A Low Cost System for Performing CT Stereotaxic Brain Biopsy

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Abstract
The cost of commercially available CT-compatible frames for stereotaxic brain biopsy has limited their availability in the U.K. Our adaptation to a pre-CT stereotaxic frame that had been in use at Atkinson Morley's Hospital for 12 years, and the availability of a GE 9800 CT scanner has allowed us to carry out accurate CT-directed stereotaxic biopsy at minimal cost. The system has the additional advantage of speed and ease of use in inexperienced neurosurgical hands. Biopsies in 100 patients have been performed by 12 different surgeons (80% by registrars) who mastered the technique without difficulty. The rates of permanent morbidity (4%) and mortality (2%) are low, the two mortalities occurring in patients with high grade astrocytomas. They compare very favourably with rates for freehand burr-hole biopsy, and our overall diagnostic success rate of 83% for the initial biopsies, rising to 90% as a result of re-biopsy in 10 of the patients, is similar to that achieved with much more costly commercial systems. Benign lesions were found in 7% of patients who would otherwise have been assumed to have malignant tumours, and this finding emphasises the value of achieving a histological diagnosis in every mass lesion of the brain.