The utility of intraoperative ultrasonography for spinal cord surgery

PLoS One. 2024 Jul 10;19(7):e0305694. doi: 10.1371/journal.pone.0305694. eCollection 2024.

Abstract

Objectives: Intraoperative ultrasonography (IOUS) offers the advantage of providing real-time imaging features, yet it is not generally used. This study aims to discuss the benefits of utilizing IOUS in spinal cord surgery and review related literature.

Materials and methods: Patients who underwent spinal cord surgery utilizing IOUS at a single institution were retrospectively collected and analyzed to evaluate the benefits derived from the use of IOUS.

Results: A total of 43 consecutive patients were analyzed. Schwannoma was the most common tumor (35%), followed by cavernous angioma (23%) and ependymoma (16%). IOUS confirmed tumor extent and location before dura opening in 42 patients (97.7%). It was particularly helpful for myelotomy in deep-seated intramedullary lesions to minimize neural injury in 13 patients (31.0% of 42 patients). IOUS also detected residual or hidden lesions in 3 patients (7.0%) and verified the absence of hematoma post-tumor removal in 23 patients (53.5%). In 3 patients (7.0%), confirming no intradural lesions after removing extradural tumors avoided additional dural incisions. IOUS identified surrounding blood vessels and detected dural defects in one patient (2.3%) respectively.

Conclusions: The IOUS can be a valuable tool for spinal cord surgery in identifying the exact location of the pathologic lesions, confirming the completeness of surgery, and minimizing the risk of neural and vascular injury in a real-time fashion.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Ependymoma / diagnostic imaging
  • Ependymoma / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurilemmoma / diagnostic imaging
  • Neurilemmoma / surgery
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods
  • Retrospective Studies
  • Spinal Cord Neoplasms* / diagnostic imaging
  • Spinal Cord Neoplasms* / surgery
  • Spinal Cord* / diagnostic imaging
  • Spinal Cord* / surgery
  • Ultrasonography* / methods
  • Young Adult

Grants and funding

This study was supported by Ministry of National Defence of Republic of Korea (800-20230466) and Doosan Yonkang foundation (800-20210527). This study was also supported by grant (30-2023-0120) from the Seoul National University Hospital research fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.