Ultrasound guided excision of intra dural spinal tumors

Abstract Background Intradural spinal tumors, though rare, pose significant surgical challenges due to risks of mislocalization and neurological deficits. Intraoperative ultrasound (IOUS) offers real-time visualization to enhance resection accuracy, yet its utility compared to traditional methods remains understudied. The study aims to evaluate the feasibility of IOUS in improving visualization, localization, and complete excision of intradural spinal tumors (intramedullary/extramedullary). This was a Prospective observational descriptive study conducted on a total of 40 patients in Mansoura University Hospitals, Department of Neurosurgery from May 2022 to May 2024. Results Mean age was 42.6 ± 13.8 years; 52.5% were female. IOUS and MRI concordantly detected GTR in 77.5% (31/40). Residual tumor was identified by IOUS in 22.5% (9/40) versus MRI in 22.5%. Postoperative complications occurred in 22.5% (9/40), predominantly motor weakness. Vascularity assessment revealed poor (32.5%), average (35%), and high (27.5%) perfusion. Tumor echogenicity varied by pathology: hyperechoic (schwannomas, meningiomas), hypoechoic (ependymomas), and heterogeneous (astrocytomas). Modified McCormick scores improved significantly at follow-up (79.5% grade 1 vs. 17.5% preoperatively, p < 0.001). Conclusion IOUS enhances surgical precision by delineating tumor margins, guiding durotomy/myelotomy, and reducing residual tumor rates. It is cost-effective, minimizes spinal cord injury, and correlates strongly with postoperative MRI findings.