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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Frameless stereotactic biopsy using a sensor-based electromagnetic neuronavigation system

Rahmenlose navigierte Stereotaxie unter Verwendung eines sensorbasierten elektromagnetischen Navigationssystems

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  • corresponding author S. Mularski - Klinik für Neurochirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin
  • T. Kombos - Klinik für Neurochirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin
  • M. Brock - Klinik für Neurochirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin
  • O. Suess - Klinik für Neurochirurgie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.02.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc146.shtml

Published: April 11, 2007

© 2007 Mularski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Frame-based stereotaxy is the gold standard for diagnostic brain biopsy. Recent studies showed that with new hard- and software improvements, frameless stereotactic biopsy (FSB) is comparable to the frame based procedure in respect to accuracy (for lesions >10mm), morbidity and diagnostic yield, and therefore has the potential to become an alternative to the frame based procedure. The goal of this study was to evaluate a newly designed biopsy adaptor for a sensor-based electromagnetic navigation system (ENS).

Methods: A ENS was equipped with a biopsy adaptor in order to perform free hand brain biopsies. The biopsy adaptor consists of a guidance tube for the biopsy needle and a rounded tip which can be used in 9-12mm burr holes. The guidance tube is connected to a sensor-equipped navigation stylus. During data preparation, one or more targets and trajectories can be selected. After system set-up and point to point matching (skin fiducials) the ENS displays the distances from the tip of the biopsy tool to the target center and the margins of the lesion. Along the selected trajectories, serial biopsies can be obtained comparable to the stereotactic procedure.

Results: A total of thirty FSBs were performed. The mean diameter of the lesions was 22mm. No lesion was smaller than 10mm in diameter. Five subcortical lesions larger than 30mm in diameter were biopsied without a rigid 3-point pin fixation of the skull. In these five cases a skull reference sensor (DRF) was used to allow free head movement during the procedure. The mean FRE (Fiducial Registration Error) was 1.63mm (max 2.88mm) and the mean TRE (Target Registration Error) was 1.62mm (max 2.68mm). The diagnostic yield was 96.6 % (29/30). In two cases the diagnosis based on the intraoperative frozen tissue sections was corrected after immunohistological testing. No biopsy related morbidity was observed.

Conclusions: The newly designed biopsy adaptor was found to be a useful tool for sensor-based frameless biopsies. Frameless electromagnetic stereotaxy proved to be an easy to use and timesaving method for diagnostic brain biopsy. Furthermore due to the sensor based technique frameless electromagnetic stereotaxy can be optionally performed without rigid pin fixation, which avoids pin-associated morbidity.