ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2019 June;63(3):270-9

DOI: 10.23736/S0390-5616.16.03336-1

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

A simple, safe and effective surface marking and targeting method combined with intraoperative ultrasonography for small subcortical intracranial lesions

Atilla KAZANCI ¹ ✉, Oktay GURCAN ¹, Ahmet GURCAY ¹, Ismail BOZKURT ¹, Oktay ALGIN ², Omer TURKOGLU ¹, Murad BAVBEK ³

¹ Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; ² Department of Radiology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey; ³ Department of Neurosurgery, School of Medicine, Yildirim Beyazit University, Ankara, Turkey

BACKGROUND: Accurately locating small subcortical brain lesions is very important for maximal surgical resection with minimal neurological damage. Intraoperative MRI has proved to be more precise than ultrasound, it is relatively expensive and is not available in all centers. Herein we describe a new, simple, safe and effective method for determining a small skin incision and craniotomy via skin staples combined with intraoperative ultrasonography to determine the margins, vascularity and residue of the lesion.
METHODS: Thirty-three patients with small subcortical lesions were admitted into the study. The maximum diameter of the lesions ranged between 18 and 30 mm. The depth of the lesion was described as the distance between the cortical surface and most outer point of the lesion. The mean of the depth of the lesions was 10.56 mm ranging between 3.3 and 18.7 mm. Multiple skin staples were used as irremovable skin markers. Before and after dural incision, ultrasound was used to assess the lesion size and location, its relationship with the surrounding tissue and the Doppler function to reveal the blood supply to the lesion.
RESULTS: In this study mean craniotomy diameter was 44 mm ranging between 32-55 mm. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation.
CONCLUSIONS: We describe a simple, safe and effective method for determining a small skin incision and craniotomy combined with intraoperative ultrasound for small subcortical intracranial lesions for health center that does not have intraoperative MRI and navigation systems.

KEY WORDS: Ultrasonography - Neuronavigation - Sutures