Intraoperative ultrasound and contrast-enhanced ultrasound in surgical treatment of intramedullary spinal tumors

Abstract Background Surgical resection of intramedullary tumors remains technically challenging. The role of intraoperative ultrasound and contrast-enhanced ultrasound (CEUS) in these surgeries have not yet been well-defined. This study was aimed to evaluate the potential of intraoperative ultrasonography, especially CEUS, in visualizing intramedullary spinal cord tumors, and to assess the values for improving surgical outcomes. Methods This prospective study recruited 14 patients with intramedullary spinal cord tumor. All patients underwent tumor resection with intraoperative ultrasound and CEUS. The first ultrasonographic scanning was performed before the dural incision. After the dural incision, a further ultrasonographic scanning was performed over the surface of the spinal cord. During and after the tumor removal, repeated ultrasonographic scanning was conducted to assess the extent of surgical resection. Follow-up data were collected and analyzed. Results Seven patients had small tumors involving one or two spinal segments, and seven patients showed relatively large tumors involving ≥3 spinal segments. Intraoperatively, ultrasonography was able to visualize the lesion clearly in all of the cases. Using intraoperative ultrasound with CEUS, the tumor boundaries were clearly defined. After an average follow-up period of 15.93 months, the neurological function was improved in 10 (71.4%) cases and remained unchanged in 4 (28.6%) cases; there was no deterioration in individual neurological functions. Conclusions Intraoperative ultrasound is of great value for localizing lesions and determining the extent of dural opening and myelotomy, thus reducing the invasiveness of spinal surgery for intramedullary tumors. CEUS helps to delineate the tumor margins and perfusion features.