of several limitations related to the present analysis, these data support routine use of IOUS as a safe and reliable technology. Larger, prospective series with updated IOUS technology are desirable to verify the accuracy of these results.