Artikel
A new system for frameless, navigation-based stereotactic brain biopsy (technical note)
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Autoren
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Jamal Assaf
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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Wilfried Schulz
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Our target was to develop a simple instrument for dynamic, frameless navigation-based stereotaxy for removal of brain serial biopsies, cyst punctures, and catheter and probe implantations.
Methods: The new biopsy-system has a lock mount to adapt different micro-instruments with diameters of 1.65 mm. A Reference Array is attached at the proximal end of the controlling element. An MRI volume dataset is generated before the operation and a large area of the scalp is provided with a maximum of 10 MR compatible adhesive markers over the projected entry point. During the period from the beginning of July 2008 until the end of December 2009, the stereotactic tool presented here was used in 38 patients with intracerebral processes without a clear diagnosis.
Results: The diameter of the lesion was at least 10 mm. The intervention never lasted more than 50 minutes. The target areas were reached with adequate precision and safety, and appropriate serial biopsies were removed. Intervention in an 8-year-old child involved implantation of an Ommaya Reservoir Catheter in the cysts of a multiple craniopharyngeoma recurrence. In our phantom studies, the system demonstrated an output error of 1.7 ± 0.5 mm for CT and 1.6 ± 1.6 mm for MRT in relation to deviation from the target point. The referencing deviation amounted to 1.4 ± 1.6 mm in patients undergoing operations. Transitory neurological deficits were only manifested as clinical complications in two cases.
Conclusions: The system features easy handling, low patient stress, appropriate precision with an incidence of complications within conventional stereotaxy and exceptionally favourable time and economy factor. Phantom studies in initial clinical trials indicate that the precision provided by the method is entirely satisfactory for processes larger than 1 cm in diameter. The system can be expanded with an appropriate catheter guide for implantation of catheters and probes to facilitate a variety of diagnostic and therapeutic purposes. The dynamic approach of navigation-based stereotaxy permits changes to different access paths without the requirement for replanning or follow-up planning on the basis of a single preoperative planning stage.
