CT-Guided Stereotaxis of Intracranial Mass Lesions: Its Complications and Diagnostic Accuracy of Biopsy

ABSTRACT

Surgical resection may not be the appropriate first treatment for all intracranial mass lesions, especially for deep or midline lesions. And a precise histopathological diagnosis is mandatory to develop adequate and specific treatments. The advent of modern imaging and CT-compatible stereotactic frames has greatly simplified the performance of streotactic procedure for small and deep seated brain tumors. We present a 44-month experience on 94 stereotactic procedures of intracranial mass lesions, using Brown-Roberts-Wells(BRW) and Cosman-Roberts-Wells(CRW) system. Procedures were undertaken with the patient under the local anesthesia for biopsy(78 procedures), cyst aspiration and/or Ommaya reservoir insertion(9 procedures), and brachytherapy(5 procedures) and under the general anesthesia for stereotactic-guided microsurgery(2 procedures). Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 8.5%(8 of 94 procedures). The postoperative complications were transient and not seriour, except aggravation of obstructive hydrocephalus in two cases of lateral ventricular tumors. Specific and correct histological diagnoses were achieved in 73(94%) of 78 biopsy. We could not obtain a specific diagnosis in 3 cases(2 cases of reactive gliosis, 1 case of necrosis). And in two cases with a diagnosis of anaplastic astrocytoma and oligodendroglioma grade I on the basis of surgical specimens by craniotomy, stereotactic biopsy revealed astrocytoma grade II and nonspecific inflammation respectively. Our data suggest that CT-guided stereotactic biopsy is a reliable and safe method for histologic diagnosis of brain-tumoral conditions and the method of choice for deep-seated and midline lesions.