Stereotactic microsurgical resection of cerebral lesions

We describe our experience with stereotactic microsurgical resection of 27 lesions using the Leksell frame in 23 patients; 7 had cerebral metastases, 6 had gliomas, 6 had vascular malformations, 3 had meningiomas and 1 had radiation necrosis. Gross total removal of the lesion was accomplished in every case. All lesions were between 1.0 and 3.5 cm in greatest diameter and located either deep within the cerebral (n = 7) or superficially in areas of functional cortex (n = 20). There was no operative mortality and only minimal morbidity. Average length of operating time including frame application, imaging and resection was 4.4 h and most patients were discharged on the second postoperative day. The indications, advantages and limitations of stereotactic craniotomy are discussed and technical modifications that extend the usefulness and safety of this technique are described.