Frameless Navigated Biopsy with the BrainLAB® VarioGuide System: A Technical Note

Abstract

The lesions had a mean maximal diameter of 42.97 mm (range, 5.8-109.8 mm). 19 lesions were supratentorial, 1 of those intraventricular, and 1 lesion was infratentorial, within the cerebellar peduncle and brainstem. During surgery, the samples were sent to neuropathological examination, and the procedure was completed after confirmation that pathological tissue was obtained. In 18 of 20 cases, definitive pathological tissue was harvested. Histopathology confirmed 8 glioblastomas, 1 oligoastrocytoma, 4 anaplastic astrocytomas, 1 astrocytoma, and 2 primary central nervous system lymphomas, as well as 1 encephalitis and 1 necrotic tissue of unknown origin. In 3 cases, including the case of necrotic tissue, there was no final diagnosis possible. Referencing the BrainLAB® navigation system and software-wizard guided sterile adjustment of the VarioGuide arm over the entry point took 5 to 10 minutes. The mean operation time was 49 minutes (range, 24-69 minutes) including the time until first neuropathological examination was completed. No adverse events occurred during or after the operation.

Minimally invasive surgery of the anterior skull base: transorbital approaches

“…In the majority of cases, fixation of the skull in a Mayfield clamp is required for neuronavigation. Frameless systems may become more prevalent in the future [ 77 ], [ 78 ]. The reference system is usually fixated to the head clamp.…”

A Miniature Optical Neuronavigation System for CT-Guided Stereotaxy

“…Routine neurosurgical procedures such as brain biopsies have also been performed with the aid of neuronavigation systems [1,2]. However, for needle placements for biopsies of small, deep-seated targets and electrode placement for deep-brain stimulation, frame-based stereotaxy is still considered by many as the gold standard due to its mechanical precision [3,4].…”