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. 2014 Sep 5;5(Suppl 8):S421-6.
doi: 10.4103/2152-7806.140211. eCollection 2014.

Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy

Masamitsu Nishihara  1 , Naoya Takeda  1 , Tomoaki Harada  1 , Keiji Kidoguchi  1 , Shoutarou Tatsumi  1 , Kazuhiro Tanaka  2 , Takashi Sasayama  2 , Eiji Kohmura  2
Affiliations

Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy

Masamitsu Nishihara et al. Surg Neurol Int. .

Abstract

Background: We compared the diagnostic yield and morbidity by frame-based computed tomography-guided stereotactic biopsy (CTSTB) with Brown-Roberts-Wells (BRW) unit and by neuronavigation-guided frameless stereotactic biopsy (NSTB) using magnetic resonance imaging (MRI).

Methods: The subjects' age range was 15-83 years. CTSTB with BRW unit was performed for 59 tumors (58 cases, 1988-2007). NSTB was performed for 38 tumors (35 cases, 2007-2013) with the needle sheath attached to the head holder. By NSTB, target locations of sampling points and trajectories were confirmed by using MRI. Diffusion tensor imaging-based fiber tractography was used to achieve safe trajectories. STB by using BRW did not visualize the trajectory virtually; however, the planning images for NSTB were able to show the trajectory virtually before the procedure.

Results: Histological diagnoses were established for 93 tumors at the first biopsy. The diagnostic yield was 94.9% by CTSTB and 97.4% by NSTB (P = 0.944). The morbidity rate was 5.1% by CTSTB and 0% by NSTB (P = 0.417). The absolute risk reduction was 23.1% by NSTB when the targets were basal ganglia (putamen, globus pallidus) or thalamus. In the cases of glioma for which the targets were basal ganglia (putamen, globus pallidus) or thalamus, the absolute risk reduction by NSTB was 30%.

Conclusions: There was no significant difference between CTSTB and NSTB concerning the diagnostic yield and morbidity. However, when the target is the basal ganglia (putamen, globus pallidus) or thalamus and glioma is suspected, NSTB by using MRI with virtual trajectory is preferable to CTSTB concerning morbidity.

Keywords: Brain tumor; neuronavigation; stereotactic biopsy.

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Figures

Figure 1
Figure 1
Tractography and the target of the tumor for biopsy. This image was made by using iPlan on the basis of the T1-weighted image of the patient. The tumor was enhanced by gadolinium diethylenetriamine pentaacetic acid. The ocher lines show presumed pyramidal tract. Arrow indicates the target of the tumor for biopsy
Figure 2
Figure 2
Trajectory, the entry point, and the target. The yellow lines show the trajectories. The entry point was made in the left superior parietal lobule (green circle). The target point is indicated by a red circle. Trajectories were made in such a way that they would not pass the vessels, sulcus, and ventricle
Figure 3
Figure 3
The target of the tumor and biopsy site on postoperative MRI. Arrowhead shows the target of the tumor (left). Postoperative MRI T1-weighted image shows the biopsy site (arrow, right)
See this image and copyright information in PMC

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