Abstract
Objective Implementation of a new neuronavigation system in the department included the opportunity
to change the brain biopsy procedures from a frame-based system to a frameless system—the
BrainLAB® VarioGuide. We report our first 20 consecutive procedures within 2 years, analyzing
the effectiveness of this new tool.
Patients, Materials, and Methods 15 men and 5 women with various intracerebral lesions were biopsied. Their average
age was 62 years (range, 41–83 years). Preoperative planning was performed using computed
tomography (CT) or magnetic resonance imaging (MRI) data provided by a radiological
picture archiving and communication system (PACS) sent to the planning station. Planning
was based on either MRI or CT in 14 and 4 cases, respectively, and a combination of
both in 2 cases.
Results The lesions had a mean maximal diameter of 42.97 mm (range, 5.8–109.8 mm). 19 lesions
were supratentorial, 1 of those intraventricular, and 1 lesion was infratentorial,
within the cerebellar peduncle and brainstem. During surgery, the samples were sent
to neuropathological examination, and the procedure was completed after confirmation
that pathological tissue was obtained. In 18 of 20 cases, definitive pathological
tissue was harvested. Histopathology confirmed 8 glioblastomas, 1 oligoastrocytoma,
4 anaplastic astrocytomas, 1 astrocytoma, and 2 primary central nervous system lymphomas,
as well as 1 encephalitis and 1 necrotic tissue of unknown origin. In 3 cases, including
the case of necrotic tissue, there was no final diagnosis possible. Referencing the
BrainLAB® navigation system and software-wizard guided sterile adjustment of the VarioGuide
arm over the entry point took 5 to 10 minutes. The mean operation time was 49 minutes
(range, 24–69 minutes) including the time until first neuropathological examination
was completed. No adverse events occurred during or after the operation.
Keywords
frameless navigated biopsy - brain tumor - frame-based stereotaxy
