REVIEW
Introdução: Gliomas são os tumores mais invasivos e fatais do sistema nervoso central, sendo a ressecção total bruta (RTB) o padrãoouro para o tratamento cirúrgico. Dos métodos de imagem que auxiliam na sua ressecção, a ultrassonografia intraoperatória (USGi) apresenta-se como recurso no tratamento dessas neoplasias. Objetivo: Analisar sistematicamente a repercussão do uso da ultrassonografia intraoperatória na extensão de ressecção de gliomas. Métodos: Revisão sistemática, realizada em três bases literárias: PubMed, Embase, Cochrane Library e BVS, considerando artigos de 2017 até 2022, utilizando os descritores: “Neurosurgery”, “Ultrasonography” e “Tumor”, combinados ao operador Booleano “AND”. Resultados: Foram identificados uma metanálise, cinco ensaios clínicos não randomizados, oito coortes (sete retrospectivas e uma prospectiva), um caso-controle e quatro revisões de literatura totalizando 19 referências selecionadas. Conclusão: A USGi demonstrou aumento da extensão de ressecção (EDR), podendo alcançar RTB em alguns estudos. Seu desempenho é maior em gliomas de baixo grau em comparação aos de alto grau, particularmente sobre os gliomas irradiados. Também evidenciou-se aumento da especificidade, com sensibilidade relativamente variável. Ademais, a USGi constatou melhor desfecho cirúrgico e clínico, impactando favoravelmente no prognóstico dos pacientes, porém apresentando limitações por ser um método operador-dependente e possuir alta curva de aprendizagem.
Introduction: Gliomas are the most invasive and fatal tumors of the central nervous system, and gross total resection (GTR) is the gold standard for surgical treatment. Of the imaging methods that aid in its resection, intraoperative ultrasound (iUS) is a resource in the treatment of these neoplasms. Objective: To systematically analyze the impact of intraoperative ultrasound on the extent of glioma resection. Methods: Systematic review, carried out in three databases: PubMed, Embase, Cochrane Library and BVS, considering articles from 2017 to 2022, using as keywords “Neurosurgery”, “Ultrasonography” and “Tumor”, combined with the Boolean “AND”. Results: The search identified one meta-analysis, five non-randomized clinical trials, eight cohorts (seven retrospective cases and one retrospective perspective), one case-control and 4 literature reviews, totaling 19 papers selected. Conclusion: The iUS showed an increase in the extent of resection (EOR), obtaining GTR in some studies. Its performance is higher in low-grade than in high-grade gliomas, particularly on irradiated gliomas. There was also evidence of increased specificity, with relatively variable sensitivity. In addition, the iUS found a better surgical and clinical outcome, favorably impacting the prognosis of patients, but presenting limitations for being operator-dependent method and having a high learning curve.
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1 Medicine student, Medicine Course, Centro Universitário Tiradentes (UNIT-AL) – Maceió (AL), Brazil.
2 MD, Professor, Medicine Course, Centro Universitário Tiradentes (UNIT-AL) – Maceió (AL), Brazil.
3 MD, Neurosurgeon, Arthur Ramos Memorial Hospital (HMAR) – Maceió (AL), Brazil.
Received Nov 25, 2022
Accepted Dec 6, 2022
