Central Nervous System Lesions Biopsied or Treated by CT-Guided Needle Placement

Abstract

Computed tomography has been utilized to guide a needle into central nervous system lesions as small as one centimeter in diameter. Direct puncture has drained many abscesses effectively, provided material for immediate Gram stain and subsequent culture, and permitted irrigation with appropriate antibioties, Multilocular cerebral lesions and loculated extracerebral fluid collections have been aspirated and treated with this technique. Aspiration of known cystic tumors has reduced their mass and obviated some palliative decompressions. Unresectable gliomas and metastases have been biopsied prior to chemotherapy or radiotherapy. Hemorrhage and other rare complications of biopsy may be detected and immediately treated.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

“…6,7,11 These procedures, of course, are very different from modern stereotaxy and the results cannot be reliably extrapolated. 6,7,11 These procedures, of course, are very different from modern stereotaxy and the results cannot be reliably extrapolated.…”

Interactive magnetic resonance imaging—guided management of intracranial cystic lesions by using an open magnetic resonance imaging system

“…10 Over the last two decades, CTguided aspiration of brain abscesses has been the primary therapeutic modality and excellent results have been reported. 2,9,19,[22][23][24]32,39 Although the benefits from this method are beyond question, our experience indicates that MR imaging guidance is as safe and effective as CT guidance and has certain advantages that are related to the better softtissue resolution of MR imaging and to the interactive feature of the procedure.…”

“…Using real-time monitoring, the aspiration needle is guided safely into different areas of the neoplasm or into a region of particular interest to reduce the chance of a sampling error. 18 Moran, et al, 24 described worthwhile palliation of symptoms by CT-guided surgery in patients harboring cysts in both primary and secondary tumors. This approach is particularly valuable in patients with recurrent cystic neoplasms and a short life expectancy, as well as in all patients with large space-occupying necrotic or cystic intracranial tumors because it facilitates surgery.…”

Reliability of Stereotactic Biopsy

“…In order to reduce the inci dence of errors, the greatest number of preoperative radiological ex aminations and an intraoperative control of the probe site are advis able. The control of the probe site is especially important, and can eventually be made with the aid of an intraoperative cytological exami nation [20,22], CT scan represents the ideal solution to almost all these problems [1,2,6,8,10,12,[14][15][16][17]19] and obviates the use of other in traoperative localization techniques used in the past, such as SEEG and rheography. The risks of multiple needle insertions required by these methods greatly outweigh the advantage of a more accurate local ization, and their use should be restricted to those few cases where they are specifically required (i.e., delimitation of an epileptic focus, etc.…”