title: Stereotactic management of intrinsic brain stem lesions.
abstract: Between 1981 and 1991, seventy-two cases of brain stem lesions have undergone CT or MRI-directed stereotactic surgery using the Brown-Roberts-Wells or Cosman-Roberts-Wells stereotactic systems. In 16 cases, the pre-operative diagnosis of haematoma had been made and the procedure was for therapeutic aspiration. In fifty-six cases, the pre-operative diagnosis was uncertain although intrinsic tumour was suspected. Histological diagnosis was obtained in fifty-four of these and unexpected findings of haematomas, granulomas, leucoencephalopathy, demyelinating disease, vasculitis and radiation necrosis occurred in over 15% of the cases. There were no operative deaths and morbidity was low. Advances in neuroradiological imaging with CT and MRI have increased the detection rate of brain stem lesions and image-directed stereotactic biopsy makes it possible in most cases to obtain histological diagnosis with relatively low morbidity which is important for treatment and prognosis. MRI-directed biopsies can compliment CT-guided biopsies in most cases where the lesion is not adequately delineated on the CT image.
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: M F
authors.initials: MF
authors.lastname: Pell
authors.forename: D G
authors.initials: DG
authors.lastname: Thomas
authors.forename: G P
authors.initials: GP
authors.lastname: Krateminos
mesh_terms: D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation*; D001927:Brain Diseases / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology* / Q000556:secondary; D001933:Brain Stem / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation