Surg-21. Stereotactic Biopsy for Deep Seated Brain Lesions Using the Leksell Stereotactic Frame System

Abstract

PURPOSE To evaluate the results of stereotactic biopsies. PATIENTS AND METHODS Fifty-two patients with intraaxial lesions suspected of brain tumor. The locations of lesions includes, 19 deep cerebral white matter, 9 basal ganglia, 10 thalamus, 4 midbrain and 6 pons. Patients age ranged from 9 to 86 years (median 65 years), 33 were men and 19 were women. Under local anesthesia the Leksell stereotactic frame was fixed and the MRI were taken. Neuroimages such as enhanced CT scan or PET study were also used as references. After MRI patients were transferred to OR and under general anesthesia, several samples were taken with 2.1mm diameter needle by aspiration. Most of the cases the biopsy was done through frontal lobe, but in some cases through temporal lobe or through cerebellum. The samples were taken deeper and nearer regions of the designed targets with same trajectory, also. If there were cysts, aspiration of the cyst was performed as much as possible. The trajectory should avoid sulci, cortical veins or ventricular system. After biopsy inside the needle were irrigated repeatedly with 0.1 - 0.2 ml saline using thin plastic tube until the fluid does not contain bloody fluids to ensure hemostasis. RESULTS In all patients appropriate samples for pathological diagnosis were obtained. The diagnoses were 28 gliomas (pilocytic 1, grade II 8, grade III 11, grade VI (GBM) 6, high grade 1, glial tumor 1), 17 lymphomas, 3 germinoma and 2 were non-tumorous pathology. There were no symptomatic bleeding nor neurological complications. CONCLUSION With detailed planning, stereotactic biopsy was safely performed even from basal ganglia or brainstem. Trajectories other than from frontal can be also considered for some lesions. Repeated irrigation with saline might effective to prevent symptomatic bleeding and this case series shows lower complication rates compared to the published literatures.

Infratentorial Stereotactic Biopsy of Brainstem and Cerebellar Lesions

“…Fritsch et al associated a high diagnostic yield with the number of systematically obtained samples per lesion, with an increased number of biopsies not leading to an increase in complications [ 28 ]. The risk of complications can be reduced by irrigating the site repeatedly with 0.1–0.2 mL saline using a thin plastic tube until the fluid does not contain bloody fluids to ensure hemostasis [ 29 ]. Moreover, it appears reasonable to discharge patients the same day or within one day of stereotactic biopsy if the postoperative CT shows no complication [ 28 ].…”