AUTHOR=Carai Andrea , De Benedictis Alessandro , Calloni Tommaso , Onorini Nicola , Paternò Giovanni , Randi Franco , Colafati Giovanna Stefania , Mastronuzzi Angela , Marras Carlo Efisio 

TITLE=Intraoperative Ultrasound-Assisted Extent of Resection Assessment in Pediatric Neurosurgical Oncology

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.660805

DOI=10.3389/fonc.2021.660805

ISSN=2234-943X

ABSTRACT=Central nervous system tumors represent the most frequent solid malignancy in the pediatric population. Maximal safe surgical resection is a mainstay of treatment, with significant prognostic impact for the majority of histotypes. 
Intraoperative ultrasound (ioUS) is a widely available tool in neurosurgery to assist in intracerebral disease resection. Despite technical caveats, preliminary experiences suggest a satisfactory predictive ability, when compared to magnetic resonance imaging (MRI) studies. Most of the available evidence on ioUS applications in brain tumors derives from adult series, a scenario that might not be representative of the pediatric population.
We present our preliminary experience comparing ioUS-assisted resection assessment to early post-operative MRI findings in 154 consecutive brain tumor resections at our pediatric neurosurgical unit. 
A high concordance was observed between ioUS and post-operative MRI. Overall, ioUS positive predictive value was 98% and negative predictive value 92On a multivariate analysis, the only variable significantly associated to unexpected tumor on residual on MRI was low grade glioma histology. Tumor location, patient positioning during surgery, age and initial tumor volume were not significantly associated with ioUS predictive ability.
Our data suggest a very good predictive value of ioUS in brain tumor resective procedures in children. Low grade glioma, high grade glioma and craniopharyngioma might represent a setting deserving specific endeavours in order to improve intraoperative extent of resection assessment ability.