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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Frameless stereotactic brain biopsy with multimodal neuronavigation and high-field intraoperative magnetic resonance imaging

Meeting Abstract

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  • JiaShu Zhang - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • XiaoLei Chen - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Fei Wang - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • FangYe Li - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • QiuPing Gui - Departments of Pathology, Chinese PLA General Hospital, Beijing, China
  • JinJiang Li - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Gang Zheng - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • XueMing Lv - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Ting Zhang - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Chen Hu - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • BaiNan Xu - Departments of Neurosurgery, Chinese PLA General Hospital, Beijing, China

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 040

doi: 10.3205/13dgnc458, urn:nbn:de:0183-13dgnc4583

Published: May 21, 2013

© 2013 Zhang 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: To introduce a novel modality of brain biopsy and further demonstrate the feasibility and efficacy of this frameless stereotactic brain biopsy aided by multimodal neuronavigation and high-field intraoperative magnetic resonance imaging.

Method: From 2009 to 2011, 51 patients with diffuse, multiple or deep-seated and eloquent lesions underwent frameless stereotactic brain biopsy assisted by multimodal neuronavigation (MN) and intraoperative magnetic resonance imaging (iMRI). Biopsy target selection was based on preoperative metabolic imaging such as Magnetic Resonance Spectroscopy and Positron Emission Tomography. Functional imaging including Functional MRI and Diffusion Tensor Imaging, were performed to localize eloquent bran structures. MN integrated anatomic, metabolic and functional information and was used for intraoperative guidance. iMRI was used to confirm the biopsy accuracy, revise incorrect target and detect intraoperative hemorrhage. Procedure parameters, diagnostic rate, perioperative neurological status and complications as well as patient prognosis were all recorded and analyzed.

Results: iMRI revised 2 (3.9%) incorrect biopsy sites, and final iMRI confirmed the biopsy accuracy in all patients. Definite diagnostic rate was 96.1% (49/51) even without frozen section. In 2 (3.9%) cases, biopsies were non-diagnostic because of insufficient tissues. In addition, 2 (3.9%) intraoperative hemorrhages were detected by iMRI and treated immediately. After biopsy, 58.8 % (30/51) of patients avoided unnecessary craniotomies and received specific and reasonable treatments. The postoperative morbidity and mortality was 0%, even though 28 (54.9%) targets involved eloquent regions. Median time cost by iMRI was 24.0 ± 8.8 min, which was comparable to frozen section.

Conclusions: The preliminary results suggested that iMRI and MN can be smoothly integrated into the biopsy workflow, and this system may maximize biopsy accuracy and minimize neurological deficits.