Clinical use of a new frameless optical neuronavigation system for brain biopsies: 10 cases (2013–2020)

Abstract

The aim of the retrospective study was to describe the brain biopsy procedure using a new frameless optical neuronavigation system and to report diagnostic yield and complications associated with the procedure. Materials and MethOds:The medical records for all dogs with forebrain lesions that underwent brain biopsy with a frameless optical neuronavigation system in a single referral hospital between 2013 and 2020 were retrospectively analysed. Following data were collected: signalment, neurological signs, diagnostic findings, number of brain biopsy samples, sampled region, complications, duration of hospitalisation, whether the samples were diagnostic and histopathological diagnoses. The device consists of a computer workstation with navigation software, an infrared camera, patient tracker and reflective instruments. The biopsy needle was equipped with reflective spheres, so the surgeon could see the position of the needle during sampling the intracranial lesion free handed through a mini-burr hole.results: Ten dogs were included. Absolute diagnostic yield based on specific histopathological diagnosis was 73.9%. Three dogs had immune-mediated necrotizing encephalitis, two dogs showed a necrotizing leukoencephalitis and two dogs a meningoencephalitis of unknown origin. In two dogs, the brain specimen showed unspecific changes. In one dog, the samples were non-diagnostic. Seven dogs showed no neurological deterioration, one dog mild temporary ataxia and two dogs died within 36 hours post brain biopsy. clinical significance: In these 10 dogs, the frameless optical neuronavigation system employed was useful to gain diagnostic brain biopsy samples. Considering the mortality rate observed, further studies are needed to confirm the safety of this procedure and prove its actual clinical effectiveness.

Case Report: Clinical Use of a Patient-Individual Magnetic Resonance Imaging-Based Stereotactic Navigation Device for Brain Biopsies in Three Dogs

“…Due to the small case series, it is not possible to determine a diagnostic yield of the biopsy procedure. In previous literature, the diagnostic yield of other brain biopsy devices was reported to range from 73.9 to 96.4% (15,(25)(26)(27)(37)(38)(39)(40)(41)(42). While the study was being conducted, two of the three dogs presented in this case report were already euthanized.…”

“…Due to the small case series, it is not possible to determine a diagnostic yield of the biopsy procedure. In previous literature, the diagnostic yield of other brain biopsy devices was reported to range from 73.9 to 96.4% ( 15 , 25 – 27 , 37 – 42 ).…”

“…The lack of flexibility is another general disadvantage of frame-based stereotactic brain biopsy systems compared to other neuronavigation systems ( 23 , 26 , 27 ), especially when using 3D printed frames, where the target trajectory can no longer be changed. Nevertheless, the information from a well-planned brain biopsy is essential to gain a specific diagnosis and initiate purposeful therapy.…”

“…Upon complete fixation, brain samples were routine processed ( 27 ). Histopathological analysis followed standard algorithms.…”

Stereotactic co-axial projection imaging for augmented reality neuronavigation: a proof-of-concept study

“…Neuronavigation provides indispensable guidance in modern neurosurgery (1)(2)(3). Most of the existing neuronavigation systems are frameless systems equipped with monitors for visualizing intraoperative and preoperative images.…”