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Frameless neuronavigation-assisted brain biopsy with electromagnetic tracking: how I do it?

  • How I Do it - Neurosurgical technique evaluation
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Abstract

Background

In recent years, thanks to several technological innovations, stereotactic cerebral biopsies have evolved from frame-based to frameless neuronavigation-assisted techniques.

Methods

The authors provide herein a detailed step-by-step description of the technique, shedding light on surgical tips and how to avoid complications. The practical application of the technique is demonstrated with a high-quality video.

Conclusion

The neuronavigation-assisted brain biopsy with electromagnetic tracking is a “true frameless” procedure. It represents a simple, safe, and effective innovation for frameless biopsy of cerebral lesions. This technique is time efficient, offering a high degree of accuracy required for the establishment of a definitive diagnosis, enabling optimal further treatment, and thus improving patient outcome.

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Abbreviations

EM:

Electromagnetic

CT:

Computed tomography

MRI:

Magnetic resonance imaging

WI:

Weighted images

DTI:

Diffusion tensor imaging

References

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale Di Circolo E Fondazione Macchi, University of Insubria, 21100, Varese, Italy

    Pierlorenzo Veiceschi, Davide Locatelli, Alessandro Dario & Gianluca Agresta

Authors
  1. Pierlorenzo Veiceschi
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  2. Davide Locatelli
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  3. Alessandro Dario
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  4. Gianluca Agresta
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Contributions

Conceptualization: GA. Methodology: AD. Formal analysis and investigation: PV. Writing — original draft preparation: PV and GA. Writing — review and editing: AD and DL. Supervision: DL.

Corresponding author

Correspondence to Pierlorenzo Veiceschi.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all the patients included in this study.

Conflict of interest

The authors declare no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

1. Brain biopsy aims to provide the diagnosis of cerebral lesions of unknown origin.

2. A recent meta-analysis did not show significant differences between the frame-based and frameless techniques regarding the diagnostic yield, morbidity, and mortality.

3. Frameless techniques avoid the usage of the Mayfield head holder, making the procedure easier, faster, and more comfortable to the patient.

4. Before surgery, it is crucial to obtain a complete neuroimaging assessment with both CT and MRI scans.

5. Once the images are uploaded to the workstation, the target and the trajectory are established, paying attention to respect eloquent neurovascular structures.

6. DTI tractography can be elaborated and added to the plan, to avoid crossing white matter pathways.

7. When the intraoperative registration with the EM system is performed, an error of < 1.5 mm is acceptable.

8. During the procedure, before harvesting the sample, the accuracy of the neuronavigation should be checked according to well-known anatomical landmarks. Hitting the target is crucial!

9. Intraoperative fluorescein and frozen sample analysis reduces dramatically the risk of non-diagnosis.

10. Patients should be always aware of the advantages, disadvantages, and alternative options.

This article is part of the Topical Collection on Neurosurgical Technique Evaluation.

Supplementary Information

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Veiceschi, P., Locatelli, D., Dario, A. et al. Frameless neuronavigation-assisted brain biopsy with electromagnetic tracking: how I do it?. Acta Neurochir 164, 3317–3322 (2022). https://doi.org/10.1007/s00701-022-05252-4

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  • DOI: https://doi.org/10.1007/s00701-022-05252-4

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