Mr William Lo

Consultant Neurosurgeon, Birmingham Children’s Hospital

Intraoperative ultrasound imaging technology is being used in brain tumour operations to give surgeons a view of the brain and help them make real-time surgical decisions.

Ultrasound imaging has long been a fixture of the radiology department and antenatal clinic, allowing healthcare professionals to make diagnoses and monitor the development of a baby in the womb. Yet, there are versions of the technology, like intraoperative ultrasound, that can also play a critical role during complex surgical procedures — including operations to remove brain tumours.

Intraoperative ultrasound benefits in surgeries

“Before surgery, the patient will usually have an MRI scan to show the location and size of a tumour,” explains Mr William Lo, Consultant Neurosurgeon at Birmingham Children’s Hospital. “However, the brain is a soft structure, which moves and shifts during the operation, so these pre-acquired images no longer represent what the surgeons are dealing with.

This is why intraoperative ultrasound is so helpful. During the operation, an ultrasound scanner provides the surgeons live images of the tumour and its precise location, including the depth not visible to the naked eye — as well as real-time information about the vessels and normal brain structures surrounding it. The information enables the surgeons to modify their surgical decision-making. Unlike X-ray-based imaging, there is no exposure to radiation.

Live images of tumour boundary during operations

At Birmingham Children’s Hospital, Mr Lo and his team routinely use the technology in various surgical scenarios, including brain tumour resections. “When performing a brain tumour resection, the aim is to remove as much of the tumour as possible to increase the chance of survival and reduce the risk of recurrence,” he says. “Ultrasound helps us visualise exactly where the tumour ends and where the healthy brain tissue begins; in other words, the resection margin. Staying along this boundary helps preserve the patient’s neurological function — for instance, movement, speech and visual function.”

The image quality from a modern
scanner is excellent, and the design
of the machine is user-friendly.

In 2021, Birmingham Children’s Hospital acquired a new intraoperative ultrasound system to improve patient outcomes. “Ultrasound technology is continuously improving,” says Mr Lo. “The image quality from a modern scanner is excellent, and the design of the machine is user-friendly, making it easier for surgeons to obtain useful visual information when they most need it.”

Enhanced precision and safety in brain biopsies

In some cases, the brain tumour is in a deep or sensitive location, and therefore, resection is inappropriate. The diagnosis then relies on a minimally invasive biopsy, where a needle is passed into the brain to obtain a small sample of the tumour. By providing live images of the needle, ultrasound provides reassurance and confirmation that the surgeons have reached the target safely.

Risk reduction advantages for patients

The ability to ‘see through’ the brain, in real-time during different kinds of brain tumour surgeries allows neurosurgeons to carry out the procedures more accurately and effectively. This ultimately improves patient safety, surgical outcomes and overall care quality for brain tumour patients.

Brain tumour surgery with intraoperative ultrasound frees patient from epilepsy seizures

Roxy Croxford

Patient

Roxy Croxford’s brain tumour was successfully removed with the help of intraoperative ultrasound — technology that gives surgeons a real-time view of a lesion’s location.

Two years ago, at 14, Roxy Croxford had a strange feeling in her right leg. “Tremors started running through it — shaking that lasted for a couple of minutes,” she remembers. “This started to happen three or four times a day.”

Impact of childhood brain tumour

Her condition got progressively worse. During a family holiday, Roxy had a shaking attack that was more violent than ever. Back in the UK, she had a full seizure. Ultimately, Roxy was referred to a specialist at Warwick Hospital and diagnosed with epilepsy.

“Epilepsy meant I couldn’t walk to school on my own in case I had a seizure,” says Roxy. “It affected everything. I couldn’t even sit on the top deck of a bus in case I fell down the stairs and couldn’t go swimming without telling the lifeguard about my condition. It’s extremely debilitating.”

I’m not as scared that I’m going
to randomly have a seizure while
walking down the street.

Being identified as a candidate for brain surgery

Despite the medication, the seizures persisted. The results of the MRI showed the cause: Roxy had a growth on her brain — a low-grade glioma (usually benign) located in the area that controlled leg movement. She was referred to Birmingham Children’s Hospital where she was identified as a candidate for surgery under the care of Mr William Lo, Consultant Neurosurgeon.

Mr Lo and his team carried out the operation earlier this year using intraoperative ultrasound, which shows surgeons a live, real-time view of the tumour and its precise location. It gives confidence to the surgical team that the tumour was completely removed without comprising the important surrounding normal brain tissue.

After its successful removal, the tumour was confirmed to be benign. Roxy has been seizure-free since. “Forty-five minutes after coming round from surgery, I was sitting up, eating,” says Roxy. “Mr Lo has been fantastic. He explained what was going to happen in a simple and matter-of-fact way, so we knew what the plan was and adhered to it.”

Roxy is now getting back to all the things she enjoys doing. “When I go out, I’m not as scared that I’m going to randomly have a seizure while walking down the street,” she says. “I feel much more confident about what I can do.”