Article

Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging.

Department of Neurosurgery, Institute of Neuroradiology, University Hospital of Zürich, Switzerland.
Journal of Neurosurgery (impact factor: 2.96). 09/2002; 97(2):354-62. DOI:10.3171/jns.2002.97.2.0354 pp.354-62
Source: PubMed

ABSTRACT The authors undertook a prospective study of frameless, magnetic resonance (MR)-guided stereotactic brain biopsy procedures performed with the aid of an open MR system. Morbidity and mortality rates, frequency of postoperative hemorrhage, and histological yield were evaluated, as well as the size and location of the lesions under investigation.
During a period of 51 months (July 1996-November 2000), 114 consecutive frameless stereotactic biopsy procedures were performed with the aid of an open intraoperative MR system to investigate supratentorial lesions in 113 patients. The median volume of the lesions was 33.5 cm3, and 31.9% were deep seated. All biopsy samples comprised pathological tissue and in 111 (97.4%) of 114 a specific neuropathological diagnosis was made. A follow-up computerized tomography (CT) scan was obtained on the 1st postoperative day in all patients to evaluate postoperative complications. In two cases (1.8%), a hemorrhage was found on postoperative CT scans, with no neurological worsening of the patients. Morbidity with neurological worsening was seen in three patients; it was transient in two of them (1.8%), and in one (0.9%) subsequent emergency craniotomy was necessary because of increased edema. There were no infections, but there was one death (0.9%)
Open intraoperative MR imaging transforms a blind conventional stereotactic procedure into a visually controlled procedure that is adaptable to dynamic anatomical changes. Routine postprocedural MR imaging makes follow-up CT scanning obsolete. This largest reported series of intraoperative MR-guided biopsy procedures shows results that are at least comparable with those in reports of larger series of conventional stereotactic biopsy sampling. The mean procedure time was 60 minutes including planning, and this method produced low morbidity and complication rates and a high histological yield.

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Keywords

1st postoperative day
 
blind conventional stereotactic procedure
 
complication rates
 
conventional stereotactic biopsy sampling
 
dynamic anatomical changes
 
intraoperative MR-guided biopsy procedures
 
larger series
 
low morbidity
 
mean procedure time
 
median volume
 
mortality rates
 
Open intraoperative MR imaging
 
open intraoperative MR system
 
open MR system
 
postoperative CT scans
 
postoperative hemorrhage
 
prospective study
 
Routine postprocedural MR imaging
 
specific neuropathological diagnosis
 
visually controlled procedure