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Stereotactic biopsy


Medical editor Ane Konglund MD
Physician in Specialization
Oslo University Hospital

General

Stereotactic biopsy is carried out for symptomatic lesions in the brain parenchyma when diagnostic clarification is important. This particularly applies to lesions that are inaccessible for resection, or when a type of tumor is suspected that requires a treatment other than surgical resection.

Stereotactic biopsy is a minimally invasive procedure with several advantages.

  • Low morbidity and mortality
  • Avoidance of a major operation involving opening the cranium
  • Cost savings
  • Fewer bed-days in the hospital  

Indications

  • Brain tumor

Goal

  •  To establish a diagnose in order to evaluate further treatment

Equipment

  • Stereotactic tray 
  • Stereotactic frame system
  • High speed drill

Preparation

  • Local anesthesia is injected.
  • The patient has a stereotactic frame attached that is fixed to the cranium on four points with disposable pins.
  • The patient is transported in the frame to the CT machine for preoperative examination.
  • The CT images are merged with MR images and the brain tumor is localized in relation to the frame.
  • Planning is carried out at a data station where the exact coordinates for insertion and biopsy in three dimensions are calculated.
  • Once the planning stage has been completed satisfactorily, the patient is transported back to the operating theater where the biopsy is performed.
  • The patient is placed in either a supine or sitting position.
  • Infection prophylaxis is given (single dose).

Implementation

  • The insertion position is localized with the help of frame coordinates.
  • Local anesthetic is given and a small skin incision is made.
  • A small drill hole is made and the dura is opened.
  • A small corticotomy is performed in the underlying gyrus where the biopsy needle is inserted.
  • Sample material is taken from the tumor tissue for histological examination; preferably several samples from different depths, and at least one sample for frozen section.  
  • The skin section is sutured in layers.
  • The frame is disassembled.   

Follow-up

  • The patient is given thrombosis prophylaxis. 
  • The patient is mobilized on the first postoperative day. 
  • A CT scan is taken on the first postoperative day to exclude any bleeding and to confirm that the correct area was targeted. 
  • The patient is discharged to the referring hospital on the first or second postoperative day.
  • The sutures are removed after 10–12 days. 
  • Conclusive histology results will be available after 7–10 days.

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