Computerized tomographic stereotaxy in the management of 200 consecutive intracranial mass lesions. Analysis of indications, benefits and outcome

Abstract

Two hundred consecutive stereotactic procedures were performed. These were 153 biopsies and 43 therapeutic procedures. The latter included aspiration of craniopharyngiomata, arachnoid cysts, deep-seated abscesses, and the destruction of colloid cysts. Cryogenesis was used to treat an arteriovenious malformation (AVM) in one case. In four cases, the system was used to locate lesions during open surgery. Leksell stereotactic systems were used throughout. The ages of the patients ranged between 12 months and 83 years. Overall, in 35% of biopsies the preoperative diagnosis was not confirmed. When the provisional diagnosis was glioma 70% were confirmed; 21% of them were benign, with 9% some other form of malignancy. Biopsy provided tissue on which a histological diagnosis could be made in 140 procedures. In eight cases the biopsy was repeated and in seven cases a positive diagnosis was subsequently made. Mortality was 1%; there was transient deterioration postoperatively in 5% and prolonged deterioration in 1%. These observations suggest that stereotactic surgery is far superior to freehand burr hole biopsy in the management of these lesions. No radiation treatment should be considered without histological confirmation.

Vertical displacement of stereotaxic target in the cat brain after burr hole production of the skull

“…In functional neurosurgery, the coordinates of the exact target point are calculated from preoperative CT scans where the skull is closed and, during physiological conditions, the brain is floating in the cerebrospinal fluid (CSF). During thalamotomy in many centres, an incision is made using an open surgical procedure with the patient in a sitting position [7,[20][21][22]. Some stereotaxic neurosurgeons have observed that such a procedure in the sitting position influenced the location of the brain relative to the skull during the functional stereotaxic thalamotomy procedure after the skull had been opened [20,21].…”

High-dose methotrexate is beneficial in parenchymal brain masses of uncertain origin suspicious for primary CNS lymphoma

“…However, in some patients biopsy is precarious or not feasible due to size or location of the lesion, cerebral edema, concomitant disease, or lack of patient's consent. Moreover, a conclusive histologic diagnosis cannot be achieved in up to 10% of biopsies (Bernays et al, 2002;Hall, 1998;Wild et al, 1990). A probable diagnosis must then be made on clinical, radiologic, and biochemical/serologic findings in this situation.…”

Management of brain abscess: an overview

“…Several authors have recorded the utility of stereotactic techniques in the management of brain abscesses. 6,11,25,34,38,43,47,53,55,61,62 There are several advantages of stereotactic aspiration. Only stereotactic aspiration is appropriate for small, deepseated abscesses or those located in eloquent regions of the brain, because it provides a direct and rapid access to the abscess through a predetermined route.…”