Brain biopsy sampling by using prospective stereotaxis and a trajectory guide.

Abstract:

OBJECT:The authors describe their initial results obtained using a skull-mounted trajectory guide for intraoperative magnetic resonance (MR) imaging-guided brain biopsy sampling. The device was used in conjunction with a new methodology known as prospective stereotaxis for surgical trajectory alignment. METHODS:Between January 1999 and March 2000, 38 patients underwent 40 brain biopsy procedures in which prospective stereotaxis was performed with the trajectory guide in a short-bore 1.5-tesla MR imager. In most cases, orthogonal T2-weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) images were used to determine the desired trajectory and align the device. The surgical trajectory was defined as a line connecting three points: the target, pivot, and alignment stem points. In all cases, surgical specimens were submitted for frozen section and pathological examination. Postoperative turbofluid-attenuated inversion-recovery and gradient-echo images were obtained to exclude the presence of hemorrhage. Trajectory determination and alignment was simple and efficient, requiring less than 5 minutes. Confirmatory HASTE images were obtained along the biopsy needle as it was being advanced or after reaching the target. All biopsy procedures yielded diagnostic tissue. One patient with a lesion near the motor strip experienced a transient hemiparesis of the hand related to passage of the biopsy needle, and another sustained a fatal postoperative myocardial infarction. No patient suffered a clinically significant or radiologically visible hemorrhage. CONCLUSIONS:In combination with prospective stereotaxis, the trajectory guide provided a safe and accurate way to perform brain biopsy procedures.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Hall WA,Liu H,Martin AJ,Maxwell RE,Truwit CL

doi

10.3171/jns.2001.94.1.0067

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

67-71

issue

1

eissn

0022-3085

issn

1933-0693

journal_volume

94

pub_type

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