Introduction: Neuronavigation or image guidance systems are a bridge to transmit 3D radiologic data onto the neurosurgical operative field. With advances in technology,accuracy is comparable to the traditional frame based systems. We analyse our experience with image guided systems for brain biopsies. All the procedures were done at a single tertiary care centre in India. We analyse the accuracy of the procedure,the variety of pathology sampled, the complications seen and some advantages over the frame based biopsy techniques
Methods: All consecutive image guided brain biopsy patients from July 2007 through March 2016 were included. A brain biopsy was advised for deep seated, multiple, unresectable lesions or in some cases where craniotomy posed a greater risk. All the procedures were to establish diagnosis to guide further treatment. Preoperative imaging consisted of unenhanced and contrast enhanced CT/MRI was obtained upto 48 hours prior to the procedure. All the procedures were performed under GA. Toward the end of the study period, a different image guidancesystem was used. Thus a few patients had electromagnetic system biopsy. In a few cases, endoscope assisted biopsies were performed. The tissue obtained was sent for frozen section and histopathology examination. A control CT was obtained six to eight hours after the procedure to assess accuracy of target and to rule out significant hemorrhage at target site.
Results: From July 2007 to March 2016, 152 biopsy procedures done. Biopsy was inconclusive in two patients. Two patients had significant hemorrhage which was treated conservatively. There was no mortality linked to the procedure. Most patients were discharged within 5 days. The average time of the procedure was under 60 minutes.
Conclusions: We find Image guided brain biopsy a safe accurate and effective technique. This could be considered the first choice of technique for a brain biopsy.
Patient Care: This study should bolster the use of emerging technology like image guidance for brain biopsy. All patients want and must get accurate, optimally invasive neurosurgical procedures. This is a step in that direction.
Learning Objectives: A needle brain biopsy, although a 'blind' procedure can be performed safely.
Image guidance systems can have comparable accuracy to the traditional frame based systems.
Image guided procedures tend to be shorter and are well accepted by patients.