Clinical Scorecard: Utilizing Navigated Intraoperative Ultrasound for Brainshift Correction to Enhance Decision-Making in Glioma Surgery

At a Glance

Key Highlights

• Brainshift is a dynamic, multifactorial process causing spatial discrepancies between preoperative imaging and actual anatomy during surgery.
• Navigated intraoperative ultrasound (iUS) fused with preoperative MRI enables real-time brainshift detection and correction via rigid image fusion.
• Use of 3D navigated ultrasound and commercial brainshift correction software improves accuracy in tumor resection and preservation of eloquent structures like corticospinal tracts.

Guideline-Based Recommendations

Diagnosis

• Use preoperative MRI with tractography for surgical planning and neuronavigation setup.
• Employ intraoperative ultrasound fused with MRI to detect and quantify brainshift at multiple surgical stages.

Management

• Apply rigid image fusion-based brainshift correction (e.g., Snap to MRI) during surgery to realign ultrasound and MRI images.
• Repeat intraoperative ultrasound scans as needed to monitor and correct brainshift throughout tumor resection.
• Use subcortical motor mapping to verify functional anatomy after brainshift correction.

Monitoring & Follow-up

• Perform serial intraoperative ultrasound scans before dural opening, after dural opening, and after resection completion.
• Qualitatively assess fusion accuracy using transparency adjustments and 'spyglass' function to evaluate landmark correspondence.

Risks

• Inaccurate neuronavigation due to uncorrected brainshift may lead to incomplete tumor resection or damage to critical eloquent brain structures.
• Elastic deformations are challenging to correct and may limit the precision of brainshift compensation.

Patient & Prescribing Data

Patients with intra-axial brain tumors undergoing resection with neuronavigation

Navigated intraoperative ultrasound allows dynamic brainshift correction improving surgical accuracy and functional preservation; cost-effective compared to intraoperative MRI.

Clinical Best Practices

• Integrate preoperative MRI and tractography data into neuronavigation systems prior to surgery.
• Acquire high-quality, wide-field 3D intraoperative ultrasound images at multiple surgical stages.
• Use rigid image fusion software to correct brainshift and verify alignment with anatomical landmarks.
• Combine brainshift correction with functional mapping techniques to ensure preservation of eloquent brain areas.
• Repeat brainshift assessment and correction as needed during surgery to maintain navigation accuracy.

References

• Brainshift definition and impact on neuronavigation
• Use of intraoperative MRI and ultrasound for brainshift correction
• Navigated intraoperative ultrasound techniques and clinical application