Acta Neurochirurgica

, Volume 87, Issue 1–2, pp 14–21 | Cite as

Applications of CT-adapted stereotaxis for the diagnosis and treatment of intracranial lesions

  • R. D. Lobato
  • J. J. Rivas


Two hundred twenty five patients with intracranial lesions underwent diagnostic and therapeutic stereotactic surgery during the period 1978–1985. In the first 98 cases target coordinates were determined by transferring the information from the CT images to the standard stereotactic films. In the remainder, a simple, CT adapted stereotactic system has been used. Operations were as a rule performed under local anaesthesia. Positive histological diagnosis using paraffin embedding was achieved in 96% of the patients (biopsy success rate). Therapeutic procedures included abscess and cyst aspiration, cyst shunting, interstitial (Ir 192) or intracavitary (Y 90) irradiation and ventriculocisternostomy. Stereotactic surgery implied a refinement of the eventual therapeutic management in 90% of the cases. Transient neurological deficit occurred in 5.7% of the patients and there were three deaths (mortality rate 1.3%). Infection or other complications were not seen. The rationale and indications for non-functional stereotaxis are discussed.


Brain abscess brain tumour computed tomography cyst needle biopsy stereotaxy third ventricle tumour 


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  1. 1.
    Adams JH, Graham DI, Doyle D (1981) Brain biopsy. The smear technique for neurosurgical biopsies. Lippincot, PhiladelphiaGoogle Scholar
  2. 2.
    Alker G, Kelly PJ, Kall B, Goers SS (1983) Stereotaxic laser ablation of intracranial lesions. AJNR 4: 727–730PubMedGoogle Scholar
  3. 3.
    Apuzzo MLJ, Sabshin JK (1983) Computed tomography guidance Stereotaxis in the management of intracranial mass lesions. Neurosurgery 12: 277–285PubMedGoogle Scholar
  4. 4.
    Backlund EO (1971) A new instrument for stereotaxic brain tumor biopsy. Acta Chir Scand 137: 825–827PubMedGoogle Scholar
  5. 5.
    Backlund EO (1979) Stereotactic radiosurgery in intracranial tumors and vascular malformations. In: Krayenbühl H,et al (eds) Advances and technical standards in neurosurgery, vol 6, pp 3–35, Springer, Wien New YorkGoogle Scholar
  6. 6.
    Backlund EO, Johansson L, Sarby B (1972) Studies on craniopharyngiomas. II Treatment by stereotaxis and radiosurgery. Acta Chir Scand 138: 749–759PubMedGoogle Scholar
  7. 7.
    Backlund EO, Von Holst H (1978) Controled subtotal evacuation of intracerebral hematomas by stereotactic technique. Surg Neurol 9: 99–101PubMedGoogle Scholar
  8. 8.
    Beaty RM, Zervas NT (1983) Stereotactic aspiration of a brain stem hematoma. Neurosurgery 13: 204–207PubMedGoogle Scholar
  9. 9.
    Bergström M, Greitz T (1976) Stereotaxic computed tomography. Am J Roentgenol 127: 167–170Google Scholar
  10. 10.
    Birg W, Mundinger F (1982) Direct target point determination for stereotactic brain operations from CT data and the calculation of setting parameters for polar-coordinates stereotactic devices. Appl Neurophysiol 45: 387–395PubMedGoogle Scholar
  11. 11.
    Boëthius J, Collins VP, Edner G, Lewander R, Zajicek J (1978) Stereotactic biopsies and computed tomography in gliomas. Acta Neurochir (Wien) 40: 223–232Google Scholar
  12. 12.
    Bosch DA (1980) Indications for stereotactic biopsy in brain tumors. Acta Neurochir (Wien) 54: 167–179Google Scholar
  13. 13.
    Bosch DA, Rähn T, Backlund EO (1978) Treatment of the colloid cysts of the third ventricle by stereotactic aspiration. Surg Neurol 9: 15–18PubMedGoogle Scholar
  14. 14.
    Brogi G, Franzini A (1981) Value of serial stereotactic biopsies and impedancy monitoring in the treatment of deep brain tumors. J Neurol Psychiat 44: 397–401Google Scholar
  15. 15.
    Brown RA (1979) A computerized tomography-computer graphics approach to stereotactic localization. J Neurosurg 50: 715–720PubMedGoogle Scholar
  16. 16.
    Cohadon F, Rougier A, Nunes Neto DS, Pigneux J, Caille JM, Constans D (1977) La tomodensitométrie en conditions stéréotaxiques. Possibilités et limites dans le diagnostic et le traitment des lésions cérébrales. Neurochirurgie 23: 434–451Google Scholar
  17. 17.
    Colombo F, Angrilli F, Zanardo A, Pinna V, Benedetti A (1981) A new method for utilizing CT data in stereotactic surgery. Acta Neurochir (Wien) 60: 125–129Google Scholar
  18. 18.
    Conway LW (1982) Stereotactic biopsy of deep intracranial tumors. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques, vol 1, pp 389–402. Grune-Stratton, New YorkGoogle Scholar
  19. 19.
    Daumas-Dupport C, Monsaingeon V, Szenthe L, Szikla G (1982) Serial stereotactic biopsies: a double histological code of glioma according to malignancy and 3-D configuration as an aid to therapeutic decision and assessment of results. Appl Neurophysiol 45: 431–437PubMedGoogle Scholar
  20. 20.
    DeGirolami V, Schmidek HH (1973) Clinicopathological study of 53 tumors of the pineal region. J Neurosurg 39: 45–462Google Scholar
  21. 21.
    Edner G (1981) Stereotactic biopsy of intracranial occupying lesions. Acta Neurochir (Wien) 57: 213–234Google Scholar
  22. 22.
    Gildenberg PL (1982) Computerized tomography and stereotactic surgery. In: Spiegel EA (ed) Guided brain operations, pp 24–34. Karger, BaselGoogle Scholar
  23. 23.
    Gildenberg PL, Kaufman HH, Murthy KSK (1982) Calculation of stereotactic coordinates from the computed tomographic scan. Neurosurgery 10: 580–586PubMedGoogle Scholar
  24. 24.
    Gleason GA, Wise BL, Feinstein B (1978) Stereotactic localization (with computerized tomographic scanning), biopsy and radiofrequency treatment of deep brain lesions. Neurosurgery 2: 217–222PubMedGoogle Scholar
  25. 25.
    Gouda KI, Freidberg SR, Lausen CR, Baker RA, Silverman RL (1983) Modification of the Gouda frame to allow stereotatic biopsy of the brain using the GE 8800 computed tomography scanner. Neurosurgery 13: 176–181PubMedGoogle Scholar
  26. 26.
    Gutin PH, Phillips TL, Wara WM, Leibel SA, Hosobuchi Y, Levin A, Weaver KA, Lambs S (1984) Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources. J Neurosurg 60: 61–68PubMedGoogle Scholar
  27. 27.
    Greenblatt SH, Rayport M, Savolaine ER, Harris JH, Hitchins MW (1982) Computed tomography-guided intracranial biopsy and cyst aspiration. Neurosurgery 11: 589–598PubMedGoogle Scholar
  28. 28.
    Hahn JF, Levy WJ, Weinstein MJ (1979) Needle biopsy of intracranial lesions guided by computerized tomography. Neurosurgery 5: 11–15PubMedGoogle Scholar
  29. 29.
    James HE, Wells M, Alksne JF, Wickbom I, Siemens P, Brahme F, Rosenberg J (1979) Needle biopsy under computerized tomographic control: A method for tissue diagnosis in intracranial lesions. Neurosurgery 5: 671–674PubMedGoogle Scholar
  30. 30.
    Kandalaft N, Diehl J, Neuwelt EA (1982) Nonneoplastic intracranial lesions simulating neoplasms on computed tomography scan. JAMA 248: 2166–2168PubMedGoogle Scholar
  31. 31.
    Kelly PJ, Alker GJ, Goerss S (1982) Computed assisted stereotactic laser microsurgery for the treatment of intracranial neoplasms. Neurosurgery 10: 324–331PubMedGoogle Scholar
  32. 32.
    Kelly PJ, Alker GJ, Zoll J (1982) A microstereotactic approach to deep-seated arteriovenous malformations. Surg Neurol 17: 260–262PubMedGoogle Scholar
  33. 33.
    Leksell L (1983) Stereotactic radiosurgery. J Neurol Neurosurg Psychiat 46: 797–803PubMedGoogle Scholar
  34. 34.
    Leksell L, Jernberg B (1980) Stereotaxis and tomography. A technical note. Acta Neurochir (Wien) 52: 1–7Google Scholar
  35. 35.
    Lobato RD, Rivas JJ, Cabello A, Roger R (1982) Stereotactic biopsy of brain lesions visualizated with computed tomography. Appl Neurophysiol 45: 426–430PubMedGoogle Scholar
  36. 36.
    Lunsford LD, Maroon JC (1982) CT localization and biopsy of intracranial lesions. In: Sweet WH, Schmidek HH (eds) Operative neurosurgical techniques, vol 1, pp 403–418. Grune-Stratton, New York LondonGoogle Scholar
  37. 37.
    Lunsford LD, Martinez AJ (1984) Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22: 222–230PubMedGoogle Scholar
  38. 38.
    Maroon JC, Bank WO, Drayer BP, Rosenbaum AI (1977) Intracranial biopsy assisted by computerized tomography. J Neurosurg 46: 740–744PubMedGoogle Scholar
  39. 39.
    Matsumoto K, Hondo H (1984) CT-guided stereotactic evacuation of hypertensive intracerebral hematomas. J Neurosurg 61: 440–448PubMedGoogle Scholar
  40. 40.
    Menezes AH, Bell WE, Perret GE (1977) Hypothalamic tumors in children. Their diagnosis and management. Childs Brain 3: 265–280PubMedGoogle Scholar
  41. 41.
    Moran CJ, Naidich TP, Marchoski JA, (1984) CT guided needle placement in the Central Nervous System. Results in 146 consecutive patients. AJNR 5: 419–426Google Scholar
  42. 42.
    Mundinger F, Rationale and methods of interstitial iridium-192 brachycurie therapy and indium-192 or iodine-125 protracted long-term irradiation. In: Szikla G (ed) Stereotactic cerebral irradiation. Elsevier-North Holland Biomedical Press Amsterdam, pp 101–116Google Scholar
  43. 43.
    Mundinger F, Ostertag CB, Birg W, Weigel K (1980) Stereotactic treatment of brain lesions. Biopsy, interstitial radiotherapy (Iridium-192 and Iodine-125) and drainage procedures. Appl Neurophysiol 43: 198–204PubMedGoogle Scholar
  44. 44.
    Norman D, Newton TM (1975) Localization with the EMI scanner. Am J Roentgenol 127: 961–964Google Scholar
  45. 45.
    Obrador S, Soto M, Gutierrez-Diaz JA (1976) Surgical management of tumors of the pineal region. Acta Neurochir (Wien) 34: 159–171Google Scholar
  46. 46.
    Ostertag CB, Mennel HD, Kiessling M (1980) Stereotactic biopsy of brain tumors. Surg Neurol 14: 275–283PubMedGoogle Scholar
  47. 47.
    Pecker J, Scarabin JM, Vallee B, Brucher JM (1979) Treatment in tumors of the pineal region: Value of stereotactic biopsy. Surg Neurol 12: 341–348PubMedGoogle Scholar
  48. 48.
    Perry JH, Rosenbaum AE, Lunsford D, Swink CA, Zorub DS (1980) Computed tomography-guided stereotactic surgery: conception and development of a new stereotactic methodology. Neurosurgery 7: 376–381PubMedGoogle Scholar
  49. 49.
    Peters TM, Olivier A (1983) CT aided stereotaxy for depth electrode implantation and biopsy. Can J Neurol Sci 10: 166–169PubMedGoogle Scholar
  50. 50.
    Pierquin B, Dutreix A, Paine CH, Chassagne P, Marinello G, Ash D (1978) The Paris system in interstitial radiation therapy. Acta Radiol Oncol 17: 33–48Google Scholar
  51. 51.
    Poppen Jl, Marino R Jr (1968) Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28: 357–364PubMedGoogle Scholar
  52. 52.
    Rivas JJ, Lobato RD (1985) CT assisted stereotaxic aspiration of colloid cysts of the third ventricle. J Neurosurg 62: 238–242PubMedGoogle Scholar
  53. 53.
    Scarabin JM, Pecker J, Brucher JM, Valle B, Guegan Y, Fairre J, Simon J (1971) Stereotaxic exploration in 200 supratentorial brain tumors. Its value in addition to computerized tomography. Neuroradiology 16: 591–593Google Scholar
  54. 54.
    Sedan R, Peragut JC, Farnarier P, Hassorn J, Torres T (1981) The role of stereotactic biopsy in the therapeutic approach to malignant glioma. Neurochirurgie 27: 285–286PubMedGoogle Scholar
  55. 55.
    Scanlon PW, Taylor WF (1979) Radiotherapy of intracranial astrocytomas: Analysis of 417 cases treated from 1960 to 1969. Neurosurgery 5: 301–308PubMedGoogle Scholar
  56. 56.
    Shelden CH, McCann G, Jacques S, Lutes HR, Frazier RE, Katz R, Kuki R (1980) Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision. J Neurosurg 52: 21–27PubMedGoogle Scholar
  57. 57.
    Szikla G, Betti O, Szenhe L, Schlienger M (1981) L'expérience actuelle des irradiations stéréotaxiques dans le traitement des gliomas hémisphériques. Neurochirurgie 27: 295–298PubMedGoogle Scholar
  58. 58.
    Walsh PR, Larson SJ, Rytel MW, Maiman DJ (1980) Stereotactic aspiration of deep cerebral abscesses after CT-directed labeling. Appl Neurophysiol 43: 205–209PubMedGoogle Scholar
  59. 59.
    Wara SM, Fellows CF, Sheline GE, Wilson CB, Townsend JJ (1977) Radiation therapy for pineal tumors and suprasellar germinomas. Radiology 124: 221–223PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • R. D. Lobato
    • 1
  • J. J. Rivas
    • 1
  1. 1.Service of Neurosurgery, Hospital “1. Octubre” and Facultad de MedicinaUniversidad ComplutenseMadridSpain

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