Evaluation of the Role of Intraoperative Ultrasound in Resection of High and Low-Grade Gliomas

Background: Glioma procedures require accurate intraoperative EOR assessment because complete resection improves prognosis and reduces recurrence. Compared to postoperative MRI, the reliability of intraoperative imaging depends on glioma grade and location. This study examines the consistency between intraoperative resection assessments and postoperative MRI results in high- and low-grade gliomas.
Methods: This descriptive analysis comprised 45 patients with high-grade (n = 31) and low-grade (n = 14) gliomas verified by MRI, contrast-enhanced MRI, and MR spectroscopy. Klinikum St. Marien Amberg, Bavaria, Germany, and Assiut University Hospital's Neurosurgery Department, Egypt, performed surgeries. Using intraoperative ultrasound, entire, subtotal, and partial resections were assessed. After surgery, residual tumor volume was assessed by MRI within 72 hours.
Results: There were significant demographic variations across groups. High-grade glioma patients were older (52.61 ± 13.18 years vs. 36.93 ± 14.90 years, p < 0.001) and generally male (61.3% vs. 28.6%, p = 0.042). Intraoperative resection evaluation matched postoperative MRI results for high-grade (κ = 0.666, p < 0.001) and low-grade gliomas (κ = 0.772, p < 0.001). Total resection was discovered intraoperatively in 15 of 16 high-grade and 6 of 7 low-grade instances. Intraoperative and postoperative assessments of subtotal and partial resections were also consistent. Lower-grade gliomas had more subtotal resections (35.7% vs. 25.8%), the biggest difference.
Conclusions: In both high-grade and low-grade gliomas, intraoperative imaging, particularly ultrasonography, is useful for measuring resection extent. Advanced imaging modalities can increase intraoperative evaluation accuracy and surgical results for high-grade gliomas, which agree significantly less with postoperative MRI findings.