Stereotactic brain biopsy

Stereotaxy, as diagnostic tool for brain tumors. Stereotactic biopsy basic concepts

1. Stereotactic brain biopsy Dr Abhishek Kumar Rai DNB Neurosurgery

2. Introduction History Indication Technique Indications Benefits Risks Advancement Points of learning

3. Root words : Stereo (solidity) + Taxy (touch) It refers to technique that involve recording and reproduction of 3D haptic (suitable to touch) information. Stereotactic surgery : Minimally invasive form of surgical intervention that makes use of 3D co-ordinates system to locate small target inside body and to perform intervention. Introduction

4. Sir Victor Horsley and Robert Clarke used an apparatus aligned by earplug and orbital tags, target was defined by bony landmarks. Historical aspects

5. The first stereotactic device used in humans was used by Martin Kirschner , for a method to treat trigeminal neuralgia by inserting an electrode into the trigeminal nerve and ablating it. He published this in 1933. Historical aspects

6. Th first human stereotactic surgery was born in 1947 when Speigel and Wycis published their groundbreaking manuscript in Science, where he used Horsley and Clarke, animal apparatus. Historical aspects

7. In 1949, Lars Leksell ( 1907–1986) a Swedish physician and Professor of Neurosurgery published a device that used polar coordinates instead of Cartesian . Historical aspects

8. In 1979, Russell A. Brown proposed a device , now known as the N-localizer , that enables guidance of stereotactic surgery using tomographic images that are obtained via medical imaging technologies such as X-ray, CT, MRI or PET. Historical aspects

9. Suspected malignant intraparenchymal tumours in eloquent areas Deep-seated lesions A focal, enhancing, peripontine mass in the midbrain, medulla or peduncle A posteriorly exophytic tumour protruding into the fourth ventricle A tumour exhibiting an uncharacteristic MRI pattern and is probably non-glial Focal , enhancing (especially ring-enhancing) lesions (to identify patients with benign non-neoplastic lesions ) Clinical or neuroimaging evidence of disease progression in tectal masses . Multiple lesions Patients reluctant for open surgery. Indication

10. Extra-axial lesions Superficial (grey-white junction) lesions Suspected vascular malformations/vascular lesions. Avoided in

11. Frame Primary frame Secondary frame Arch support attachments Stereotactic arch Biopsy instruments Instruments

12. Types of frames : Leksell Brown-Roberts-Wells Patil Cosman -Roberts-Wells Instruments

13. Biopsy instruments : • Cup forceps • Spiral needles • Side-cutting instruments • Needle core devices. Instrument

14. Technique

15. Technique

16. Technique

17. Technique

18. Non diagnostic biopsy yield (5.2-13%) Technical failure rate(2.4-3.7%) Complications (1.2 -7.36%) Perioperative (4.8-6.3%) Post op (4.8-10.5%) Hemorrhage/vessel rupture(2.1-4.35%) Mortality 0.6-3.7% Limitations

19. frameless stereotaxy Incorporation of fluorescence imaging spectrometry Incorporation of optical probes for reavessel detection along and around biopsy needle trajectory. In vivo confirmation of diagnosis of tumor Advancements

20. . Thank you