Visualizing spinal tumors: a review of intraoperative contrast enhanced ultrasound during spinal tumor resections

Objective: Contrast-enhanced ultrasound (CEUS) is an imaging tool that has recently gained popularity for neurosurgical applications. By using microbubble contrast agents, CEUS improves the real-time visualization of vascular structures and tissue perfusion patterns in the brain and spinal cord. Visualizing tumor margins and vascular structures is an essential aspect of spinal cord tumor resections. However, current intraoperative methods are limited. CEUS offers a dynamic, noninvasive approach to delineate margins and vascular characteristics, potentially guiding more effective tumor resection. The objective of this review is to evaluate the current body of literature on the applications and advantages of CEUS for spinal cord tumor resections. Methods: PubMed, SCOPUS, and Cochrane databases were searched for studies pertaining to CEUS utilized during spinal tumor resections. Two authors extracted and independently reviewed the data to reduce bias. Tumor type, tumor location, and primary findings were summarized. Results: Eight studies with 76 subjects were analyzed. CEUS was used in the resection of 74 intradural intramedullary and 2 intradural extramedullary tumors, all of varying tumor types. CEUS proved to be a valuable intraoperative tool for visualizing tumor margins and illustrating perfusion characteristics of intramedullary spinal tumors in real-time. Conclusion: Current literature suggests that CEUS has the capability to provide real-time data for the visualization of tumor margins and perfusion patterns of spinal cord tumors. However, with only case reports and case series currently published, there is a need for future investigation into the clinical potentials of CEUS as an adjunct tool for guiding spinal cord tumor resections.