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  • Stereotactic brain biopsy under real-time MR-imaging. A feasibility study

    Final Number:

    Uwe Spetzger MD, PhD; Gerd Winkler; Andrej von Schilling; Thomas Remmele; Sebastian Arnold

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Stereotactic biopsy of cerebral lesions is a routine procedure in neurosurgery. At present, the concept of intra-operative MR-imaging is realized in different sites, allowing different neurosurgical procedures under radiological control. The overall idea is to bring the whole stereotactic set-up into a conventional MR suite and perform real-time MR-imaging of frame-based stereotactic biopsies.

    Methods: In a scientific and industrial collaboration we developed a fully MR-compatible stereotactic frame (InnoguideTM). All components and materials fit into the bore of a conventional high-field 1.5T scanner. The purpose was to perform a stereotactic biopsy within the MR-suite, and therefore, have the image acquisition and the planning of the procedure, as well as the real-time intra-operative radiological control of the whole stereotactic biopsy in one set-up. The movement of the biopsy needle to the target and final positioning is visible on-line, due to ongoing MR-image acquisition (cine-mode) during the biopsy.

    Results: The planning, development and construction of this fully MR-compatible stereotactic frame (PEEK) are demonstrated. The set-up of the navigation out of the 5 gauss line (0.5 mT) and the procedure of registration and navigation with in this line, as well as the equipment and performance of the bure hole are shown. Initial tests, a phantom study as well as a feasibility study and accuracy evaluation of the biopsy (mean: 0.5 mm) in a cadaver head are described.

    Conclusions: The modern concept of the planning and the intra-operative real-time MR-imaging of stereotactic biopsies within the MR-scanner improve the whole workflow of the procedure and also enhance the precision and the safety of the procedure.

    Patient Care: improvment of workflow of frame-based stereotaxy

    Learning Objectives: Discription of a new modality of intraoperative MR-imaging of a stereotactic biopsy. Use of frame-based stereotaxy with intraoperative on-line radiological control in a conventional MR suite.


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