gms | German Medical Science

Objective: Frame based stereotactic biopsy of cerebral lesions is an established method and has been used as a standard procedure in neurosurgery for decades. The preoperative preparation of the planning data set is often associated with considerable logistical effort and burden on the patient. We have developed and applied a new method for the intraoperative acquisition of the planning dataset with a multiaxial robotic C-arm system.

Methods: The stereotactic frame was attached under analgesia in the operating room. Subsequently, the CT indicator was attached to the frame and a Dyna-CT of the skull was made with the C-arm system. The planning data set was merged with a preoperative MRI and planning was performed with a planning software. Subsequently, the stereotactic biopsy was performed according to the clinic's internal standard. Each patient received a head-CT within eight hours postoperatively. Further procedures such as trajectory planning and biopsy were successfully carried out according to the previous clinic-internal standard.

Results: In 12 patients (four women, eight men; median age 58 years) the C-arm system was used for intraoperative acquisition of the planning dataset at our institution within a period of four months. A suitable planning dataset for stereotactic planning could be acquired for all patients. Dyna-CT was not associated with higher radiation dose as compared to standard head-CT. Target areas were correctly targeted for all patients as demonstrated by postoperative head-CT. In 10 patients (83%) the biopsy was diagnostic with six (50%) Glioblastoma and four (33%) CNS Lymphoma. In one patient (8%) biopsy was non-diagnostic and subsequent tumor resection revealed brain metastases from non-small cell lung cancer. In another patient (8%) biopsy for suspected brain abscess failed to verify diagnosis.

Conclusion: The acquisition of a planning dataset for stereotactic biopsy with the multiaxial robotic C-arm system is a feasible method. The image quality is suitable for stereotactic planning and no change of the operative procedure is necessary. Furthermore, success rates are comparable to those reported in the literature. Through conducting of the imaging into the OR stress for the patient and staff can be reduced and in-hospital processes are optimized.