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Neuronavigation-guided open biopsy


Medical editor Ane Konglund MD
Physician in Specialization
Oslo University Hospital

General

The neuronavigation-guided biopsy is performed for symptom producing lesions in the brain parenchyma where diagnostic clarification is important. This applies especially for lesions that are not accessible for resection or where there is a suspicion of a tumor type that should receive a different treatment than surgical resection.

This kind of biopsy is only chosen when endoscopic or stereotactic biopsy are not applicable.

Indication

  • Brain tumor

Goal

  • Determine the diagnosis in order to evaluate further treatment

Equipment

  • Craniotomy tray, adult
  • Craniofix tray
  • High-speed drill and saw (craniotomy)
  • Neuronavigation equipment
  • (Operation microscope for deep-lying tumors)

Preparation

  • Give the patient anesthetic and place in supine position.
  • Fix the head. The face should be visible for the neuronavigation apparatus, since this is easily "recognizable” and increases precision.
  • Configure neuronavigation.
  • Administer prophylaxis for infection (single dose).

Implementation

  • Make a suitable skin incision.
  • Remove a free bone patch and open the dura.
  • Use neuronavigation to localize the tumor and find the best access.
  • Use biopsy forceps or needle to take tissue samples for frozen section and histology. By attaching a marker, the instruments can be recognized by the neuronavigation system.
  • Finish when a satisfactory frozen section or convincing tissue material has been obtained.
  • Close the dura watertight and attach the bone flap with titanium clamps and midline sutures.
  • Close the skin incision in layers.

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