| Objectives: 1.Summarize the intraoperative ultrasound (IOUS) images of some kinds of intracranial lesions, and compare them with their preoperative magnetic resonance (MR) images and pathological results to discuss the sameness and differences between the two kinds of images and the pathological basis of IOUS images.2. To monitor the whole operation process by IOUS, do a comparative analysis of the operation processe and postoperative result between the monitored and the unmonitored group, and to discuss the value of the IOUS in order to provide a new monitor way for neurosurgery.Methods: 101 patients diagnosed intracranial lesions by preoperative computer tomography (CT) and/or MR and accepted operation were collected in the study, between January and October 2008. Monitor by IOUS were done in their operations. 53 males and 48 females aged from 13y to 77y (averaged, 47.3y) were included in the study.1. The location, shape, dimension, echo and adjacent structures of lesions resected before were examined and recorded by IOUS.2. IOUS monitored and conducted the operation real time. We recorded the operation process and patients'condition after operation, including intraoperative bleeding volume, operation time, days in intensive care unit (ICU), postoperative complications, and so on.3. To do a contrastive analysis between the IOUS images and MR images of intracranial lesions, and summarize the sameness and differences of this two kinds of images. To do a contrastive analysis between the IOUS images and the pathological results of the lesions, and study a possible pathological basis of the IOUS images.4. Collect and arrange the history materials of homochronous patients accepted operation but without IOUS monitor. The patients operated with IOUS monitor were assigned to experimental group, and the ones without IOUS monitor were assigned to control group. Do a contrastive analysis of the resection rate of lesions, intraoperative bleeding volume, operation time, the days in ICU, postoperative complications, and so on between two groups, and discuss the monitor value of the IOUS in Neurosurgery.Results: 1. Pathological results: Among 101 cases(105 lesions), 37 were gliomas (37 lesions), grade I 10 (10/37, 27.03%), grade II 8 (8/37, 21.62%), grade III 12 (12/37, 32.43%) and grade IV 7 (7/37, 18.92%) included, 31 were meningeomas (32 lesions)(32/105,30.48%), 15 were acoustic neurilemomas (15 lesions)(15/105, 14.29%), 5 were cerebral abscesses (7 lesions) (7/105, 6.67%), 4 were craniopharyngiomas (4 cases)( 4/105, 3.96%), 3 were metastatic tumors (4 lesions) (4/107, 3.81%), 1 was Arteriovenous malformation (AVM)(1 lesion) (1/105,0.95%), 1 was Cerebral Gliomatosis (1 lesion)(1/105, 0.95%), 2 were ependymocytomas(2 lesions)(2/105,1.90%), and 2 were hemangioblastomas (2 lesions)( 2/105, 1.90%).2. The IOUS images: 101 cases (105 lesions) were showed clearly by IOUS and have their own characteristic IOUS images.(1) Gliomas: More are solid(30/37,81.08%) and show uniform high echo(14/37,37.84%) or ununiform echo(16/37,43.24 %), no lemma'echo, and more have clear boundary(21/37,56.76%); A few are cyst and solid(7/37,18.92%), cyst shows echoless and solid shows nodus like uniform high echo, all have clear boundary(7/37,18.92%). Color Doppler flow imaging (CDFI) shows color flow signals in 29 lesions (29/37, 78.38%). It also show a wide-ranging brain edema in 22 lesions (wide-ranging)( Edema tissue conformed by CT ), and the echo is lower than lesion's but higher than normal brain tissue's. There is the sameness between grade I and II gliomas (low grade) or grade III and IV ones (high grade), and it is difficult to discriminate them, but there are differences between low and high grade gliomas, and the former's echo is more uniform, the boundary is more clear, the color flow signal is less abundant and the range of edema is smaller than the latter's.(2) Meningeomas: The tumors are usually large, and solid (28/32, 87.50%)with show uniform high echo (22/32, 68.75%) or ununiform echo (6/32, 18.75%); A few are cyst and solid (4/32, 12.50%), cyst shows echoless and solid show nodus like uniform high echo, all have lemma'high echo and clear boundary. CDFI shows color flow signals in 21 lesions (21/32, 65.63%) and it shows a little wide-arranging edema echo in 28 lesions (28/32, 87.50%).(3) Acoustic neurilemomas: 6 lesions (6/15, 40.00%) are solid with uniform high echo, 9 lesions (9/15, 60.00%) are cyst and solid, cyst shows echoless and solid shows nodus like uniform high echo, and all have lemma'high echo and clear boundary. CDFI shows color flow signals in 10 lesions (10/15, 66.67%) and it shows a narrow-arranging edema echo in 6 lesions (6/15, 40.00%).(4) Other types: It shows cerebral abscess with clear boundary, circle high echo outside and low echo to echoless inside, a little color flow signals and a narrow-arranging edema. It shows metastatic tumors with clear boundary, high echo or circle high echo outside and low echo to echoless inside, without color flow signals and with a wide-arranging edema. It shows craniopharyngioma echoless and without any color flow signals. It shows AVM with high echo and echoless like a honeycombing, indiscriminate color flow signals in echoless area and no edema echo. It shows cerebral Gliomatosis with ununiform and indistinct boundary like a map and abound in color flow signals, and the image is similar with some gliomas'. It shows hemangioblastoma more echoless images and without any color flow signals.3. The comparison between the images of IOUS and MRIn our study, the measurement of IOUS of gliomas and cerebral Gliomatosis is larger than that of MR, but it's similar in other lesions; They are similar in showing lesions'cyst or solid, boundary, and uniform or not inside, but IOUS showed the fine calcifications in 2 lesions and a little piece of the colliquation and necrosis clearly while MRI didn't.4. Operation resultsIOUS shows 101 cases (105 lesions) clearly, 75 lesions with clear or a little clear boundary. CDFI shows great vessels inside or outside of 63 lesions, and surgeons avoided or blocked them successfully. IOUS shows some important structures adjacent to operation cave of 59 lesions, and surgeons avoided them and resected the lesions completely or partly. 1 lesion was diagnosed cerebral abscess by MR before operation, and surgeons punctured the lesion monitored by IOUS without any liquor puris and then changed the operation of drainage to resection,and the pathologic result of resected tissue is glioma.There is a statistical significance in the comparison of resection extent, as well as intraoperative bleeding volume, operation time, postoperative complications between experimental and control group (P﹤0.05), but no statistical significance in the comparison of the days in ICU (P﹥0.05).Conclusions: 1. In our study, gliomas, meningeomas and coustic neurilemomas have their own IOUS image characters. Gliomas show mainly uniform high echo or ununiform echo, no lemma'high echo but more or less edema echo, and there is the sameness between grade I and II gliomas (low grade) or grade III and IV ones (high grade), but differences between the low and high grade ones. Meningeomas and coustic neurilemomas have clear boundary because of lemma'high echo, and meningeomas usually are larger than coustic neurilemomas, and mainly show uniform high echo and a little wide-arranging edema while coustic neurilemomas mainly show uniform high echo or cyst and solid echo and a narrow-arranging edema. Therefore, it has a great value in diagnosing gliomas, meningeomas and coustic neurilemomas, and also in discriminating the low and high grade gliomas.2. There are a few differences between the two kinds of images of IOUS and MR of some kinds of intracranial lesions. The differences are that the measurement of IOUS is larger than that of MR of gliomas and cerebral Gliomatosis, while the measurement of other lesions and the other images of all kinds of intracranial lesions look the same, and IOUS may be more sensitive than MR in showing some fine calcification or a small range of colliquation and necrosis. The images of IOUS of all lesions may have the relationship with their pathological characters.3. IOUS is convenient, simply handled and reliable. It can provide exact position, real-time intraoperative images, it can also conduct the operation path and its process to avoid the important structures and great vessels injured, improve the safety and accuracy of the neurosurgery operation, and improve the resection extent, reduce the intraoperative bleeding volume, shorten the operation time and reduce the postoperative complications. IOUS is the most real-time navigation technology now.
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