Removal of Child Brain Tumours

Daniele Marinazzo^*
*Correspondence: Daniele Marinazzo, Department of Data-Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Belgium, Email:

Introduction

In the majority of juvenile brain tumours, the degree of resection serves as an essential prognostic indicator. Controlling resection is made easier by intraoperative imaging. There is little research on the use of intraoperative ultrasound (IOUS), a less expensive alternative to intraoperative magnetic resonance. Using guided three-dimensional ultrasound, we examined all paediatric brain cancers treated at our facility in the past (US). The effectiveness of the US in resection control was noted and the scope of the resection was assessed.

For the majority of paediatric tumours, radical excision still serves as the main surgical goal. Given the limits of traditional microscopic vision of the tumor-brain interface, it is becoming more common to utilise an appropriate intraoperative adjunct to improve this information. The most effective method for observing malignancies and the tumor-brain interface with better multiplanar resolution is still intraoperative magnetic resonance (IOMR). The low image contrast (in relation to brain tumours) and radiation danger associated with intraoperative computed tomography (CT) are limitations, particularly when repeated picture updates are necessary. Despite not being able to match the MR's resolution, intraoperative ultrasound (IOUS) has become recognised as a very effective intraoperative imaging technique due to rapid technology breakthroughs and increases in picture quality over time. Its benefit over the IOMR is due to how simple, safe and widely used it is in most contexts. The difference between IOUS and IOMR has been reduced with the incorporation of navigation and three-dimensional US (3DUS) technologies, positioning IOUS as an excellent replacement for IOMR. Few papers specifically address its use to children cancers, despite the abundance of published material on adult brain tumours. The purpose of our study is to unbiasedly evaluate the effectiveness of IOUS in a subset of paediatric brain tumours.

Description

The use of intraoperative adjuncts for the removal of brain tumours is rising. The most effective image guiding for such procedures is still intraoperative MR. Pediatric neurosurgery in general and paediatric cancers in particular have demonstrated successful uses of IOMR. With slightly different outcomes, both low-field and high-field IOMR systems have been deployed. While high-field solutions are recommended for tumour surgery due to the superior image resolution needed, low-field IOMR is probably more suited for cyst drainage, neuro-endoscopy guiding and catheter insertion operations. However, logistical difficulties and financial costs prevent the broad application of IOMR technology.

In this case, IOUS has shown to be a practical and affordable replacement for IOMR. It is a highly helpful tool in tumour surgery for localising lesions, monitoring the resection and determining the residual status in real-time. A customised tool called Navigated 3DUS combines the advantages of real-time US picture updates with navigational technology. This has been demonstrated in multiple publications, mostly among adults. However, there aren't many reports of it being used on children. It is interesting that greater attention has not been given to the function of adjuncts supporting resection control in this group, given that the degree of resection is likely just as essential (if not more) in many juvenile brain tumours.

The main benefit of brain network modelling is that it creates accurate biophysically oriented models of the brain that go beyond being a straightforward black-box predictor of surgical outcome, potentially making it a useful tool to predict a wide range of outcomes like epilepsy status, cognitive performance, functional network integrity and survival. Thus, by giving predictions of favourable and/or unfavourable outcomes, brain network modelling may be a valuable supplementary source of data to support patients and clinicians in the process of surgical and medical decision-making. In addition, biologically inspired dynamical models could shed light on the regional dynamics driving the structure of large-scale networks in health and sickness. As a result, they could serve as a starting point for comprehending brain illnesses and the healing processes after therapies on a causal mechanistic level [1-5].

Conclusion

IOUS is a helpful technique for accurately locating brain tumours and directing excision. Its application may be expanded and it can become a useful intraoperative imaging tool for juvenile brain tumours with widespread use.

Acknowledgement

None.

Conflict of Interest

The author shows no conflict of interest towards this manuscript.

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