title: Frameless stereotactic cerebral biopsy: our experience in 296 cases.
abstract: OBJECTIVE
  To evaluate the reliability, safety and accuracy of a the frameless stereotactic system in our clinical series and the differences between head fixation by means of a standard Mayfield head holder and the pinless FESS frame, and to evaluate the usefulness of biopsy targeting on the basis of magnetic resonance spectroscopy (MRS) data.
  
  
  METHODS
  The spectroscopic analysis was used to facilitate the targeting of the lesion. The fusion image function embedded in the Neuronavigation Unit was used postoperatively to assess the level of accuracy of the biopsy. The grading of the glioma specimens was correlated to the spectroscopic data.
  
  
  RESULTS
  296 patients underwent cerebral biopsy in 8 years. The diagnostic yield was 99.7%. The spectroscopic choline/N-acetyl aspartate ratio in different areas of the same tumor correlated well with the histological grading of the lesion.
  
  
  CONCLUSIONS
  The frameless stereotactic systems guarantee excellent biopsy results. Advanced imaging, in particular MRS, facilitates the correct targeting of nonenhancing lesions.
authors.affiliation: Neurosurgery, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frati
authors.forename: Angelo
authors.initials: A
authors.lastname: Pichierri
authors.forename: Stefano
authors.initials: S
authors.lastname: Bastianello
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Felice
authors.initials: F
authors.lastname: Giangaspero
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvati
mesh_terms: D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies