Stereotactic surgery in children

Stereotactic biopsy has been popularized over the last decade since the advent of newer, more sophisticated instrumentation and technology. However, less than 300 cases of pediatric stereotaxy are recorded in the literature and few reports emphasize the necessary modifications required in children. Sixty-six stereotaxic procedures were performed on 62 children using the Brown-Roberts-Well (BRW) apparatus at our institutions. The mean age was 9.0 years (range 5 months to 18 years). The indication for the technique was diagnostic in 36 cases and therapeutic in 9 cases; location was a factor in 21 children with the lesion involving a 'deficit-prone' area of the brain. The BRW technique was applicable in 61 procedures (93%). Inability to enter cysts or biopsy of necrotic tissue and tumor capsule occurred in 5 cases. One patient had a transient increase in cerebral edema, for an overall complication rate of 2%. It appears that the BRW stereotactic technique is equally effective in children and adults and will no doubt play an ever increasing role in the future of pediatric neurosurgery.