Intraoperative Ultrasound an Economical Tool for Neurosurgeons: A Single-Center Experience.

BACKGROUND: Over the past decade, the use of intraoperative image guidance in neurosurgery has gradually gained in importance. Apart from some sophisticated and very expensive techniques, intraoperative ultrasound (IOUS) is a simple and economical technique that allows the surgeon to localize deep-seated lesions under a real-time ultrasonic image display without dissection. The purpose of this study was to present our own preliminary experiences in various (n=1250) neurosurgical procedures carried out at our tertiary care centre in a developing country. MATERIALS AND METHODS: A Prospective study was carried out in our department of neurosurgery at Grant Medical College and Sir J J Group of hospitals from January 2010 to May 2019. IOUS was used during various elective neurosurgical procedures done during this period as given in table no below. A total of 1250 patients, 850 supratentorial lesion, 290 infratentorial lesion and 110 spinal lesion, were included in this study. All studies were performed using an ultrasound machine with variable 3.5~7.5 MHz sector transducers. The echogenicity and pathomorphology between IOUS and computed tomography/magnetic resonance imaging (CT/MRI) of various disease entities were compared. RESULTS: Intracranial structures could be well demonstrated by ultrasound once the skull was opened. Most of the intracranial lesions were hyperechoic, except those with a cystic component. IOUS was more sensitive in demonstrating non-enhanced solid lesions and lesions with a cystic component than was preoperative CT/MRI. The border between the tumor and healthy brain was better delineated on IOUS in all cases aiding in tumor resection. CONCLUSIONS: High-resolution real-time IOUS is a convenient and user-friendly method for identifying, localizing, and characterizing the pathological focus during an operation. Such information is very important and can enhance surgical results.

Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies.

PURPOSE: Nerve disorders are commonly encountered in clinical practice. Ultrasonography (USG) is a useful modality in the evaluation of most of the peripheral and superficial pathologies amenable to penetration by ultrasound. The primary objective is to study the USG findings of various peripheral nerve pathologies and to correlate them with electrophysiological (EMG-NCV) findings. METHOD: 42 patients referred with suspicion of peripheral nervous system affection were evaluated with USG along with EMG-NCV. After reviewing detailed anatomy of the region, the affected nerve was visualized along the major neurovascular bundle or at a known anatomical landmark with a high-frequency (9-20 MHz) linear/hockey stick transducer. RESULTS: The USG parameters, namely loss of fibrillary pattern, hypoechogenicity and nerve thickening, showed significant p value (p < 0.05) on the tests of significance, suggesting these parameters are significant predictors of nerve affection/pathology on USG. Each ultrasound parameter was correlated individually with SNAP and CMAP. The results revealed positive correlation of echogenicity (r = 0.210, p = 0.05), fibrillary pattern (r = 0.209, p = 0.05) and thickening (r = 0.387, p < 0.05) with sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). CONCLUSION: USG can be used as corroborative investigation to strengthen the findings of EMG-NCV. This combination represents a powerful tool in enabling appropriate planning for treatment, preventing unnecessary intervention and thus improving overall outcomes in patients with peripheral neuropathy.

Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound.

Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge, this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

Sonographic diagnosis of ectopic pregnancy 2 years after total hysterectomy.

We report a case of a 35-year-old multigravida with a chief complaint of 8 days of mild pain in the lower abdomen with history of vaginal hysterectomy 2 years prior. Ultrasonography and MRI showed a gestational sac-like structure with a fetal pole in the pelvis. Urine pregnancy test was positive with increased beta-HCG levels. Diagnosis of ectopic pregnancy was made. Surgical exploration and subsequent histopathology confirmed the sonographic findings.

Role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano.

OBJECTIVE: The purpose of this study was to evaluate the role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano and to assess its possible role as a first-line investigation, for follow-up, and as a possible substitute for magnetic resonance imaging. METHODS: Transcutaneous perianal ultrasonography was performed in 30 patients with fistulas in ano with the use of a 3- to 6-MHz sector probe, a 7- to 11-MHz linear probe, and a 5- to 7-MHz endocavitary probe. Patients were followed clinically and at surgery to assess the accuracy of transcutaneous perianal ultrasonography. RESULTS: A total of 43 fistulas, sinus tracts, or both were found in 26 patients. They appeared as hypoechoic tracts. Eleven of 30 patients had the presence of a collection or abscess, which appeared as hypoechoic areas. Twenty-four of 29 patients with positive findings underwent surgery. In these, 35 of 39 tracts were surgically confirmed (positive predictive value, 90%). The positive predictive value for demonstration of an internal opening was 85% (22/26) when compared with direct visualization or probing. Sensitivity for detection of tracts was 100%, and that for demonstration of an internal opening was 96% (26/27). The negative predictive value for sinus/fistulous tracts was nearly 100%. Transcutaneous perianal ultrasonography could not adequately evaluate suprasphincteric-type fistulas. However, it is a good, inexpensive modality in the evaluation of patients with fistulas in ano and also helps in follow-up of these patients. It can also be used to select patients who need magnetic resonance imaging. CONCLUSIONS: Transcutaneous perianal ultrasonography has the potential to become the first investigation in patients with perianal fistulas and abscesses.