title: Stereotactic craniotomy for lesions in eloquent areas.
abstract: CT compatible stereotactic systems are being increasingly used in the management of intracranial mass lesions. This study deals with the use of BRW stereotactic system for excisional biopsy of small (<30 mm), superficial, solitary cerebral lesions located in eloquent areas. Out of a total of 113 cases of stereotactic craniotomy carried out in the department since 1987, 78 fitted the above criteria. Out of these 78 patients, 70 lesions (90%) were less than 20 mm in size. Local anaesthesia was used in 10 cases (13%) whereas the rest had general anaesthesia. Cortical incision using standard techniques were used in 51 patients (65%), whereas in 27 patients (35%) excisional biopsy was done using trans-sulcal microsurgical techniques. Twenty-one (41%) patients had some degree of neurological deficit in the immediate postoperative period when a cortical incision was used compared to 4 patients (15%) when a trans-sulcal microsurgical excisional biopsy was done (P < 0.05). However, significant neurological deficits were present in 10 cases (12.8%) and all but two had had cortical incisions. When assessed one month after surgery significant residual deficit was present in only 2 patients (2.5%) who had had cortical incisions. There was no postoperative infection or mortality in this series. CT guided stereotactic craniotomy coupled with trans-sulcal microsurgical techniques can be safely used for the excisional biopsy of small superficial lesions located in eloquent areas of the brain.
authors.affiliation: Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India.
authors.forename: A
authors.initials: A
authors.lastname: Ranjan
authors.forename: V
authors.initials: V
authors.lastname: Rajshekhar
authors.forename: M J
authors.initials: MJ
authors.lastname: Chandy