Computed tomogram-guided stereotactic brain biopsy in the pediatric patient

Area of Science:

• Neurosurgery
• Pediatric Radiology
• Medical Imaging

Background:

• Stereotactic biopsy offers a minimally invasive approach for diagnosing deep-seated or strategically located lesions in pediatric patients, where open biopsy poses significant risks.
• The Brown-Roberts-Wells (BRW) system is a specialized stereotactic apparatus used for precise targeting in neurosurgical procedures.
• Pediatric patients present unique challenges for stereotactic procedures due to anatomical differences and the need for specialized anesthetic and surgical considerations.

Observation:

• Eleven computed tomogram-guided stereotactic biopsy procedures were performed on 9 pediatric patients (9 months to 16 years old).
• Lesions were deep-seated or in deficit-prone areas, making open biopsy hazardous.
• The BRW system was applied after anesthesia and intubation to avoid interference; specific adaptations were made for young children regarding pin fixation and cranial access.

Findings:

• The procedure successfully obtained diagnoses in all cases, with 2 requiring repeat biopsies for adequate tissue.
• Vascularity at the entry site was visualized and avoided using a standard burr hole, minimizing hemorrhage risk.
• Intra-arterial contrast enhancement improved visualization of deep biopsy site vasculature in most cases.
• No complications were encountered during the procedures.

Implications:

• Computed tomogram-guided stereotactic biopsy is a safe and effective diagnostic tool in pediatric neurosurgery.
• The technique can be both diagnostic and therapeutic, enabling drainage of cysts or abscesses in 3 cases.
• Careful technical considerations, including frame application timing and pediatric-specific adaptations, are crucial for successful outcomes.