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Acta Neurochirurgica

Published in:

01-09-2009 | Technique Applications

Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound

Authors: Ole Solheim, Tormod Selbekk, Frank Lindseth, Geirmund Unsgård

Published in: Acta Neurochirurgica | Issue 9/2009

Abstract

Background

Surgical resection of giant meningiomas may pose different challenges. Normal brain tissue is often compressed to the limit and is vulnerable to further traction. In addition, severe intraoperative bleeding may be a problem as many giant meningiomas are vascularised with deep feeding vessels entering from the skull base. Neuronavigation based on preoperative imaging can be of limited use as there may be extensive brain shifts during surgery.

Method

We have retrospectively evaluated navigated resection based on intraoperative 3D ultrasound in a series of 15 giant meningiomas with a diameter of more than 5 cm. A pre- and postoperative MRI was preformed in all patients. Preoperative and postoperative neurological function was assessed.

Findings

We were able to safely perform ultrasound-guided intracapsular gross total resection of tumour tissue in all patients. Twelve out of 15 patients were radically operated (Simpson grade I and II). Major feeding arteries and adjacent normal arteries could be identified by ultrasound power Doppler angiography. In one patient we were not able to indentify important venous structures. All patients experienced postoperative improvement of their symptoms. Postoperative MRIs did not reveal significant ischemic changes in adjacent normal brain tissue. The mean duration of hospitalisation after surgery was 4.9 days.

Conclusion

We present a method of ultrasound-guided resection of giant meningiomas. The method enables image-guided resection through narrow approaches that minimise traction. Power Doppler angiography allows the identification of feeding vessels that may be coagulated to limit bleeding. Likewise, normal arteries can be avoided during surgery. The tumour capsule is often surprisingly easy to remove from the arachnoid membrane after gross intracapsular tumour reduction.

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Title: Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound
Authors: Ole Solheim
Tormod Selbekk
Frank Lindseth
Geirmund Unsgård
Publication date: 01-09-2009
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 9/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0395-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound

Abstract

Background

Method

Findings

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Findings

Conclusion

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