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[Stereotaxically guided versus ultrasound guided surgery--a comparative report of experiences]
1Landes-Nervenklinik Wagner-Jauregg, Abteilung für Neurochirurgie, Linz, Osterreich.
Abstract:
Localisation and approach are the keys of surgery on brain tumours. Apart from the up and coming neuronavigational devices, stereotactical and ultrasound guidance are well established methods in locating intracranial tumours and in selecting the optimal approach for resection. Nevertheless it is not clear, which guidance tool is more practicable in the daily routine. Both methods have been used in our department since 1989. During the last six and half years we have operated on 1314 patients suffering from intracranial tumours. In 148 cases we have used either stereotactical (n = 37) or ultrasonic (n = 111) intraoperative guidance. The performing surgeon had documented ease of use, accuracy and users acceptance of the chosen guidance tool. The data were summarised together with the patients history and images in to a descriptive report. Since 1992 we noted a steady increase in guiding operations from 4% to 24%, mainly due to the more frequent use of ultrasound guidance. Saving time, easy handling, accuracy and plausible guidance with real time pictures have been the major advantages in favouring ultrasound guidance. Additionally, the freedom in choosing the appropriate approach seems to be essential. To achieve full advantage of all these benefits, experience and individual expertise are necessary. Conversely, the high accuracy of stereotactic guidance is not within the reach of the ultrasound, which is sufficient to guide the operation. According to our experiences, we recommend intraoperative ultrasound as an easy guiding tool. Except a few cases, this guiding tool seems to be superior to the stereotactic localisation of intracranial lesions.
Insights
Intraoperative ultrasound guidance is recommended for brain tumor surgery due to its ease of use and real-time imaging. While stereotactic guidance offers high accuracy, ultrasound provides sufficient precision for daily practice, proving superior in most cases.
Area of Science:
- Neurosurgery
- Medical Imaging
Background:
- Accurate localization and optimal surgical approach are critical for brain tumor resections.
- Neuronavigational devices, stereotactic, and ultrasound guidance are established methods for intracranial tumor localization.
Purpose of the Study:
- To compare the practicality and effectiveness of stereotactic versus ultrasound guidance in routine brain tumor surgery.
- To evaluate surgeon preference and user acceptance of different intraoperative guidance tools.
Main Methods:
- Retrospective analysis of 148 brain tumor surgeries using stereotactic (n=37) or ultrasound (n=111) guidance.
- Surgeon-documented ease of use, accuracy, and user acceptance were recorded.
- Data were compiled with patient history and imaging for a descriptive report.
Main Results:
- A significant increase in the use of guidance techniques was observed from 4% to 24% since 1992, primarily driven by ultrasound.
- Ultrasound guidance was favored for its time-saving, ease of handling, real-time imaging, and flexibility in approach selection.
- While stereotactic guidance offers higher accuracy, ultrasound's precision was deemed sufficient for guiding operations.
Conclusions:
- Intraoperative ultrasound guidance is recommended as an easy-to-use and effective tool for brain tumor surgery.
- Ultrasound guidance appears superior to stereotactic localization for most intracranial lesions in daily surgical practice.
- Experience and individual expertise are crucial for maximizing the benefits of intraoperative guidance tools.