Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center

Abstract

-Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50% for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7% and 83.4%, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8% cases of the first group and 9.8% cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.KEY WORDS: brain tumor, neuronavigation, stereotaxy.biópsia cerebral: comparação entre estereotaxia com arco e neuronavegação em um centro de oncologia resumo -O manejo das lesões intracranianas tumorais está relacionado ao seu diagnóstico histológico adequado. Foi realizado estudo retrospectivo com 32 pacientes submetidos a 36 biópsias cerebrais por neuronavegação e 44 pacientes por estereotaxia com arco. A idade média foi 46,6 e 49,3 anos respectivamente. Nos dois grupos a distribuição por sexo foi 50% para cada. A maioria das lesões biopsiadas eram lobares nos dois grupos. A positividade diagnóstica foi 91,7% para neuronavegação e 83,4% para a estereotaxia com arco, respectivamente (p=0,26). Identificou-se hemorragia intracraniana na TC pós-operatória em 13,8% dos casos no primeiro grupo e em 9,8% no segundo, a maioria de pequena monta sem provocar piora neurológica. Ocorreu uma morte relacionada ao procedimento em cada grupo. Os diagnósticos mais freqüentes foram astrocitomas e adenocarcinomas metastáticos. A positividade diagnóstica, taxas de hemorragia pós-operatória e de mortalidade foram equiparáveis estatisticamente entre os dois métodos e se assemelham com as descritas na literatura. PALAVRAS-CHAVE: tumor cerebral, neuronavegação, estereotaxia.

A Sequential Comparison on the Risk of Haemorrhage with Different Sizes of Biopsy Needles for Stereotactic Brain Biopsy

“…Stereotactic brain biopsy is a well-established diagnostic method to guide the clinical management of various brain diseases with low complication rate and high diagnostic yield, either using frame-based or frameless stereotaxy in modern literature [2,3,10,14,16,18]. …”

“…The prevalence of asymptomatic haemorrhage documented in the literature ranged from 3.4 to 50% [1,7,9,12,18,25,36,40]. One of the reasons for such a wide range might be that postoperative haemorrhage is not strictly defined.…”

Neuronavigation in the surgical management of brain tumors: current and future trends

“…Consequently, while frame-based stereotaxy is still used, particularly, in the setting of deep brain stimulation, frameless systems have been increasingly adopted for brain biopsy [22,23] and brain tumor surgery [24–26]. Importantly, frameless systems provide comparable accuracy with frame-based systems [27,28]. In addition, the use of frameless stereotaxy has been shown to be safe and effective in collecting diagnostic tissues in both eloquent and non-eloquent regions of the brain [29].…”

Frameless Stereotactic Insertion of Viewsite Brain Access System with Microscope-Mounted Tracking Device for Resection of Deep Brain Lesions: Technical Report

“…The principle components of frameless stereotactic surgery include a probe, a computer-based image module, and a reference. Frameless stereotactic navigation has been shown to achieve accuracy of 2–3 mm based on electrode-based studies, as well as good accuracy and safety regarding access of deep intracranial lesions [11,14-15]. Errors in frameless stereotaxy generally involve factors outside the computer-based modules, such as the quality / timing of the preoperative imaging or factors that cause brain shift during the surgery [16].…”