In the surgical resection of intracranial tumors, exact localization of the intracranial mass is the key to achieving complete tumor resection to reduce the recurrence rate but preserve or improve the patient′s neurological functions. At present, imaging guided neuronavigation techniques include intraoperative CT (iCT), intraoperative MRI (iMRI), and intraoperative ultrasound (ioUS). iCT and iMRI are restricted not only by time and space, but also by expensive equipment and the need for a dedicated room. Therefore, their use has been limited. IoUS ensures rapid, reproducible, and cost-effective real-time intraoperative imaging without those limitations to help surgeons understand the spatial location of the lesions after craniotomy. In this regard, standard B-mode ultrasound offers significantly useful morphologic information, and different Doppler modalities as well as contrast-enhanced ultrasound offer information regarding tumor vascularization and perfusion. Intraoperative elastosonography appears to be of value in evaluating tumor borders, parenchymal infiltration, and tumor consistency, which needs further research. This paper introduces the application of ioUS in neurosurgery.%在颅内肿瘤切除手术中,如何最大程度地切除颅脑肿瘤以控制其生长和复发,同时最大程度地保留正常的神经功能而改善生活质量,其关键在于对病变的准确定位,因此神经系统定位导航的存在有其必要性.目前影像学引导的神经导航技术包括术中CT、术中磁共振(MRI)以及术中超声定位技术,术中CT、术中MRI受时间、空间的限制,且设备昂贵,需专用的房间,因此使用和推广受到了限制.术中超声则不受这些限制,具有实时方便、安全无创、费用低廉、定位准确、可重复操作等优势,为术者提供准确、清晰的实时图像,帮助术者了解病变的空间位置关系及开颅后病灶移位情况.显示形态学信息的术中二维超声模式以及显示肿瘤内及其周围血流信号的彩色多普勒超声、超声造影(CEUS)技术已成为神经外科手术切除颅脑肿瘤的常用方法,弹性成像在评价肿瘤边界,对组织的浸润程度及肿瘤的硬度方面有一定的价值,还有待进一步研究.本文主要介绍术中超声的多种模式在神经外科手术中的应用情况.
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