STEREOTAXIC CRANIOTOMY FOR LESIONS IN ELOQUENT AREAS

CT compatible stereotactic systems are being increasingly used in the management of intracranial mass lesions, This study deals with the use of the BRW stereotactic system for excisional biopsy of small (<30 mm ), superficial, solitary cerebral lesions located in eloquent areas, O ut of a total of 113 cases of stereotactic craniotomy carried out in t he department since 1987, 78 fitted the above criteria, Out of these 7 8 patients, 70 lesions (90%) were less than 20 mm in size. Local anaes thesia was used in 10 cases (13%)whereas the rest had general anaesthe sia. Cortical incision using standard techniques were used in 51 patie nts (65%), whereas in 27 patients (35%) excisional biopsy was done usi ng trans-sulcal microsurgical techniques, Twenty-one (41%) patients ha d some degree of neurological deficit in the immediate postoperative p eriod when a cortical incision was used compared to 4 patients (15%) w hen a trans-sulcal microsurgical excisional biopsy was done (P < 0.05) , However, significant neurological deficits were present in 10 cases (12.8%) and all but two had had cortical incisions, When assessed one month after surgery significant residual deficit was present in only 2 patients (2.5%) who had had cortical incisions, There was no postoper ative infection or mortality in this series. CT guided stereotactic cr aniotomy coupled with trans-sulcal microsurgical techniques can be saf ely used for the excisional biopsy of small superficial lesions locate d in eloquent areas of the brain. (C) 1995 Pearson Professional Ltd.