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Non-navigated 2D intraoperative ultrasound: An unsophisticated surgical tool to achieve high standards of care in glioma surgery

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Abstract

Purpose

In an era characterized by rapid progression in neurosurgical technologies, traditional tools such as the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) risk being overshadowed. Against this backdrop, this study endeavors to provide a comprehensive assessment of the clinical efficacy and surgical relevance of nn-2D-IOUS, specifically in the context of glioma resections.

Methods

This retrospective study undertaken at a single center evaluated 99 consecutive, non-selected patients diagnosed with both high-grade and low-grade gliomas. The primary objective was to assess the proficiency of nn-2D-IOUS in generating satisfactory image quality, identifying residual tumor tissue, and its influence on the extent of resection. To validate these results, early postoperative MRI data served as the reference standard.

Results

The nn-2D-IOUS exhibited a high level of effectiveness, successfully generating good quality images in 79% of the patients evaluated. With a sensitivity rate of 68% and a perfect specificity of 100%, nn-2D-IOUS unequivocally demonstrated its utility in intraoperative residual tumor detection. Notably, when total tumor removal was the surgical objective, a resection exceeding 95% of the initial tumor volume was achieved in 86% of patients. Additionally, patients in whom residual tumor was not detected by nn-2D-IOUS, the mean volume of undetected tumor tissue was remarkably minimal, averaging at 0.29 cm3.

Conclusion

Our study supports nn-2D-IOUS's invaluable role in glioma surgery. The results highlight the utility of traditional technologies for enhanced surgical outcomes, even when compared to advanced alternatives. This is particularly relevant for resource-constrained settings and emphasizes optimizing existing tools for efficient patient care.

NCT05873946 – 24/05/2023 – Retrospectively registered.

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Data availability

A portion of the MRI scans used in this study is publicly available through The Cancer Imaging Archive at https://doi.org/10.7937/4545-c905.

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Acknowledgements

This work was partially funded by a grant awarded by the "Instituto Carlos III, Proyectos I-D-i, Acción Estratégica en Salud 2022". Reference PI22/01680.

Funding

This work was partially funded by a grant awarded by the "Instituto Carlos III, Proyectos I-D-i, Acción Estratégica en Salud 2022". Reference PI22/01680.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Río Hortega, Calle Dulzaina, 2, 47012, Valladolid, Spain

    Santiago Cepeda, Sergio García-García, Ignacio Arrese & Rosario Sarabia

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  1. Santiago Cepeda
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  2. Sergio García-García
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  3. Ignacio Arrese
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  4. Rosario Sarabia
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Contributions

Conception and design of study: Santiago Cepeda. Acquisition of data: Santiago Cepeda. Analysis and interpretation of data: Santiago Cepeda, Sergio García, Drafting the manuscript: Santiago Cepeda. Revising the manuscript critically for important intellectual content: Rosario Sarabia, Ignacio Arrese. Approval of the version of the manuscript to be published: Santiago Cepeda, Sergio García-García, Ignacio Arrese, Rosario Sarabia.

Corresponding author

Correspondence to Santiago Cepeda.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. This study received approval from the Institutional Review Board of the Rio Hortega University Hospital and the Ethics Committee for Drug Research (CEIm) of the West Valladolid Health Area (Ref. 21-PI085).

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Consent to participate

Written informed consent was obtained from the parents.

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Details of Previous Publication: A preprint version of the manuscript has been made available and can be accessed at the following link: https://doi.org/10.1101/2023.06.01.23290675.

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Cepeda, S., García-García, S., Arrese, I. et al. Non-navigated 2D intraoperative ultrasound: An unsophisticated surgical tool to achieve high standards of care in glioma surgery. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04614-5

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