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Year : 2005  |  Volume : 53  |  Issue : 2  |  Page : 212

Invited Comment

Neurochirurgische Abteilung, Donauspital, Langobardenstrasse 122, 1220 Vienna, Austria

Correspondence Address:
Guenther Kleinpeter
Neurochirurgische Abteilung, Donauspital, Langobardenstrasse 122, 1220 Vienna
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Kleinpeter G. Invited Comment. Neurol India 2005;53:212

How to cite this URL:
Kleinpeter G. Invited Comment. Neurol India [serial online] 2005 [cited 2020 Jan 29];53:212. Available from:

For the past two decades, intraoperative ultrasonography (IOUS) was a well-established true real-time imaging instrument in brain surgery. Long before the advent of modern intraoperative CT and MR devices, this helpful tool could assess intraoperative orientation as well as facilitate effective tumor resection. Hence, its daily use depends on the specific experience of the user. Usually neurosurgeons are not familiar with ultrasonographic imaging to use it in their daily routine. Maybe because of this in the Scientific Echo statements heralding the benefits of the use of IOUS were low. Furthermore, the upcoming neuronavigation methods made the IOUS fall into desuetude.

Currently, modern neurosurgery is debating the benefits of neuronavigation in brain tumor surgery as the facilitation through resection via intraoperative CT and MR imaging. The most interesting feature for me is that modern ultrasonographic devices can offer both in one with far lower costs. There are promising data in the literature about the effectiveness of the new methods, showing that ultrasonographic resolution is equal to that of CT and MR imaging. For all the centers in the world with lesser resources, IOUS can indeed be an alternative to the expensive MR devices that have come into use.

From this angle, the present article deserves interest. Neurosurgeons have to familiarize themselves (again) with the use of intraoperative ultrasonographic devices and the imaging data they obtain before, during and after their resection work.

The intention of the authors was to characterize features of malignant brain tumors obtained from IOUS. The number of patients (40) seems to be appropriate for the purpose of comparing the sonographic appearance and configuration of cystic, solid, and necrotic parts of various malignant lesions. However, why is it important to 'predict' intraoperatively 'the pathological nature of the lesions?' What then is the value of the frozen section? And why do they not restrict their description merely to, for example, Grade IV malignant gliomas?

I am confused in the light of the fact that the study population comprised an inhomogeneous mix of patients with 'previously operated and irritated recurrent tumors, metastatic malignant lesions' and true 'primary malignant glial tumors!' From my operative experience, the excision of well-delineated metastatic lesions (mostly capsulated) differs significantly from that of intrinsic gliomas.

Therefore, for me the demonstrated features such as necrotic parts, perilesional edema, irregular contour and contrast enhancement could be more of intraoperative help in orientation and consequent tumor removal than in differentiating between various histological entities. All the further results of the paper are somehow related to this, which is my major objection, so I abstain from discussing them.


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Online since 20th March '04
Published by Wolters Kluwer - Medknow