Computed Imaging Stereotaxy: Experience and Perspective Related to 500 Procedures Applied to Brain Masses

Abstract

The evolution of more sophisticated imaging techniques has initiated a renewed interest in stereotactic devices, methods, and applications. The Brown-Roberts-Wells instrument was available to us early in its prototype stage, and this report reviews the first 500 cases using the system at the University of Southern California Medical Center Hospitals. Procedures were undertaken after recognition of apparent structural alterations on imaging studies, with objectives being both diagnostic and therapeutic. Target locations were predominantly within the cerebral centrum-basal ganglia (284 cases) and diencephalic-mesencephalic regions (129 cases). Operative objectives included: histological and microbiological assay, cyst and abscess aspiration, installation of temporary or permanent drainage conduits, point source and colloid base brachytherapy, cerebroscopy and ventriculoscopy with biopsy, aspiration, and excision, and intraoperative vascular localization. Using multiple instrumentation at the target point (741 point placements), we realized procedural objectives in 95.6% of the cases. The mortality was 0.2% and the morbidity was 1%: hematoma, 2 cases; infection, 1 case; increased deficit, 1 case; intraprocedural seizure, 1 case. A specific diagnosis was not obtained in 4.4% (necrosis, 10 cases; inflammatory response, 9 cases; granuloma, 1 case; gliosis, 1 case; diagnostic error, 1 case). Individual guidelines for case selection, technique, institutional requirements, and applications of the method are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

“…Past series appear to be relatively evenly divided between the use of biopsy forceps [1,4] or a side-cutting biopsy needle [17,18] while many report using both [15,19,20], and still other surgeons still use needle aspiration techniques or the Backlund spiral devise (Elekta, Inc, Norcross, GA). More recent series tend to favor a side-cutting needle exclusively [10,11,18], which has the advantage of preserving a core of intact cross-sectional tissue architecture which facilitates histological interpretation.…”

“…It has proved a safe and effective tool since it was first coupled with computed planar imaging nearly three decades ago [1][2][3][4][5][6][7]. Despite its history, questions still persist regarding FB, including quantifying the risk of non-diagnosis or sampling error for tumor biopsy, and the actual need for post biopsy neuroimaging.…”

Abordagem estereotáxica guiada por imagem de lesões do sistema nervoso central: precisão diagnóstica, morbidade, mortalidade

“…Ela é considerada o procedimento cirúrgico menos invasivo para obtenção de amostras de tecido cerebral 1 . As técnicas estereotáxicas no ser humano foram introduzidas por Spiegel e Wycis em 1947 tendo como objetivo a psicocirurgia 2 .…”

“…Atualmente a biópsia estereotáxica guiada por imagem é um método amplamente utilizado com índices de morbidade de 0 a 6,5% 1,[7][8][9][10][11][12][13][14] , mortalidade 0 a 9% 1,9,12,13,15-17 e acurácia de 88% a 100% 1,9,[11][12][13]16 . Analisamos a experiência de nosso Serviço.…”

Hemorragia intracerebral diferida tras biopsia estereotáctica

“…A pesar de tratarse de un procedimiento quirúrgico poco invasivo, puede presentar complicaciones hemorrágicas que en determinadas ocasiones pueden ser fatales. La incidencia de sangrado intracraneal tras la práctica de una biopsia de esta naturaleza oscila en la literatura entre 0.4 y 59.8% 1,12 dependiendo de que se consideren únicamente las hemorragias sintomáticas o aquellos pequeños sangrados que pueden observarse en las pruebas de imagen pots-biopsia y que se localizan sobre el punto de toma de la muestra. La mortalidad asociada al procedimiento oscila en las distintas series entre el 0% y el 11.8% 3,7,11 .…”