Ultrasound: The Invaluable Tool For Neurosurgical Navigation.

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Aloka_ultrasound_probAloka Holding Europe AG is working with Dr Klaus Resch, neurosurgeon of the University of Greifswald and Klinikum München in Germany, to promote the potential for ultrasound to be used in combination with, or as a substitution of, CT/MRI as a neuro-navigational tool in certain operations.

As part of this collaborative effort, Dr Resch has this month started planning to extend his training program for neurosurgeons across all of Latin America after a successful pilot with surgeons in Mexico. He will unveil the full results of the Latin American initiative at the Neuroendoscopy 2011 conference taking place in Guadalajara (Mexico).

Ultrasound is more preferable than CT & MRI for neurosurgical navigation.

Dr Resch believes ultrasound has been greatly underused in neurosurgery over the past 20 years. He said, "I strongly advise all neurosurgeons to widen their imaging tools beyond just CT and MRIs. Intra-operative ultrasound can solve many problems that cannot be achieved with other imaging techniques. We are discovering new surgical uses of ultrasound daily and its use in the developing world could have enormously positive implications to patient safety — as the use of CT and MRI is low in these countries due to its prohibitive costs.”

Dr Resch's recommendation is based on a 1084-patient case study he conducted on the uses of ultrasound in surgery, one third of which were observed intra-operative and two thirds peri-operatively. In this study, it was proved completely that ultrasound was an excellent neuro-navigational system, which provided the surgeon with both real-time imaging and targeting capabilities in all of the intra-operative cases he observed (376 cases). In addition, it was also found that neurosurgical therapy outside the operating room could be markedly assisted by ultrasound.

Dr Resch is well known for the use of neurosurgical ultrasound and has discovered a broad variety of applications and indications both intra- and peri-operatively. He conducted his research using four bespoke Aloka probes in different settings,  including the TCD probe (use: intensive care unit), the small part sector probe (use: intra-operative), and the burr-hole probe (use: intra-operative). The results showed that ultrasound enabled the surgeon to be more reactive during surgery, with real-time images showing exactly how the lesion is being manipulated and how the brain reacts. In plain terms, this means the surgeon can view what is happening as he operates, without the need to stop the operation to obtain new images (CT or MRI), which can be very dangerous for the patient.

Moreover, ultrasound is also better than CT or MRI during these cases as, with real-time images, there is no risk of error due to the brain shifting. Furthermore, the surgeon can also rapidly locate vascular feeders and the source of any bleeding, a common and life threatening problem during operations. Additionally, Dr Resch has shown in Mexico that ultrasound could be an incomparable surgical tool in the developing world, where the cost of procuring an MRI or CT scanner is highly expensive in comparison to an ultrasound unit, he said: “Due to the cost-effective nature, logistical ease of use, and ergonomic character of ultrasound, it could have profound implications in the developing world and, this November, I will begin expanding my training programs for neurosurgeons across all of Latin America. However, high-end neurosurgical ultrasound depends entirely on having selected the appropriate probes and Aloka technology has been a big contributory factor in advancing its clinical uses.”

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