Using the Neuronavigation System in stereotactic Biopsy of Focal Brain Lesions: the Experience of 107 Surgeries

I.Yu. Kyrpa

Abstract


Objective: to improve the efficacy of frameless stereotactic biopsy of brain tumors of supratentorial localization by applying it according to our methodology.
Materials and Methods. We used the navigation system Stealth Station® TREON® Plus by Medtronis (USA). From February 2009 to December 2012 in the Department of cerebral neurosurgery number № 2 of Municipal institution «Dnipropetrovsk regional clinical hospital named after I.I. Mechnikov» in 107 patients the authors carried out frameless stereotactic biopsy of focal brain lesions of supratentorial localization.
Comprehensive preoperative examination included ophthalmological and neurological examination, CT and MRI of the brain. MRI was performed on MRI Magnetom P8 (Siemens) with magnetic field strength of 0.2 T. In all cases, intravenous enhancement was carried out using magnevist.
Results and Discussion. In 107 (100 %) cases at preoperative stage we conducted spiral computed tomography (SCT) of the brain with intravenous enhancement using iodine-siluble contrast medium, in 46.7% of cases — brain MRI with intravenous enhancement. Patients underwent sampling of abnormal tissue on 3 levels in the range of 8 to 15 fragments (average 11.0 ± 1.2). A positive result is obtained in 101 case (94.4 %).
Complications from a biopsy. Postoperative mortality was not observed. In 3 cases, there is bleeding from the biopsy needle. In this regard, sampling was discontinued and biopter was not removed until bleeding stopped. Control SCT showed blood imbibition of the tumor, pneumocephalus. It does not worsen the overall condition of the patients and did not require immediate surgery.
Multiple tumors of the brain, inoperable tumors of deep localization and functionally important areas of the brain need accurate diagnosis for optimal treatment strategy.
Despite the rapid development of modern technology for neurovisualization, stereotactic biopsy is still the gold standard for ascertaining the nature of the pathological processes of the
brain.


Keywords


focal brain lessions; neuronavigation; frameless stereotactic biopsy; spiral computed-tomographic angiography; magnetic resonance imaging

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DOI: https://doi.org/10.22141/2224-0713.7.61.2013.86067

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