MR and CT images of the head can be accurately registered without using external markers or substantially altering image acquisition protocols. The resulting images can show the radiologic information more clearly than conventional viewing.

In this pilot study a combination of Aβ(1-42) levels and total tau protein levels predicted favorable surgical outcomes at 6 months with adequate accuracy to be of clinical use. Further study in a larger group with longer follow-up is warranted.

ObjectivesStereotactic brain biopsy is among the most common neurosurgical procedures. Planning a safe surgical trajectory requires careful attention to a number of features including:traversing the skull perpendicularly;avoiding critical neurovascular structures; andminimising trajectory length.The aim of this study was to develop a platform, SurgiNav, for automated trajectory planning in stereotactic brain biopsy.MethodsA prospectively maintained database was searched between February and August 2017 to identify all adult patients that underwent stereotactic brain biopsy in whom post-operative imaging was available. In each case, the standard pre-operative T1-weighted gadolinium-enhanced MRI was used to generate models of the cortex and vasculature. A surgical trajectory was then generated using automated computer-assisted planning (CAP) and metrics compared to the trajectory of the implemented manual plan (MP) using the paired T-test.Results15 consecutive patients were identified; who had a diagnostic biopsy and there were no immediate complications. Feasible trajectories were generated using CAP in 12 patients, and in these the mean trajectory length using CAP was comparable to MP (31.7 mm vs. 37.1 mm; p=0.3), and mean angle was similarly perpendicular from orthogonal (9.3° vs. 15.3° p=0.1), but the risk-metric was significantly lower (0.16 vs. 0.48; p=0.03).ConclusionsComputer-assisted planning for stereotactic brain biopsy appears feasible in most cases and may be safer in selected cases.

A man aged 23 years, with a previous clinical diagnosis of Behçet disease (recurrent genital and oral ulceration and papulopustular rash), sought treatment for a 3-week history of headache, fever, and progressive right-sided weakness. Clinical examination revealed a right homonymous hemianopia and mild right spastic hemiparesis. MRI of the brain showed a mass lesion involving the left temporal lobe with signal change extending into the left cerebral peduncle, thalamus, internal capsule, basal ganglia, and corona radiata posteriorly (figure, A and B). Stereotactic-guided biopsy of the left temporal lesion was performed, and histologic examination revealed a perivascular inflammatory infiltrate but no neoplasia. There was a clinical and radiologic response to treatment with prednisolone and azathioprine.The most common lesions in CNS neuro-Behçet disease are multiple small T2 hyperintensities, predominantly at the mesencephalodiencephalic junction, but such lesions were not seen in this case.1 Large masslike lesions on CT or MRI are extremely rare, and stereotactic biopsy should be considered in this situation.

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