Tumor Resection by Stereotactic Craniotomy Using the Brown-Roberts-Wells System

Abstract

Precise localization of subcortical targets contributes to the technical challenge of craniotomies. To address this challenge, the application of readily available stereotactic localization techniques to open craniotomies was investigated. Over a 2-year period, 62 consecutive stereotactic craniotomies were performed successfully using the CT-compatible Brown-Roberts-Wells (BRW) apparatus. Standard BRW hardware and software were employed. This series consists of craniotomies in 50 patients for resection of subcortical mass lesions. Targets were consistently and precisely localized by the stereotactic frame. Pathology revealed 32 metastases, 18 glial tumors, 5 nonglial tumors, and 7 nonneoplastic lesions. Histology differed from presumptive diagnoses by neurodiagnostic imaging studies in 30.6% of cases. The average volume of tumors resected was 55,903 mm3. Gross total resection of all solid tumor tissue was consistently confirmed by postoperative contrast-enhanced CT. Postoperatively, 38 patients with masses were neurologically improved, 22 were unchanged, and 2 were worse. Median postoperative survival for glioblastoma multiforme after adjuvant therapy was 58.7 weeks and for metastases was 39.2 weeks. There were no postoperative deaths. Overall surgical morbidity was 3.7%. CT-directed stereotactic craniotomy using the BRW system is a safe, efficacious, and readily available technique. It successfully confers the precision of stereotactic methodology on open microneurosurgical procedures.