title: Real-time ultrasound monitoring during intracranial needle biopsies: operative results and detection of complications in 100 cases.
abstract: OBJECTIVE
  Intraoperative ultrasound displays dynamic processes intraoperatively. Performing burr-hole biopsies under a real-time visual control is an interesting option for the neurosurgeon. However, the percentage of conclusive diagnoses obtained by this technique and the rate of complications must be evaluated in a larger series.
  
  
  METHODS
  One hundred consecutive intracranial biopsies were analyzed. Through a burr hole, the lesion was localized by ultrasonography, and the planned needle trajectory was superimposed onto the image. Intracranial vessels were imaged by Doppler flow signals. Biopsies were taken in a mean depth of 41 mm (maximal 65 mm) from different parts of each tumor.
  
  
  RESULTS
  Thirty-six lesions involved the corpus callosum, 16 lesions were located deeply within the white matter, five in the internal capsule, and one in the upper brainstem. There were three cerebellar and 17 temporal lesions. Ten tumors did not exceed a diameter of 15 mm in any plane. The mean time interval from skin incision to the end of suturing was 45 minutes, and the mean time from the surgeons entering the operating theater to leaving the theater was 63 minutes. In 95% of the lesions, a diagnosis could be established. Transient neurologic deficits occurred in five patients, which were permanent in three. In 42 patients without postoperative neurological symptoms, postoperative computed tomography scans were obtained within 24 hours; a visible hemorrhage occurred in eight (19%), six of which were seen intraoperatively.
  
  
  CONCLUSIONS
  When intraoperative ultrasound-navigated biopsies were used they obtained a similar percentage of conclusive diagnoses as stereotactic biopsies. The complication rate is comparable as well. Emerging intracranial complications such as hemorrhages can be observed. However, their incidence cannot be decreased.
authors: Department of Neurosurgery, Zentralklinik, Bad Berka, Germany.
authors: Hassan
authors: H
authors: Allouch
authors: Institute of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.
authors: Sabine
authors: S
authors: Pfeifenbring
authors: Department of Neurosurgery, Zentralklinik, Bad Berka, Germany.
authors: Julianne
authors: J
authors: Behnke-Mursch
authors: Department of Neurosurgery, University of Ulm, Ulm, Germany.
authors: Marc-Eric
authors: ME
authors: Halatsch
authors: Department of Neurosurgery, Zentralklinik, Bad Berka, Germany. Electronic address: kay.mursch@zentralklinik.de.
authors: Kay
authors: K
authors: Mursch
mesh_terms: D000768:Anesthesia, General; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods*; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Biopsy; Brain neoplasm; Complications; Histopathology; Stereotaxy; Ultrasonography