الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background
The application of imaging during surgery can improve patient outcomes by accurate and thorough removal of lesions while having minimal impact on healthy tissue.
Maximum safe resection has shown to improve outcome by extending survival and relieving tumor pressure. Multiple intraoperative aids have been introduced over the last two decades to help surgeons achieve maximum safe resection. In this study we compared the use of Neuronavigation to intraoperative ultrasound guidance in excision of intra-axial brain lesion.
Patients and methods
We conducted a cohort study comparing the use of neuronavigation to intraoperative ultrasound guidance in excision of intra-axial brain lesion. We included patients with intra-axial brain lesion is amenable to gross total resection. The primary outcome was extent of resection assessed using a non-volumetric technique. Other outcomes included the postoperative functional status and the rate of operative complications.
Results
There were 34 patients in the Neuronavigation group and 17 patients in the ultrasound group. The extent of resection was significantly better in the ultrasound group as the extent of tumor resection based on the GTR/NTR/STR
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method of assessment showed that the IOUS group had statistically significant higher chance of achieving GTR (29.4%) than the navigation group (8.8%). In the IOUS group near total and subtotal resection rates were 17% and 52% respectively. In neuronavigation group 11.8% and 79.4%.
Discussion
Neuronavigation systems have been developed for image-guided neurosurgery to aid in the accurate resection of brain tumors.
Navigation techniques help to make non traumatic openings and approaches. Also, it decreases the risk for neurological morbidity by allowing the surgeon to determine the relationships of the lesion and surgical approach to nearby critical brain structures. . One of the shortcomings of this system is Brain Shift and Local Tissue Deformation. This can be minimized by intraoperative ultrasonography. (IOUS) is a useful tool in achieving a higher extent of tumor resection (EOR). IOUS is also a relatively cheap technology that can be easily learned, making it an ideal image guidance choice in a limited resource setting.
Conclusion
We recommend application of ultrasound integrated in Neuronavigation system guidance in surgery excision of intra-axial brain lesions as a useful tool in achieving a higher extent of tumor resection (EOR)