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Journal of Neurosurgical Sciences 2000 September;44(3):115-22

lingua: Inglese

Intraoperative sonog­ra­phy for spi­nal ­tumors. Correlations ­with MR find­ings and sur­gery

Maiuri F., Iaconetta G., Gallicchio B., Stella L.

Neurosurgical Department, School of Medicine, University “Federico II”, Naples, Italy


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Background. To inves­ti­gate ­the ­role of intra­op­er­a­tive ultra­so­nog­ra­phy dur­ing sur­gery for spi­nal ­tumors and the cor­re­la­tion ­between ech­o­graph­ic, mag­net­ic res­o­nance and sur­gi­cal find­ings.
Methods. Twenty ­patients ­with spi­nal ­tumor, ­explored by MRI of the ­spine, ­have ­been treat­ed ­with ultra­sound-guid­ed sur­gery. The ultra­sound explo­ra­tion has ­been per­formed dur­ing lam­i­nec­to­my on the ­dural sur­face in all cas­es and, ­after the ­dural open­ing, on the spi­nal ­cord sur­face for intra­me­dul­lary ­tumors.
Results. In all ­patients the ultra­sound explo­ra­tion has ­allowed to exact­ly ­define the ­extent of the lam­i­nec­to­my, the ­dural open­ing and the mye­lot­o­my. Meningiomas ­were hyper­echo­ic and homo­ge­ne­ous, ­with ­well ­defined mar­gins and ­often vis­ible hyper­echo­ic ­dural attach­ment; neu­rin­o­mas ­were ­less hyper­echo­ic and ­less homo­ge­ne­ous ­than menin­gio­mas. Intramedullary ­tumors ­showed hyper­echo­ic sol­id and hypo­echo­ic cys­tic-necrot­ic com­po­nents, ­although a spe­cif­ic tis­sue char­ac­ter­iza­tion (­tumor infil­tra­tion, gli­o­sis, ede­ma) is not pos­sible.
Conclusions. Intraoperative ultra­so­nog­ra­phy ­should be ­used rou­tine­ly dur­ing sur­gery for spi­nal ­tumors in ­order to ­reduce the ­extent of the lam­i­nec­to­my, ­dural open­ing and mye­lot­o­my. A ­good cor­re­la­tion ­exists ­between sig­nal inten­sity on T1-weight­ed imag­es of MR, the ech­o­graph­ic ­aspect of the ­tumor and the path­o­log­i­cal find­ings at oper­a­tion.

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