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estereotaxia cerebral pdf merge. Quote. Postby Just» Tue Aug 28, am. Looking for estereotaxia cerebral pdf merge. Will be grateful for any help! Top. Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center. Biópsia cerebral: comparação entre estereotaxia. estereotaxia cerebral pdf converter. Quote. Postby Just» Tue Aug 28, am. Looking for estereotaxia cerebral pdf converter. Will be grateful for any.

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Treatment of intracranial tumoral lesions is related to its correct histological diagnostic.

We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was Most of lesions were lobar in both groups. Diagnostic yielding was We found in the postoperative CT scans intracranial hemorrhages in Most of them were mild post-operative hemorrages in the biopsy site.

There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.

Ocorreu uma morte relacionada ao procedimento em cada grupo. Treatment of intracranial mass lesions is highly reliant in its correct histological diagnosis. Treatment based only on clinical and radiological aspects is unsuccessful in one third of cases even using modern diagnostic techniques 1,2.

Advances on stereotactic techniques and more recently on image guided surgery or neuronavigation have left empirical treatment of intracranial tumors, without histological confirmation, to be exceptions 3. Nowadays the concept of minimally invasive surgery is becoming a daily reality in modern neurosurgery 4.

Among the advantages of this kind of surgery we can list smaller and more precise approaches, lower surgical time, less damage to eloquent structures, and, as a consequence, smaller morbidity and infection rates, and hospital staying 5,6. Navigation means, by definition, orientation in space.

On medical settings we consider it as the orientation on a given anatomical volume 7. Image guided surgery is the use of preoperative images previously transferred to a computer for surgical guidance during surgery 8. It enables the surgeon to make 3D localization of a lesion, program surgical trajectory, and localize anatomical structures and surgical instruments at real time 9.

Knowing the exact location of important and eloquent intracranial structures makes its preservation more likely and permits the surgeon a better resection control Many evidences suggest that neuronavigation reduces costs when compared it to standard cerebbral procedures 6, On the other hand, frame-based stereotactic biopsy was the gold standard for acquiring intracranial samples for a long time With the advent of neuronavigation the use of frame-based biopsy is becoming smaller because image guided biopsies offers many advantages, like: Taking these advantages in consideration it is easy to realize why neuronavigation reached such a great importance in actual neurosurgery.

Chiefly in neurooncology services, neuronavigation became a very useful tool with many cerebrap in the treatment of intracranial neoplasm. The objective of this study is to present the experience of the Oncologic Neurosurgery Service of the National Institute of Cancer in Brazil with frameless cerebral biopsies and to make a comparison with the frame-based method analyzing diagnostic yielding, postoperative hemorrhage, and mortality, related cerebrzl the two procedures.

We did a retrospective analysis of two groups: The first group was composed of 32 patients with the esfereotaxia age of The second group of 44 patients with the mean age of estereotaxja Half of the patients in each group was composed of male patients. Surgery was performed by the members of neurosurgery staff of esterwotaxia service for getting the correct diagnosis of varied intracranial mass lesions.


Hospital staying considered the time necessary cerbral any procedures related to treatment, not only the biopsies. Criteria for performing the immediate post-operative CT scans were not strictly adopted and were considered at an individual basis. The main extereotaxia to indicate the CT scans were a small bleeding through the biopsy needle occurred, or patients exhibiting post-operative neurological deterioration. Patients provided informed consent agreeing with data publication and the study was accepted by the Ethic Committee of the National Institute of Cancer – Brazil.

This interface helped to establish the exact surgical target, entry point, and surgical trajectory, avoiding vital structures and through the safer way. Choosing the surgical target was based in many factors mainly as the most enhancing point of the lesion or the esttereotaxia of a hipointense mass.

Proximity of vascular structures and very eloquent areas were avoided.

estereotaxia cerebral pdf merge – PDF Files

Depending on the pre-operative patient consciousness level we have chosen among general or local anesthesia with sedation. Head was fixed with the three-points Mayfield head-holder in which we adapted a device with infrared reflexive spheres for recognition with the neuronavigator.

It was used a Sedan-Nashold biopsy needle with reflexive spheres attached to it. Forehead and facial surface anatomical landmarks were obtained with the laser pointer scanner. Minimal accepted registration error was 2 mm. Whenever a bigger estimated error was considered, a new registration process was performed.

estereotaxia cerebral pdf merge

Biopsy needle was calibrated and recognized by the neuronavigation software in relation to the head position and inserted based on three-planar images generated by the neuronavigator Fig 1AB. The number of the samples of tissue obtained and the decision to switch to a new target were considered according to the per-operative neuropathologist smear hystological analysis of the samples.

The software used for neuronavigation was Cranial Navigation v.

Frame-based cerebral biopsy is a well-known and standardized technique 7, Moments before the surgery an ETMB estereotaxi frame Micromar, Diadema, SP was fixed to the patient head, and a contrast-enhanced CT-scan performed for x, y, and z target coordinates determination. In case of patient confusion and altered states of consciousness general anesthesia was performed.

estereotaxia cerebral pdf converter – PDF Files

Biopsy needle attached to the stereotactic frame was inserted to the target defined by the coordinates. Surgical target was the most estdreotaxia point of a lesion on CT-scan or the center of cerebrral hipodense mass. A new target point was calculated, and we chose a different trajectory in the case of inconclusive in-print analysis by the pathologist. Table 1 shows data relative to both studied groups: We observed an increasing trend for using frameless biopsy throughout the time period studied.

Both groups had a preponderance of lobar lesions biopsies, Diagnostic yielding for frameless cerebral biopsy was Considering non-diagnostic frame-based biopsies, seven were repeated using the same method, one was repeated with frameless stereotaxy, one patient was submitted to craniotomy for surgical tumor resection and open biopsy, and one patient had empirical corticoid treatment with lesion disappearance. Five out of seven non-diagnostic cases repeated with frame-based stereotaxy were diagnostic on second procedure, one case was considered and treated as a demializating eestereotaxia, and one patient died before a new diagnosis attempt.

Only four of the frameless biopsy procedures were not sstereotaxia. These cases were submitted to a second frameless procedure with positive diagnosis. Mean hospital staying was We observed five post-operative intracranial hemorrhages on frameless biopsies group Three small volume cerebral hemorrhages on biopsy site, and one case of small third ventricle hemorrhage, all of then without clinical significance.


Nevertheless there was one case of surgical treated cerebral hemorrhage that evolved to death. Five cases of frame-based cerebral biopsies developed small post-operative cerebral hemorrhage at biopsy site 9.

One patient submitted to frame-based biopsy presented important clinical deterioration at PO day 1. CT-scan showed transtentorial herniation, sub-falcine herniation, herniation of the left uncus, and intense supratentorial edema at the lesion site.

This patient was submitted to decompressive craniotomy immediately after diagnosis but evolved to death at PO day 4 Table 2Fig estereotxaia. Table 3 presents histological diagnosis at both groups studied. Esfereotaxia is a clear predominance of low-grade and high-grade gliomas on both of then. There are four cases of frame-based biopsies not presented on this table: Other studies show that frameless cerebral biopsy can be as precise as, or even more, than etereotaxia stereotaxy 21,25, Mean localization error is similar in both methods 25, Difficulties on frameless biopsies are many.

Its targeting precision is intimately related to pre-operative radiological imaging that needs a well defined protocol Its adequate using depends on imaging manipulation and proper array of equipment on operation room.

For fewer targeting errors it is necessary an adequate registration of cranial surface points. Depending on the method used for this registration, neuronavigation accuracy can be lowered down Neuronavigation biopsies of about 1 cm lesions, profound lesions, and estereofaxia fossa lesions are usually less accurate than ecrebral biopsies Brain shift after trepanation and dural opening is not so important compared to estereotaxja craniotomy We use frame-base biopsy for lesions as small as 1 cm.

Neuronavigation is usually done with general anesthesia while frame-based biopsy are normally performed with patient sedation and local anesthesia which permits a better neurological evaluation just after the procedure Costs for neuronavigation acquisition are high considering a emerging country like Brazil, but long term neuronavigation cost evaluation seems to be lower Our study shows similar results on both methods compared to the literature considering diagnostic yielding, pos-operative hemorrhage, and mortality rates Post-operative hemorrhage rates of These rates are justified because all patients studied are from an oncology center with predomination of astrocitic lesions.

It is well known that glioma biopsies tends to have higher post-operative hemorrhage rates, specially those located at eloquent areas and deep seated Mortality related to volumous post-operative hemorrhage found on our study are compared to those found in the literature, i. That is why patients with hemorrhage at biopsy site on CT-scan must stay on hospital for observation and new imaging 6.

Post-operative hemorrhages found on our study were found on gliomas extending to the corpus callosum, or to the thamalus and mesencephalon. Exception was a patient with a huge fronto-temporo-insular lesion with negative frame-based biopsy that died without diagnosis. Neuronavigation-guided cerebral biopsy is a very useful method for the neurosurgeon armamentarium.

Advantages over frame-based ceregral are many, and similar diagnostic yielding, post-operative hemorrhage, and mortality rates are found. Using neuronavigation for cerebral biopsies of lesions bigger than 1 cm have many justifiable advantages: Even thought frame-based biopsy still holds an important position on treating intracranial mass estereotaia because its cost accessibility, and its high diagnostic rates specially considering tumors of 1 cm or less, new software and equipment development tend to make neuronavigation an even more diffused method among neurosurgeons with lesser acquisition costs and better precision.

The incidence of unexpected cerwbral findings in an image-guided biopsy series: Stereotactic biopsy of brain lesions visualized with CT.