Intraoperative Ultrasound in Neurosurgical Oncology: A National Survey of French Practices, Benefits, and Limitations - 03/09/26

Doi : 10.1016/j.neuchi.2026.101875

Aymar Thierry d’Argenlieu ^a,^b, Johan Pallud ^a,^b, Gaetan Poulen ^c,^{^{1
These authors participated equally.}}, Jean-Rodolphe Vignes ^d,^{^{1
These authors participated equally.}}, Alexandre Roux ^a,^b,⁎, ^{^{1
These authors participated equally.}}

^a Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France

^b Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France

^c Service de Neurochirurgie, Unité de Neurochirurgie Fonctionnelle et Stéréotaxique, Hôpital Universitaire Gui de Chauliac, Montpellier, France

^d Service de Neurochirurgie A, Hôpital Université de Bordeaux, Bordeaux, France

^⁎ Corresponding author.

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Highlights

•	Widespread adoption : Intraoperative ultrasound (IOUS) is broadly used in French neurosurgical oncology, particularly for gliomas, metastases, and intramedullary spinal tumors.
•	Perceived benefits : IOUS significantly enhances tumor boundary delineation and resection quality, but its utility for vascular assessment remains limited.
•	Technical limitations : Primary barriers include image quality, technical constraints, and a steep learning curve, rather than cost or operative time.
•	Training demand : Strong interest in dedicated IOUS training and deeper integration with MRI-based neuronavigation, despite limited access to structured programs.
•	Future directions : Emerging technologies (CEUS, elastography, functional ultrasound) may address current gaps in vascular and functional assessment.

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Abstract

Objective

To evaluate the patterns of use, perceived benefits, limitations, and needs related to intraoperative ultrasound (IOUS) in neurosurgical oncology practice in France.

Methods

A structured 24-item questionnaire was distributed to members of the French Neurosurgical Society (Club de Neuro-Oncologie - Société Française de Neurochirurgie). The survey explored demographics, IOUS usage patterns in cranial and spine tumor surgery, perceived utility, limitations, integration with neuronavigation, training, and interest in future research.

Results

108 neurosurgeons, predominantly from high-volume academic centers, completed the survey. IOUS was widely used for gliomas, metastases, and intramedullary tumors, primarily for lesion localization and residual tumor assessment. It was often combined with MRI-based neuronavigation. The highest perceived benefits were for tumor boundary delineation (mean 3.64 ± 1.02) and improved resection quality (mean 3.26 ± 1.08), while vascular assessment was rated lower (mean 2.02 ± 1.07). Main limitations included insufficient image quality (52.8%) and technical constraints (30.6%). Despite limited formal training (96.3%), most respondents expressed interest in dedicated IOUS training (85.2%) and multicenter studies (90.7%).

Conclusion

IOUS is widely adopted in neurosurgical oncology and perceived as useful for improving tumor resection. Its benefits vary with surgical experience, and current limitations are primarily technical and educational. Future advancements and structured training may enhance its utility.

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Keywords : Intraoperative ultrasound, Neurosurgical oncology, Tumor resection, Survey, France