Technique of stereotactic biopsy in a 5-month-old child

We describe a technique of stereotactic frame-based biopsy in young children who have open fontanels and a deformable skull. A 5-month-old girl with a growing lesion in the right thalamus and basal ganglia underwent stereotactic biopsy, which disclosed an anaplastic astrocytoma. To avoid insertion of the four stereotactic frame fixation pins through the infant's skin and into bone, the pins were advanced into the hollowed end of rubber tops obtained from Vacutainer blood sampling tubes. The pressure applied to the skin was diffused through the rubber onto a wide skin surface, obviating skin puncture or bone deformation. This technique provided firm head fixation, and target accuracy was confirmed on post-operative imaging. This technique is safe and should permit use of conventional stereotactic techniques in young infants.