{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T06:53:26Z","timestamp":1782456806147,"version":"3.54.5"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Intraoperative contrast-enhanced ultrasound (iCEUS) offers dynamic imaging and provides functional data in real time. However, no standardized protocols or validated quantitative data exist to guide its routine use in neurosurgery. The authors aimed to provide further clinical data on the versatile application of iCEUS through a technical note and illustrative case series.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Five patients undergoing craniotomies for suspected tumors were included. iCEUS was performed using a contrast agent composed of lipid shell microspheres enclosing perflutren (octafluoropropane) gas. Perfusion data were acquired through a time-intensity curve analysis protocol obtained using iCEUS prior to biopsy and\/or resection of all lesions.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Three primary tumors (gemistocytic astrocytoma, glioblastoma multiforme, and meningioma), 1 metastatic lesion (melanoma), and 1 tumefactive demyelinating lesion (multiple sclerosis) were assessed using real-time iCEUS. No intraoperative complications occurred following multiple administrations of contrast agent in all cases. In all neoplastic cases, iCEUS replicated enhancement patterns observed on preoperative Gd-enhanced MRI, facilitated safe tumor debulking by differentiating neoplastic tissue from normal brain parenchyma, and helped identify arterial feeders and draining veins in and around the surgical cavity. Intraoperative CEUS was also useful in guiding a successful intraoperative needle biopsy of a cerebellar tumefactive demyelinating lesion obtained during real-time perfusion analysis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Intraoperative CEUS has potential for safe, real-time, dynamic contrast-based imaging for routine use in neurooncological surgery and image-guided biopsy. Intraoperative CEUS eliminates the effect of anatomical distortions associated with standard neuronavigation and provides quantitative perfusion data in real time, which may hold major implications for intraoperative diagnosis, tissue differentiation, and quantification of extent of resection. Further prospective studies will help standardize the role of iCEUS in neurosurgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.11.focus15570","type":"journal-article","created":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T03:37:27Z","timestamp":1456803447000},"page":"E6","source":"Crossref","is-referenced-by-count":26,"title":["Versatile utilization of real-time intraoperative contrast-enhanced ultrasound in cranial neurosurgery: technical note and retrospective case series"],"prefix":"10.3171","volume":"40","author":[{"given":"Ilya","family":"Lekht","sequence":"first","affiliation":[{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Brauner","sequence":"additional","affiliation":[{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Bakhsheshian","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Eun","family":"Chang","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mittul","family":"Gulati","sequence":"additional","affiliation":[{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward G.","family":"Grant","sequence":"additional","affiliation":[{"name":"Departments of Radiology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisha","family":"Christian","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15570","series-title":"Cancer","first-page":"4376","article-title":"Extent of resection and overall survival for patients with atypical and malignant meningioma","volume":"121","author":"Aizer","year":"2015"},{"key":"b2-focus15570","series-title":"Curr Neurol Neurosci Rep","first-page":"517","article-title":"The value of extent of resection of glioblastomas: clinical evidence and current approach","volume":"15","author":"Almeida","year":"2015"},{"key":"b3-focus15570","series-title":"Ultraschall Med","first-page":"478","article-title":"Evaluation of cerebral perfusion deficit in stroke patients using new transcranial contrast imaging CPS technology\u2014preliminary results","volume":"26","author":"Bartels","year":"2005"},{"key":"b4-focus15570","series-title":"Molecular Imaging: Principles and Practice","first-page":"425","article-title":"Ultrasound contrast agents","author":"Borden","year":"2010"},{"key":"b5-focus15570","series-title":"Ultraschall Med","first-page":"28","article-title":"Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) -update 2008","volume":"29","author":"Claudon","year":"2008"},{"key":"b6-focus15570","series-title":"Neuroradiology","first-page":"560","article-title":"Tumefactive demyelinating lesions","volume":"38","author":"Dagher","year":"1996"},{"key":"b7-focus15570","series-title":"Ultrasound Med Biol","first-page":"571","article-title":"Feasibility of contrast-enhanced sonography during resection of cerebral tumours: initial results of a prospective 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