Improving glioma resection with 2D-intraoperative ultrasound: Observational results and systematic literature...

Maximizing tumor resection is a key prognostic factor in glioma surgery. Intraoperative cerebral ultrasonography (IOUS) offers real-time, cost-effective guidance that can enhance the extent of resection (EOR) and gross total resection (GTR) rates, but data remain heterogeneous.

We conducted a retrospective analysis of a prospective observational database including patients with gliomas undergoing surgery with or without IOUS guidance in one tertiary neurosurgical center. Inclusion criteria were preoperative magnetic resonance imaging-suspected gliomas, intended GTR, and available early postoperative imaging. Outcomes were compared using propensity score matching. In addition, a systematic literature review covering 2018-2024 was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

A total of 38 patients were included after matching, with 19 patients in each group. IOUS use significantly improved the mean EOR (85.0% vs. 66.2%, P = 0.028) and GTR rate (47.4% vs. 10.5%, P = 0.029). Benefits were more pronounced in tumors larger than 10 cm³. A learning curve effect was observed, with increasing resection rates over time. The literature review identified nine relevant studies, with GTR rates ranging from 42% to 91%, and recent studies showing improved outcomes with advanced IOUS techniques. These findings should be interpreted cautiously given the small sample size and single-center design.

IOUS significantly enhances resection outcomes in glioma surgery and demonstrates a progressive benefit with surgeon experience. Given its versatility, low cost, and growing integration with technologies such as contrast-enhanced ultrasound and artificial intelligence, IOUS remains a fundamental tool in modern neurooncology. Future multicenter prospective studies are needed to standardize its use and assess long-term patient outcomes.