Stereotactic Craniotomy and Trans-Sulcal Approach for Small Subcortical Lesions

OBJECTIVE: It is difficult to localize accurately the small mass lesions seen in CT, MRI images in the operating field, espacially in the subcortical location. To minimize possible neurologic deficit for intraprenchymal exploration, the stereotactic technique is essential. Authors evaluated the stereotactic craniotomy and transsulcal approach in localizing various small subcortical mass lesions. METHOD: For last 3 years, stereotactic craniotomy was done in 7 patients in our institute. They were 1 cysticercosis, 1 cavernous hemangioma, 1 inflammatory sclerosis, 3 tuberculous granulomas, 1 metastatic tumor. They were all subcortical location and associated with mass effect. According to locations, four of them were located in the somatosensory cortex, 1 in supplementary frontal cortex, 1 in temporal cortex, 1 in parietal cortex. After application of stereotactic frame, the patients were transferred to CT/MR unit for target localization. Multiple target points were obtained from images and the patient were taken to the operating room. Scalp incisions and bone flaps were designed with physical placement method with stereotactic probe. After dural opening, the subcortical mass was traced with stereotactic probe. Transgyral approaches were used in 4 patients and transculcal approach in 3 patients under the stereotactic guidance. RESULTS: Small craniotomy with accurate localization was possible without difficulty in all cases. Furthermore there was no need for intraparenchymal exploration to localize the subcortical mass. There was no operative mortality, 1 patient developed transient hemiparesis lasting 3 weeks. No other patient showed neurologic deficit. CONCLUSION: Stereotactic craniotomy and localization seems to be helpful for removal of small subcortical masses. small craniotomy with accurate localization was possible. In the eloquent areas, transsulcal approach seems to be particularly useful to prevent possible neurologic sequele.

Value of Molybdenum Target X-ray Stereotactic Localized Biopsy with Resident Metal Wire in Breast Minute Lesions / 实用放射学杂志

Objective To evaluate X-ray stereotactic localized biopsy with resident metal wire in the diagnosis of breast minutelesions. Methods 28 cases of breast minute lesions were analyzed retrospectively,all cases were non-palpable clinically,but were positive by mammography.Needle biopsies were executed under X-ray stereotactic localization,and a thin metal wire was sited in lesion to instruct resection. Results All of 28 cases with minute lesion were successfully localized and completely resected,localization satisfaction rate was 93% percent.Pathological diagnosis showed benign lesion in 19 cases,and malignant lesion in 9 cases.Among the 9 malignant cases,there were 5 cases of invasive duct carcinoma,1 case of duct carcinoma with early invasion,2 cases of duct carcinoma,and 1 case of medullary carcinoma. Conclusion X-ray stereotactic localized biopsy with resident metal wire can provide accurate localization and precise diagnosis,especially in the diagnosis of occult breast cancer.It is an efficient method in the diagnosis of early breast carcinoma.