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Guiding Tumour Resections in Neurosurgery with Intraoperative Ultrasound: Prof. Geirmund Unsgård


Geirmund Unsgård is Professor Emeritus of Neurosurgery at the Norwegian University of Science and Technology (NTNU), where he worked for 30 years. For 22 years he served as Chief of the Neurosurgical Department at St. Olavs Hospital, Trondheim University Hospital, in Trondheim, Norway. An expert of ultrasound-guided neurosurgery, Prof. Unsgård has used intraoperative ultrasound imaging to guide his neurosurgical procedures for over two decades.

Today, we are talking with Professor Unsgård about the visualisation and planning of tumour resection surgeries.

Visualisation and Planning of Tumour Resection

According to Prof. Unsgård, visualisation of the tumour beyond the surface of the tissue during a neurosurgical procedure is only made possible by real-time, intraoperative ultrasound. Real-time intraoperative ultrasound offers reliable visualisation of brain tumours and helps guide tumour resections. “Ultrasound is very important for tumour resection because of brain shift and the need to see residual tumour and the tumour border,” says Prof. Unsgård.


Tumour Resection Procedure

Prof. Unsgård recommends using intraoperative ultrasound for repeated scans during tumour resection surgery. This provides surgeons with real-time information about the extent of resection. During tumour resection, Prof. Unsgård uses intraoperative ultrasound for:

  1. After the craniotomy, intraoperative ultrasound can be used through the dura to get acquainted with the lesion and how it looks on ultrasound.
  2.  After the dura is opened, the next scan can be taken, and this becomes the basis for the resection.
  3. The surgeon can then go ahead based on the information in the ultrasound image and carry out the resection.
  4. Another ultrasound acquisition can be taken. If some tumour tissue remains, the surgeon can then continue to resect.

Prof. Unsgård uses intraoperative ultrasound for an average of seven or eight times during one operation.


Using Color Doppler to Avoid Harm to Blood Vessels

“As a neurosurgeon, you do have to be very cautious not to damage blood vessels,” says Prof. Unsgård. Colour Doppler, Power Doppler, and Pulse Wave Doppler are available on BK Medical’s bk5000 intraoperative ultrasound system. These modes enable visualisation of blood flow location and direction.

This is important when, for example, a surgeon is resecting an insular glioma. “The surgeon will need to be able to visualise the exact location of the insular arteries,” says Prof. Unsgård. “Power Doppler imaging during intraoperative ultrasound helps surgeons to visualise the lenticulostriate vessels, which are crucial vessels to the pyramidal tracts, and must be avoided during tumour surgeries.”


Brain Shift and Tumour Resection

Intraoperative ultrasound can also be used to account for brain shift during tumour resection. Current ultrasound technology provides detailed visualisation of the true location of the tumour and nearby structures of the brain, helping the surgeon to account for brain shift and update the surgical plan intraoperatively. “To perform a successful resection, you must be able to see the tumour border and residual tumour at their true locations,” he says.


“By visualising a tumour at its true location, surgeons can potentially remove more problematic tissue than they would if not using intraoperative ultrasound,” says Prof. Unsgård. “I plan for the use of ultrasound in every tumour operation.”

To learn more about BK Medical’s Ultrasound solutions, visit our page at https://bmec.asia/products_services/bk-medical/

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