Intraoperative Ultrasonography in Small Craniotomy, Balloon Technique: Technical Note

Intraoperative ultrasonography (IoUSG) is an essential real-time imaging tool in neurosurgical practice. However, a physical mismatch between standard probe dimensions and narrow craniotomy windows often hinders its effectiveness. We present a practical and cost-effective "balloon technique" using a saline-filled sterile surgical glove to establish an acoustic bridge. A 61-year-old male with a metastatic brain lesion in the right frontal region underwent a 3x3.5 cm crani-otomy, where a standard 4 cm wide probe exceeded the bone margins. By utilizing a saline-filled interface, we successful-ly achieved high-resolution visualization and total resection without enlarging the craniotomy. This technique provides real-time feedback and brain-shift compensation while maintaining the principles of minimally invasive surgery, offering a superior alternative to costly and time-consuming intraoperative imaging modalities.