Jason Labuschagne1,2, Denis Mutyaba3,4, Jacques Nel5, Claudia Casieri6. 1. Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa. Jason.labuschagne@icloud.com. 2. Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital, 6 Jubilee Rd, Parktown, Johannesburg, 2193, South Africa. Jason.labuschagne@icloud.com. 3. Department of Neurosurgery, University of the Witwatersrand, Johannesburg, South Africa. 4. Department of Paediatric Neurosurgery, Nelson Mandela Children's Hospital, 6 Jubilee Rd, Parktown, Johannesburg, 2193, South Africa. 5. Jacques Nel and Associates, Atterbury Estate, Pretoria, South Africa. 6. Department of Neurophysiology, Nelson Mandela Children's Hospital, Johannesburg, South Africa.
Abstract
INTRODUCTION: Frameless stereotactic navigation is used to direct the trajectory and biopsy site of target lesions. We report on a novel intra-operative stimulating (IOS) probe that is integrated into a commercially available stereotactic biopsy needle with the rationale that stimulation of the intended biopsy site should predict functional tissue thus preventing inadvertent biopsy of eloquent tissue. METHODS: Patients undergoing brainstem biopsies for atypical lesions were offered the additional stimulation procedure. The IOS probe was used to deliver stimulation in an attempt to determine the proximity of eloquent tissue. Once the desired location of the biopsy needle was achieved, the IOS probe was inserted down the centre of the biopsy needle and the stimulus applied. If no action potential was recorded, biopsies from four quadrants of the lesion were taken. If however a compound action potential was recorded, a new target was selected. RESULTS: Nine patients had the biopsy and stimulation procedure performed. The median age was 36 months. A minimum of 8 samples were obtained from each patient. Biopsy material was adequate to obtain a diagnosis in all 9 patients. In 2 cases use of the device influenced the insertion trajectory or biopsy site. No patients experienced any complications directly attributable to either the biopsy procedure or application of the stimulation. CONCLUSIONS: Use of the IOS probe for intra-operative stimulation of the intended brainstem biopsy site was found to be safe and feasible. The addition of stimulation using the IOS probe can be done with minimal change in workflow.
INTRODUCTION: Frameless stereotactic navigation is used to direct the trajectory and biopsy site of target lesions. We report on a novel intra-operative stimulating (IOS) probe that is integrated into a commercially available stereotactic biopsy needle with the rationale that stimulation of the intended biopsy site should predict functional tissue thus preventing inadvertent biopsy of eloquent tissue. METHODS:Patients undergoing brainstem biopsies for atypical lesions were offered the additional stimulation procedure. The IOS probe was used to deliver stimulation in an attempt to determine the proximity of eloquent tissue. Once the desired location of the biopsy needle was achieved, the IOS probe was inserted down the centre of the biopsy needle and the stimulus applied. If no action potential was recorded, biopsies from four quadrants of the lesion were taken. If however a compound action potential was recorded, a new target was selected. RESULTS: Nine patients had the biopsy and stimulation procedure performed. The median age was 36 months. A minimum of 8 samples were obtained from each patient. Biopsy material was adequate to obtain a diagnosis in all 9 patients. In 2 cases use of the device influenced the insertion trajectory or biopsy site. No patients experienced any complications directly attributable to either the biopsy procedure or application of the stimulation. CONCLUSIONS: Use of the IOS probe for intra-operative stimulation of the intended brainstem biopsy site was found to be safe and feasible. The addition of stimulation using the IOS probe can be done with minimal change in workflow.
Authors: F Chico-Ponce de León; M Perezpeña-Diazconti; E Castro-Sierra; F J Guerrero-Jazo; L F Gordillo-Domínguez; R Gutiérrez-Guerra; T Salamanca; G Sosa-Sainz; B L Santana-Montero; A DeMontesinos-Sampedro Journal: Childs Nerv Syst Date: 2003-05-06 Impact factor: 1.475