Frameless image-guided stereotaxy with real-time visual feedback for brain biopsy

Jens Gempt, Niels Buchmann, Yu Mi Ryang, Sandro Krieg, Jürgen Kreutzer, Bernhard Meyer, Florian Ringel

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background Frame-based stereotaxy remains the "gold standard" for cerebral biopsies and functional neurosurgery though new frameless stereotactic systems are evolving continually. As the technique of frameless stereotaxy gains increasing acceptance among neurosurgeons, this study assesses the feasibility of a system for frameless imageguided stereotaxy. Methods All patients biopsied for intracranial lesions between February 2007 and August 2010 using the BrainLAB VarioGuide frameless stereotactic system were evaluated prospectively. Prior to surgery, patients underwent magnetic resonance (MR) imaging; additionally, fluoroethyl-tyrosine (FET)-positron emission tomography (PET) images were acquired and fused to MR images in selected cases. Biopsy trajectory length, lesion volume, procedure duration, and diagnostic yield were assessed. Results Ninety-six diagnostic biopsies in 91 patients were evalu 0.17 to 121.8 cm3; trajectory length from 25.3 to 101.9 mm. Diagnostic yield was 93.8%. Mean operation time from skin incision to wound closure was 42 min; in the operating room, it was 99 min. Conclusions Clinical experience indicates VarioGuide to be safe and accurate. Reachable range of lesion localisation appears to be comparable to a frame-based stereotaxy system. Operation times are brief. The unique design of this frameless stereotactic system allows real-time visual feedback of needle positioning.

Original languageEnglish
Pages (from-to)1663-1667
Number of pages5
JournalActa Neurochirurgica
Issue number9
StatePublished - Sep 2012
Externally publishedYes


  • Brain biopsy
  • Brain tumour
  • Frameless stereotaxy
  • Image guidance


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