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Published on: July 16, 2020
Real-Time 2D Ultrasound Guided Frameless Biopsy of a Multifocal Glioma: Improving Accuracy and Diagnostic Yield
Ujwal Yeole1, Vikas Singh1, Prakash Shetty1
1Neurosurgery Services, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Background And Introduction:
Intraoperative ultrasound imaging can be a multi-dimensional tool with various applications, including localization, resection control, and biopsy of brain tumors.
Objective:
We demonstrate a frameless biopsy technique by using real-time 2D ultrasound (RT-2DUS) for localizing and guiding the biopsy of cranial tumors.
Technique:
A 60-year-old male presented with progressive right hemiparesis, memory, and behavioral disturbances. MRI brain showed a multifocal lesion in the left temporal, parietal, and occipital lobes with extension into the splenium. He underwent left parietal mini-craniotomy with frameless RT-2DUS-guided biopsy.
Result:
Postoperative US scan showed a small biopsy site hematoma. Histopathology confirmed it to be IDH-negative primary glioblastoma. For multifocal glioma, the patient underwent adjuvant WBRT with concurrent and adjuvant temozolomide.
Conclusion:
RT-2DUS improves the sampling accuracy of the tumor by detecting the solid component of the lesion intraoperatively. In addition, the detection of operative site hematoma can be picked up immediately, avoiding post-procedure imaging.
