Abstract
Purpose
The aim of our retrospective study was to evaluate the feasibility, safety, and diagnostic yield of a frameless method for stereotactic neurosurgical procedures in pediatric patients.
Methods
Twenty-two frameless stereotactic neurosurgical procedures (18 biopsies, 4 catheter placements), using a modified frameless stereotactic navigational system, were performed in 21 pediatric patients in our institution from 2004 to 2009. All procedures were performed by the senior authors (AAK, SC).
Results
We completed 18 biopsy procedures in 18 patients, yielding usable diagnostic specimens in 100% of the procedures. Of this biopsy group, two patients experienced an asymptomatic hemorrhage per CT, and one patient experienced a transient hemiparesis, recovering to baseline within 1 week after surgery. Four catheter placement procedures were completed in three patients, including one patient who had to have the procedure repeated. We had no peri-operative mortality or technical difficulties related to the catheter placements.
Conclusions
Frameless stereotactic neurosurgical procedures in the pediatric population are feasible and can be completed safely for histological tumor diagnosis as well as for accurate placement of intracranial catheters. This method has low rates of morbidity comparable to frame-based procedures, with the advantage of greater operative convenience.
Similar content being viewed by others
References
Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond GD (1993) Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children’s Cancer Group. Neurosurgery 33:1026–1029, Discussion, 1029–1030
Azeem SS, Origitano TC (2007) Ventricular catheter placement with a frameless neuronavigational system: a 1-year experience. Neurosurgery 60:243–247, Discussion, 247–248
Brainard JA, Prayson RA, Barnett GH (1997) Frozen section evaluation of stereotactic brain biopsies: diagnostic yield at the stereotactic target position in 188 cases. Arch Pathol Lab Med 121:481–484
Cartmill M, Punt J (1999) Diffuse brain stem glioma. A review of stereotactic biopsies. Childs Nerv Syst 15:235–237, Discussion, 238
Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJ, Vincent AJ (2008) Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 150:23–29
Daszkiewicz P (2001) Technical and diagnostic difficulties in stereotactic biopsy in children. Neurol Neurochir Pol 35:899–905
Epstein F, Wisoff JH (1988) Intrinsic brainstem tumors in childhood: surgical indications. J Neurooncol 6:309–317
Gil Z, Siomin V, Beni-Adani L, Sira B, Constantini S (2002) Ventricular catheter placement in children with hydrocephalus and small ventricles: the use of a frameless neuronavigation system. Childs Nerv Syst 18:26–29
Grossman R, Sadetzki S, Spiegelmann R, Ram Z (2005) Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir (Wien) 147:627–631, Discussion, 631
McGirt MJ, Woodworth GF, Coon AL, Frazier JM, Amundson E, Garonzik I, Olivi A, Weingart JD (2005) Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 102:897–901
Paleologos TS, Dorward NL, Wadley JP, Thomas DG (2001) Clinical validation of true frameless stereotactic biopsy: analysis of the first 125 consecutive cases. Neurosurgery 49:830–835, Discussion, 835–837
Rajshekhar V, Moorthy RK (2010) Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients. Stereotact Funct Neurosurg 88:360–366
Roujeau T, Machado G, Garnett MR, Miquel C, Puget S, Geoerger B, Grill J, Boddaert N, Di Rocco F, Zerah M, Sainte-Rose C (2007) Stereotactic biopsy of diffuse pontine lesions in children. J Neurosurg 107:1–4
Schumacher M, Schulte-Monting J, Stoeter P, Warmuth-Metz M, Solymosi L (2007) Magnetic resonance imaging compared with biopsy in the diagnosis of brainstem diseases of childhood: a multicenter review. J Neurosurg 106:111–119
St George EJ, Walsh AR, Sgouros S (2004) Stereotactic biopsy of brain tumours in the paediatric population. Childs Nerv Syst 20:163–167
Steck J, Friedman WA (1995) Stereotactic biopsy of brainstem mass lesions. Surg Neurol 43:563–567, Discussion, 567–568
Tilgner J, Herr M, Ostertag C, Volk B (2005) Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis--influence of clinical factors. Neurosurgery 56:257–265, Discussion, 257–265
Valdes-Gorcia J, Espinoza-Diaz DM, Paredes-Diaz E (1998) Stereotactic biopsy of brain stem and posterior fossa lesions in children. Acta Neurochir (Wien) 140:899–903
Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parreño, M.G., Bo, X., Kanu, O.O. et al. Frameless stereotactic procedures in pediatric patients: safety and diagnostic efficacy. Childs Nerv Syst 27, 2137–2140 (2011). https://doi.org/10.1007/s00381-011-1506-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-011-1506-x