Application Of Intraoperative Ultrasound Assisted With Neuronavigation In Brian Tumor Resection:A Prospective Study

Objective: The research purpose is to compare the location of brain tumor in the craniotomy using intraoperative ultrasound combined with neuronavigation,and using neuronavigation alone,evaluate the value of brain shift in the intraoperative ultrasound-aided neuronavigation compensation operation;measured the brain shift extent in the brain tumor operation quantitatively,discuss related factors of affecting brain tumor shift preliminarily,and screen the tumor type to be located by intraoperative ultrasound-aided neuronavigation.Research method:(1)30 brain tumor patients were selected prospectively in the research.They were divided into two groups at random.In the research group,brain tumor was localized by intraoperative ultrasound-aided neuronavigation;in the control group,brain tumor was localized by neuronavigation.Preoperative and postoperative iconographic data,KPS scoring and pathological results were retained.(2)The bone flap positions of all patients were designed according to the location of neuronavigation.In the research group,intraoperative ultrasound was placed in the epidural,subdural and on the surface of brain parenchyma to scan so as to confirm the position of focus,measure the size of focus,and depth from the cortex,and record time spent by ultrasound inspection.In the control group,the operation was done according to the location of preoperative neuronavigation.Taking visible superfacial part boundary of tumor of all patients visually and microscopically as the observation endpoint,the time from opening of bone flap to the observation end point was recorded.Then,location rate,spent time and postoperative KPS scoring in the research group and control group were analyzed statistically.(3)In the research group,the brain tumor shift degree was measured using intraoperative ultrasound.In the control group,the brain tumor drift degree was measured using neuronavigation.The brain tumor shift degree before and after cutting dura mater open and the drift degree from preoperation to observation endpoint(the visible intraoperative superfacial part boundary of focus)were measured.(4)Factors that affected brain tumor shift were analyzed statistically according to the morphological and pathological feature of tumor.Result:(1)There are 15 patients in the research group.Intraoperative ultrasound combined with neuronavigation realizes successful location and the accuracy rate is 100%.There are 15 patients in the control group and 11 of them are localized accurately using neuronavigation alone,so the accuracy rate is 73%.(2)Operation time: average used time of operation in the research group is 30.7±7.3 min,and the average used time of operation in the control group is 45.8±12.6min,and the difference of two groups has statistical significance(P<0.05).(3)Postoperative KPS scoring: the median of KPS scoring in the research group is 80,the median of KPS scoring in the control group is 70,and the difference of two groups has statistical significance(P<0.05).(4)There are 30 cases in the research.The shift range of brain tumor is 2.8-13.5mm,average range is 6.3mm,and standard deviation is 2.18 mm.Through statistical analysis,it is seen,the intraoperative brain tumor shift degree is negatively related to the depth of tumor from the cortex(r=-0.57),positively related to the size of tumor(r=0.634),and insignificantly correlated to the pathological pattern of tumor.Conclusion:(1)Intraoperative ultrasound-aided neuronavigation can localize the focus accurately in the brain tumor excision,correct the error caused by the brain tumor drift effectively,save the operation time,reduce the cerebral injury,and improve postoperative KPS scoring of patients;(2)brain tumor shift degree is significantly related to the depth of tumor from cortex and the size of tumor,but insignificantly related to the pathological type of tumor.