Positron Emission Tomography (PET Scan) in NeuronavigationGuided Biopsy of Complex Brain Tumors

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Male patient, 38 years old, with a history of previous surgical intervention in another center for brain lesion in the left fronto-parietal region, who had undergone a biopsy, with a result of failed pathological anatomy (he had no diagnosis). In the neurological examination, the patient was conscious, oriented in the three spheres, without neurological deficit, Glasgow 15/15. In the cranial MRI was observed in the left fronto-parietal subcortical region a hypointense lesion on T1, and an irregular hyperintense image in relation to the midline on T2, which did not uptake the contrast medium. Surgical intervention was performed, with a biopsy guided by the neuronavigation system (Brain Lab Curve) using a trephine less than 1 cm and the target planned by fusion of PET scan choline (Positron Emission Tomography) and contrasted cranial MRI, the most representative sample of the lesion was taken where observed the maximum affinity of the lesion for radioactive choline. The Pathological Anatomy result was low grade Astrocytoma, establishing a diagnosis. Control cranial CT scan 6 hours post-operatively, which determined the planned biopsy sample site. The post-surgical evolution was satisfactory, Glasgow 15/15, without neurological deficit. It has been proposed to continue treatment for these cases. In cases of complex lesions where CT and MRI cannot offer adequate resolution through imaging of the lesion, PET scan choline can offer an option to plan an appropriate biopsy of the lesion and obtain representativeness and obtain the best diagnosis. We recommend the use of PET scan in these cases.