Application of intraoperative ultrasound and sodium fluorescein supported by neuronavigation in microsurgery for malignant neoplasm of cerebrum brain

Objective To investigate the role of intraoperative ultrasound and sodium fluorescein supported by neuronavigation in microsurgery for malignant neoplasm of cerebrum brain. Methods A retrospective analysis was conducted on 9 patients with malignant tumors in the sports area from November 27, 2017 to March 12, 2018 in the Brain Center of the Shenzhen Second People’s Hospital. After diffusion tensor imaging (DTI) combined with neuronavigation, all patients were designed for surgical approach. We injected sodium fluorescein into veins before surgery to highlight brain tumors and used intraoperative ultrasound to determine the location of brain tumors. The consistency of tumor localization was compared by neuronavigation, ultrasound and sodium fluorescein. Under electrophysiological monitoring, the tumor resection was performed by the same surgeon based on the spatial relationship between the tumor and the pyramidal tract as shown by neuronavigation and the tumor boundary displayed by sodium fluorescein. Results The accuracy of neuronavigation to locate brain tumors and pyramidal tract was achieved in 100% before surgery. The consistency of neuronavigation and ultrasound to locate brain tumors was achieved in 100% before cutting the dura. The consistency of ultrasound and sodium fluorescein to locate brain tumors was achieved in 100% after cutting the dura. Eight patients (89%) underwent total resection and one case (11%) underwent subtotal resection. Muscle strength was improved in 2 patients while 4 patients was the same as before. Three patients experienced a transient decline in muscle strength, which gradually returned to normal after rehabilitation exercise. Conclusion Neuronavigation combined with DTI can well define the spatial relationship between tumor and pyramidal tract. Intraoperative ultrasound and sodium fluorescein staining can locate the tumor in real time and increase the tumor resection rate and reduce the probability of postoperative dysfunction. Key words: Malignant neoplasm ofcerebrum brain; Neuronavigation; Intraoperative ultrasound; Sodium fluorescein