title: Frameless stereotactic procedures in pediatric patients: safety and diagnostic efficacy.
abstract: OBJECTIVE
  The aim of our retrospective study was to evaluate the feasibility, safety, and diagnostic yield of a frameless method for stereotactic neurosurgical procedures in pediatric patients.
  
  
  METHODS
  Twenty-two frameless stereotactic neurosurgical procedures (18 biopsies, 4 catheter placements), using a modified frameless stereotactic navigational system, were performed in 21 pediatric patients in our institution from 2004 to 2009. All procedures were performed by the senior authors (AAK, SC).
  
  
  RESULTS
  We completed 18 biopsy procedures in 18 patients, yielding usable diagnostic specimens in 100% of the procedures. Of this biopsy group, two patients experienced an asymptomatic hemorrhage per CT, and one patient experienced a transient hemiparesis, recovering to baseline within 1 week after surgery. Four catheter placement procedures were completed in three patients, including one patient who had to have the procedure repeated. We had no peri-operative mortality or technical difficulties related to the catheter placements.
  
  
  CONCLUSIONS
  Frameless stereotactic neurosurgical procedures in the pediatric population are feasible and can be completed safely for histological tumor diagnosis as well as for accurate placement of intracranial catheters. This method has low rates of morbidity comparable to frame-based procedures, with the advantage of greater operative convenience.
authors.affiliation: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Parreño
authors.forename: Xiao
authors.initials: X
authors.lastname: Bo
authors.forename: Okezie O
authors.initials: OO
authors.lastname: Kanu
authors.forename: Shlomi
authors.initials: S
authors.lastname: Constantini
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kanner
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001927:Brain Diseases / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010372:Pediatrics; D011183:Postoperative Complications; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000009:adverse effects; D055815:Young Adult