Background: Stereotactic brain biopsy represents one of the most frequently performed neurological procedures for the identification of malignancy in brain tumours. In order to plan optimal trajectories, it is essential to consider the following ten features, as described by Prof. Stefan Wolfsberger: 1) Minimize length 2) Perpendicular at the entry point 3) Perpendicular of the target area 4) Use transgyral corticotomy 5) Avoid eloquent cortex 6) Avoid eloquent tracts 7) Avoid sulci/fissures/ventricles/cisternae 8) Maximize distance to vessels 9) Avoid sinuses 10) Avoid facial areas. Objective: The objective of this study is to compare the feasibility and diagnostic yield of Ten Rules-guided trajectory planning with manual planning to identify potential areas for improvement and to develop semi-automated planning software in the future. Methods: A database search was conducted retrospectively between June and August 2023 to identify all adult patients who had undergone SBB at the University Hospital of Neurosurgery, Graz between 2013 and 2023. For each patient, pre- and post-operative images in the form of MRI or CT scans were available. Two patients were excluded from the study due to the unavailability of MRI images. In each case, two different trajectories were generated: the first one was created by a student using the Ten Rules method, while the second was performed manually by a senior neurosurgeon using the Stealth Platform (Medtronic). The mean and median differences between target points in tumours and entry points on the skull were then compared. Results: The implementation of the Ten Rules was feasible in all patients. For trajectories, the median difference was 11.9 mm at the entry point and 2.6 mm at the target point, whereas the mean difference was 16.6 mm at the entry point and 3.3 mm at the target point. Of the 19 TGPs, 16 trajectories were accepted by the neurosurgeon.
Ten Rules Guided Planning Versus Manual Planning for Stereotactic Brain Biopsy: A Retrospective Comparative Study
Pariyar, A. (Author). 2025
Student thesis: Diploma thesis