title: Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases.
abstract: BACKGROUND
  Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject.
  
  
  METHODS
  All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature.
  
  
  RESULTS
  The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed.
  
  
  CONCLUSIONS
  Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, Freiburg im Breisgau, Germany. Electronic address: luciano.furlanetti@uniklinik-freiburg.de.
authors.forename: Luciano L
authors.initials: LL
authors.lastname: Furlanetti
authors.affiliation: Department of Neurology, Division of Functional Neurosurgery, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Monaco
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, Freiburg im Breisgau, Germany.
authors.forename: Joacir G
authors.initials: JG
authors.lastname: Cordeiro
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, Freiburg im Breisgau, Germany; Department of Neurology, Division of Functional Neurosurgery, University of Sao Paulo, São Paulo, Brazil.
authors.forename: William Omar Contreras
authors.initials: WO
authors.lastname: Lopez
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University Freiburg Medical Center, Freiburg im Breisgau, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Trippel
mesh_terms: D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted / Q000382:microbiology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014495:Universities
keywords: Frame-based stereotaxy; Pediatric neurosurgery; Safety; Skull Pins