A technical note: pre-operative ultrasound-guided wire localization in head and neck surgery

Ultrasound-guided wire localisation: a GPS for hidden head and neck tumours? A case series

Objectives

Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection.

Methods

All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons.

Results

Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications.

Conclusions

USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.

Lower extremity peripheral nerve pathology: Utility of preoperative ultrasound-guided needle localization before operative intervention

Historically, the use of ultrasound (US) in the management of peripheral nervous system (PNS) pathology has been limited to diagnostic confirmation or guidance for interventional injections. This technical case series will demonstrate the utility and versatility of preoperative US-guided needle localization for the excision of lower extremity neuromas and other pathology of the PNS. Five patients with symptomatic lower extremity PNS tumors were retrospectively reviewed. This case series corroborates the technical nuances of localizing lower extremity neuromas by US-guided needle and wire placement prior to operative excision. This was achieved by a multidisciplinary team that included plastic surgery, neurosurgery, and radiology. Five patients had US-guided needle localization of a lower extremity PNS target prior to operative intervention. Three patients had lower extremity neuromas of varying origins, including the lateral femoral cutaneous nerve (LFCN), saphenous nerve, and sural nerve. The remaining two patients had a sciatic nerve sheath Schwannoma and a femoral nerve glomus tumor. Under sonographic visualization, a needle was advanced to the target perimeter and withdrawn, leaving behind a percutaneous guidewire. This technique simplified the marking of the nerve course prior to dissection and led to efficient intraoperative identification of all five PNS tumors without any complications. Preoperative US-guided needle localization led to safe, accurate, and efficient perioperative and intraoperative identification of neuromas and other PNS tumors of the lower extremity prior to excision. By reducing the challenges of nerve identification in a scarred tissue bed, this multidisciplinary approach may decrease postoperative patient morbidity.

Ultrasound-guided hookwire localization of non palpable cervical lymphadenopathy: A case-control study of operative time

OBJECTIVE

We aimed at evaluating the impact of ultrasound-guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time.

DESIGN AND METHODS

Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H-) per operative US-guided hook-wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery-related adverse events data were collected.

RESULTS

Mean operative time was significantly shorter in H+ group versus H- group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H-, p = 0.1). No significant between group difference in surgery-related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1).

CONCLUSION

US-guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H-.

Use of wire guided localization for resection of recurrent, oligometastatic gynecologic clear cell carcinoma to anterior abdominal wall

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Pretreatment with both radiation and surgery potentially complicate further efforts to surgically resect recurrent tumors.

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Patient habitus and presence of fibrotic tissue may impair identification of cancerous disease.

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In this case, image-guided wire localization improved resection accuracy and minimized anatomic disfiguration.

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Our use of wire guided localization resulted in negative margins and an uneventful patient recovery.

We present the case of apparent oligometastatic, recurrent clear cell carcinoma in the abdominal wall. Due to central obesity, previous abdominal wall surgeries, and previous radiotherapy, the mass was non-identifiable by conventional surgical dissection. A wire guided localization technique placed preoperatively facilitated the identification and resection of the malignant nodule with negative surgical margins.

Preoperative Ultrasound-guided Wire Localization of Soft Tissue Masses Within the Musculoskeletal System

Ultrasound-guided hookwire localization was initially introduced to facilitate the excision of nonpalpable breast lesions by guiding surgical exploration, thereby reducing operative time and morbidity. The same technique has since found utility in a range of other applications outside breast and can be useful within the musculoskeletal system. Despite this, there remains limited literature with respect to its technical aspects and practical utility. We describe our technique and a series of preoperative ultrasound-guided wire localizations in the musculoskeletal system to assist surgical excision of 4 soft tissue masses.

Pre-operative ultrasound guided wire localization for recurrent or persistent thyroid disease: A series of four cases

INTRODUCTION

Successful pediatric revision thyroid surgery depends primarily on effective localization of recurrent or persistent lesions. Secondary to fibrosis and scarring, blind regional dissection can fail to retrieve the tissues of concern. Conventionally, high resolution CT or ultrasound of the neck has been used to map lesions within the thyroid bed. The success rate of excising recurrent lesions using these mapping techniques is at best 80%. We present a small series of patients in which hook wire localization was used to help localize and excise recurrent and/or persistent neck disease during secondary operations.

METHODS

The wire-localization technique was utilized for a prospective case series of four pediatric patients with history of previous thyroidectomy and recurrent or persistent malignant thyroid disease.

RESULTS

All four patients had recurrence or persistence of their disease process in the central or lateral neck. Patients successfully underwent preoperative hook wire localization of their persistent or recurrent neck lesions with successful subsequent neck dissection. Each case involved a single wire localization for a unique mass, equally a total of 4 lesions accessed by the technique over the four cases. The ultrasound-guided wire-localization technique assisted in the localization and excision of non-palpable lesions. No complications were seen in our small series as a result of this technique.

CONCLUSION

Hook wire localization may be a useful tool to help the surgeon more efficiently localize and excise recurrent or persistent disease in a scarred/previously operated field.

Preoperative Ultrasound-Guided Wire Localization of the Lateral Femoral Cutaneous Nerve

BACKGROUND

Difficulty and sometimes inability to find the lateral femoral cutaneous nerve (LFCN) intraoperatively is well known. Variabilities in the course of the nerve are well documented in the literature. In a previous paper, we defined a tight fascial canal that completely surrounds the LFCN in the proximal thigh. These 2 factors sometimes render finding the nerve intraoperatively, to treat meralgia paresthetica, very challenging.

OBJECTIVE

To explore the use of preoperative ultrasound to minimize operative time and eliminate situations in which the nerve is not found.

METHODS

Since 2011, we have used preoperative ultrasound-guided wire localization (USWL) in 19 cases to facilitate finding the nerve intraoperatively. Data were collected prospectively with recording of the timing from skin incision to identifying the LFCN; this will be referred to as the skin-to-nerve time.

RESULTS

In 2 cases, the localization was incorrect. In the 17 cases in which the LFCN was correctly localized, the skin-to-nerve time ranged from 3 min to 19 min. The mean was 8.5 min, and the median was 8 min.

CONCLUSION

Preoperative USWL is a useful technique that minimizes the time needed to find the LFCN. For the less experienced surgeon, it is extremely valuable. For the experienced surgeon, it can identify anatomical abnormalities such as duplicate nerves, which may not be readily recognizable without ultrasound. Collaboration between the surgeon and the radiologist is very important, especially in the early cases.

Pre-operative CT-guided wire localization of a retroperitoneal mass for laparoscopic surgery

A 48-year-old female with a 9-year history of granulosa cell tumour presented with progression of a mass in the left flank after the recent gradual rise of her inhibin B levels. She had experienced multiple recurrences and had undergone multiple operations to resect previous tumour recurrences. Initial laparoscopy did not identify the most recent recurrent mass. MRI was repeated a month after the surgery; it confirmed the presence of the mass and demonstrated an increase in the size of the tumour. Owing to difficulties in finding the tumour, a CT-guided wire localization of the mass was performed immediately prior to a second elective laparoscopy, leading to successful removal of the recurrent granulosa cell tumour. We describe the use of a conventional localization wire under CT guidance to facilitate the resection of a unique retroperitoneal tumour. This case report discusses the current applications of the wire localization technique, the evolution of the hook wire system, the potential complications that may occur and the factors influencing the likelihood of success of wire localization in the retroperitoneal space.

Neck tumor dissection improved with 3-dimensional ultrasound image guidance: technical case report

BACKGROUND AND IMPORTANCE

Three-dimensional ultrasound navigation has been performed to assist in resection of cranial and spinal tumors, but to the best of our knowledge, no one has described the use of real-time 3-dimensional ultrasound navigation in the resection of neck tumors beyond biopsy.

CLINICAL PRESENTATION

This case report describes the use of 3-dimensional ultrasonic navigation in assisting with resection of a large neck paraganglioma. The 3-dimensional ultrasonic navigation improved real-time visualization of the carotid arteries, the trachea, and other vital structures.

CONCLUSION

The use of 3-dimensional ultrasound navigation should be considered in aiding resection of large neck tumors because it can allow more efficient and safer tumor resection.

Endoscopic surgery of the parathyroid glands: methods and principles

Targeted endoscopic parathyroidectomy without gas insufflation is a relatively non-invasive means of discovering and resecting parathyroid adenomas in sporadic primary hyperparathyroidism. This standardized technique depends on the quality of the preoperative imaging: cervical ultrasound and sestamibi scintigraphy, and can be optimized by preoperative insertion of an ultrasound-guided "harpoon" and rapid peroperative parathyroid hormone analysis. Failure rates range between 1.7% and 4%.