Practical utility of ultrasound-guided brain shift correction during glioma: patient series.

backgroundIn glioma surgery, intraoperative brain shift compromises navigational accuracy, especially at subcortical functional boundaries. When integrated with neuronavigation, intraoperative ultrasound (iUS) enables iterative image-based updates through rigid image fusion (RIF), restoring alignment with anatomical and functional landmarks. The authors present a 6-patient series demonstrating the clinical utility of navigated iUS-based brain shift correction. Serial iUS datasets acquired using the bk5000/bkActiv system integrated with the Brainlab Kick platform were updated using a rigid fusion algorithm to correct for accumulated brain shifts. The alignment of functional tracts was correlated with intraoperative subcortical mapping findings. OBSERVATIONS: Application of RIF successfully realigned the anatomy and corrected for deviations in subcortical white matter tract location. This restored the functional anatomy and ensured that subcortical mapping efforts were appropriately directed. In select cases, corrected navigation remained concordant with functional anatomy even toward the end of resection. LESSONS: Navigated iUS with RIF-based brain shift correction provides a dual advantage in glioma surgery: it restores the spatial reliability of image guidance and offers real-time visualization for resection control. When used in conjunction with subcortical stimulation and neuromonitoring, this approach may improve intraoperative navigation accuracy and facilitate functional resections, particularly in resource-variable or nonawake settings. https://thejns.org/doi/10.3171/CASE26683.