Ultrasound-guided stereotaxic biopsy using a new apparatus

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✓ A skull-mounted apparatus is described for use with ultrasound probes 16 mm in diameter (5.0-MHz probes for near-field and 7.5-MHz probes for far-field lesions). The system permits ultrasound-guided stereotaxic biopsy of intracranial lesions through a burr hole in awake or anesthetized patients. This apparatus has been used in 19 patients for biopsy of central nervous system lesions 1.5 to 5 cm in diameter and for drainage of abscess cavities and cysts. The time required to obtain a tissue sample after incision of the skin ranged from 25 to 40 minutes. The only complication was a delayed hemorrhage in a patient with acquired immunodeficiency syndrome. The advantages of this method over those guided by computerized tomography (CT) include less time required for the entire procedure, immediate confirmation of the biopsied target by imaging the echogenic needle track, assessment of cyst or abscess drainage, and detection of hemorrhage within minutes after biopsy. The apparatus may be especially useful in pediatric patients because it obviates the need for general anesthesia during transport to and from the CT scanner. This ultrasound-guided system does not require a craniotomy, craniectomy, or two separate burr holes.

Article Information

Address reprint requests to: Mitchel S. Berger, M.D., c/o The Editorial Office, Department of Neurological Surgery, 1360 Ninth Avenue, Suite 210, San Francisco, California 94122.

© AANS, except where prohibited by US copyright law.

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Figures

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    Components of the stereotaxic ultrasound apparatus. Upper: From left to right: base plate, clamping plate, phantom ultrasound probe (16 mm diameter), ultrasound probe holder, and locking ring. A Nashold biopsy needle is shown below. Lower: The ultrasound transducer inserted into the probe holder. Note the locking ring (arrow) screwed into the base plate.

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    Left: Contrast-enhanced computerized tomography scan showing a periventricular abscess (arrow) Right: Ultrasound image (obtained with the 5.0-MHz probe) of the lesion shown left. The cursors (+) are spaced 1 cm apart; the first cursor represents the tip of the ultrasound transducer (arrowhead). The hypoechoic center of the abscess cavity (arrow) is surrounded by an echogenic rim that corresponds to the contrast-enhancing ring shown left.

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    Left: Computerized tomography scan of a low-grade astrocytoma. The tumor (arrow) remains hypodense after infusion of contrast material. Right: Ultrasound image (obtained with the 5.0-MHz probe) of the lesion shown left. The tumor is circumscribed and highly echogenic (arrows).

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    Ultrasound image of the abscess cavity in Fig. 2 showing that the lesion is drained (large black arrow) and the ventricle has reexpanded (white arrow). The echogenic needle track is easily seen along the path of the cursors (small black arrows).

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