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Heather Smith, AmiLyn Taplin, Sohail Syed and Matthew A. Adamo

anatomical landmarks such as the ventricles or falx. Intraoperative ultrasound was conducted periodically throughout to assess the progression and appropriate trajectory of resection. Once the tumor appeared completely resected by gross inspection, the ultrasound machine was brought back in for a final scan. If IOUS detected remnant tumor, resection was carefully continued until the final IOUS scan yielded a negative evaluation. Residual tumor in 11 patients was known at the time of surgery or even predicted during surgical planning because the tumor encroached on

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Hidetoshi Nojiri, Kei Miyagawa, Hiroto Yamaguchi, Masato Koike, Yoshiyuki Iwase, Takatoshi Okuda and Kazuo Kaneko

, 16 Abdominal ultrasound distinguishes both solid organs and the intestinal tract and enables visualization of the structure of the intestinal layers and intestinal lesions. 3 The use of intraoperative ultrasound during heart surgery 9 and laparoscopic surgery 6 has been extensively studied. Moreover, ultrasound has reportedly been used for visualizing the position of spinal cord tumors and the spinal cord in spinal surgery as well as in surgeries for nerve compression caused by bone fragments and herniated discs. 14 To the best of our knowledge, our study is

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Clayton L. Haldeman, Christopher D. Baggott and Amgad S. Hanna

Historically, peripheral nerve surgery has relied on landmarks and fairly extensive dissection for localization of both normal and pathological anatomy. High-resolution ultrasonography is a radiation-free imaging modality that can be used to directly visualize peripheral nerves and their associated pathologies prior to making an incision. It therefore helps in localization of normal and pathological anatomy, which can minimize the need for extensive exposures. The authors found intraoperative ultrasound (US) to be most useful in the management of peripheral nerve tumors and neuromas of nerve branches that are particularly small or have a deep location. This study presents the use of intraoperative US in 5 cases in an effort to illustrate some of the applications of this useful surgical adjunct.

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Robert Goodkin, David R. Haynor and Michel Kliot

A nterior vertebrectomy has become popular for the treatment of cervical myelopathy caused by cervical spondylosis with extensive posterior osteophyte formation, posterior longitudinal ligament hypertrophy or ossification, cervical kyphosis, or tumors or infections of the vertebral body. One of the factors believed to affect surgical outcome is the completeness of the vertebrectomy laterally, which can affect decompression of the spinal canal and spinal cord. We report the use of intraoperative ultrasound to determine the extent of vertebral body resection

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Ignazio G. Vetrano, Francesco Prada, Ilaria F. Nataloni, Massimiliano Del Bene, Francesco Dimeco and Laura G. Valentini

, Nataloni, Del Bene. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Prada. Study supervision: DiMeco. References 1 Baker KB , Moran CJ , Wippold FJ II , Smirniotopoulos JG , Rodriguez FJ , Meyers SP , : MR imaging of spinal hemangioblastoma . AJR Am J Roentgenol 174 : 377 – 382 , 2000 2 Chadduck WM , Flanigan S : Intraoperative ultrasound for spinal lesions . Neurosurgery 16 : 477 – 483 , 1985 3 Chu BC

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Zvi Ram, Thomas H. Shawker, Mary H. Bradford, John L. Doppman and Edward H. Oldfield

ultrasound system to compensate for soft-tissue attenuation in standard B-mode ultrasound imaging. 10 In this article we report the results of intraoperative scanning in 28 patients with sellar tumors using the modified equipment. Clinical Material and Methods Patient Population Twenty-eight patients were evaluated by intraoperative ultrasound (IS). Twenty-one of these patients had Cushing's disease (three with recurrent tumors); three had growth hormone (GH)—secreting tumors, two thyroid-stimulating hormone (TSH)—secreting tumors, one a nonfunctioning adenoma

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Hideo Otsuki, Susumu Nakatani, Mami Yamasaki, Akira Kinoshita, Fuminori Iwamoto and Naoki Kagawa

with coupling gel and placed within a sterile cover. An acoustic window was obtained through the craniotomy site, and the sheathed scanning head was placed on the dura. The probe was moved over the intact dura, providing real-time images of the lesion and surrounding anatomy. Three-dimensional images were reconstructed from these two-dimensional images. Duplex CHA ultrasonography was performed with and without intravenous administration of UCA. The institutional review board at Osaka National Hospital approved the intraoperative ultrasound examinations performed

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Peter D. LeRoux, Mitchel S. Berger, George A. Ojemann, Keith Wang and Laurence A. Mack

obtained from brain adjacent to tumor that was not contrast-enhancing on CT scans yet showed an abnormal (increased) signal on MR pulse repetition time (TR) images. 17 Since the advent of real-time ultrasound scanning, numerous investigators have demonstrated its benefits during neurosurgical procedures. 4, 8, 10, 12, 19, 22, 37, 39 Tumors are easily localized as hyperechoic relative to normal brain, and detailed information about morphology, consistency, and spatial relationships to adjacent structures can be obtained. Intraoperative ultrasound delineates the tumor

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Maarouf A. Hammoud, B. Lee Ligon, Rabih Elsouki, Wei Ming Shi, Donald F. Schomer and Raymond Sawaya

margins and of any infiltration outside the margins. Preoperative computerized tomography (CT) and magnetic resonance (MR) imaging readily identify the morphological features of tumors, but neither one sufficiently depicts the margins of a solid tumor, infiltrating tumor cells, peritumoral edema, or normal brain adjacent to tumor. 10, 11, 20, 21 Intraoperative ultrasound (IOUS) has been shown to have especially important potential because it identifies most brain lesions, 6, 7, 35 and differentiates solid tissue from liquefaction or cyst. 19 Its particular relevance

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Rand M. Voorhies, William O. Bell, Russel H. Patterson Jr. and Francis W. Gamache Jr.

performed at 5 MHz. Left: A superficial parietal lesion (arrow) and a deep midline lesion (double arrow) are visualized. Center: The small cottonoid patty in the bottom of the cortisectomy (open arrow) is lying to one side of the superficial tumor. Right: The linear echo extending to the left at the 10 o'clock position is the falx. The cottonoid patty is now in the center of the superficial tumor ( white arrow with open arrow superimposed). Discussion Intraoperative ultrasound allows the surgeon to visualize a tumor before the cortical