Intraoperative Neurosonography in Patients with Spinal Cord Tumors

Objective: To analyze the application of the ultrasonic methods in surgery of spinal cord tumors and the correlations between echographic, magnetic resonance and surgical findings. Material and methods: Since 2007, eighteen patients with spinal tumors, diagnoseg by MRI have been treated with ultrasound-guided surgery. Ultrasound anatomy of spinal cord next to the pathologic processes was investigated. Ultrasound exploration was performed during laminectomy on the dural surface in all cases and after the dural opening of the spinal cord surface for intramedullary tumors. Results: In all patients the ultrasound exploration allowed to exactly define the extent of the laminectomy, dural opening and myelotomy. Meningiomas were hyperechoic and homogeneous with well defined margins and often visible hyperchogenic dural attachment. Neurinomas were less hyperechoic and less homogeneous than meningiomas. Intramedullary tumors showed homoechoic solid and hypoechoic cystic-necrotic components, although a specific tissue characterization (tumor infiltration, gliosis, edema) is not possible. Discussion: Intraoperative neurosonography should be used routinely during surgery for spinal tumors in order to reduce the extent of the laminectomy, dural opening and myelotomy. A good correlation exists between the signal intensity on T1-weighted images of MRI, echographic aspect of the tumor and pathological interaoperative findings.