Leksell G frame in pediatric neurosurgery: experiences from 73 stereotactic procedures

Pediatric neurosurgery demands extreme precision due to the unique anatomical development of the infant and adolescent brain. Prior research has shown that stereotactic systems provide the necessary accuracy for targeting deep-seated lesions or functional zones. Traditional methods often struggle with the thin skull structures and rapid growth phases characteristic of younger populations. Clinicians frequently encounter challenges when managing complex conditions like refractory epilepsy, intracranial tumors, or symptomatic cystic lesions. While adult applications of fixed-frame systems are well-documented, data regarding their performance in very young cohorts remains limited. The absence of standardized safety profiles for frame-based interventions in infants complicates the selection of surgical approaches. This absence of evidence motivated the current evaluation of frame-based interventions in a diverse pediatric surgical population.

This retrospective analysis assesses the feasibility and safety of utilizing the Leksell G frame for diverse pediatric neurosurgical interventions. Investigators sought to determine the diagnostic yield and therapeutic success across multiple procedural categories including oncology and functional neurosurgery. The research team focused on quantifying perioperative complications specifically related to the fixation of the stereotactic device on immature skulls. Another objective involved evaluating how pediatric-specific technical adaptations influence the overall surgical outcome and targeting precision. Researchers aimed to validate the reliability of this localization tool in managing hydrocephalus and intracranial abscesses through catheter placement. The study also examined the effectiveness of the system for placing invasive electrodes and radioactive seeds for brachytherapy. Scientists intended to provide a comprehensive risk profile for these procedures to guide future clinical decision-making in pediatric centers.

The clinical team performed a single-center retrospective review of 58 patients who underwent 73 separate stereotactic operations. Participants ranged in age from 8 months to 17 years, with a median age of 9.5 years and a standard deviation of 5.3 years. Surgeons utilized Cranial Magnetic Resonance Imaging (MRI) and Cranial Computed Tomography (CT) for precise preoperative planning and target localization. The surgical protocol incorporated specific technical modifications designed to accommodate the smaller head sizes and thinner calvaria of children. Data collection focused on postoperative neurological status and the occurrence of any adverse events linked to the hardware fixation. Statistical analysis described the distribution of procedures, including brain tumor biopsies and Stereoelectroencephalography (SEEG) electrode placements. The study period spanned from September 2021 to November 2024, capturing a modern cohort of pediatric neurosurgical patients.

Placement of intraventricular catheters or reservoirs constituted the largest procedural group, representing 42.5% of the total cases. Brain tumor biopsies achieved high diagnostic accuracy across 28 distinct procedures, accounting for 38.4% of the cohort. Invasive electrode placement for Stereoelectroencephalography (SEEG) was successfully completed in 9.6% of the surgical sessions. Cyst and abscess drainage procedures were performed in six instances, while one patient received interstitial brachytherapy seed placement. Complications remained minimal, consisting only of minor skin irritation at the pin fixation sites that resolved without intervention. No patients required surgical revision due to frame-related issues or significant neurological deficits following the interventions. The integration of multi-modal imaging guidance ensured that all 73 procedures met the high standards required for pediatric brain surgery.

The findings indicate that the Leksell G frame is a highly reliable and versatile tool for pediatric neurosurgical applications. Its precision enables the safe management of complex intracranial pathologies in patients as young as 8 months. The system demonstrates excellent adaptability across varied indications, from oncological biopsies to functional epilepsy mapping. Low complication rates suggest that the device is safe for use even in the developing pediatric skull with appropriate adaptations. Future research may further refine the pediatric-specific adaptations to enhance the efficiency of these stereotactic workflows. This study supports the continued integration of frame-based stereotaxy into standard pediatric neurosurgical practice for improved patient outcomes. Clinicians should consider this approach for high-precision tasks in children where anatomical complexity demands superior localization accuracy.