Hiroshi Ooba, Tatsuya Abe, Yasutomo Momii, Minoru Fujiki

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Stereotactic Biopsy with Electrical Monitoring for Deep-Seated Brain Tumors Hiroshi Ooba, Tatsuya Abe, Yasutomo Momii, Minoru Fujiki World Neurosurgery Volume 79, Issue 1, Pages 207.e1-207.e5 (January 2013) DOI: 10.1016/j.wneu.2010.05.028 Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 1 The iPlan Stereotaxy 2.6 software program (BrainLAB, Feldkirchen, Germany) demonstrates the tentative targets and trajectories for the stereotactic biopsy in patient 1 (A) and patient 2 (B). World Neurosurgery 2013 79, 207.e1-207.e5DOI: (10.1016/j.wneu.2010.05.028) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 2 The tentative target on a stereotactic map from the Schaltenbrand and Wahren atlas, the alternation of neuronal discharges along the trajectory, the distance from the tentative target, and the interpretation of the neural nucleus. The tentative target is set in the dorsal thalamic VIM on a stereotactic map. The neuronal discharges change along the trajectory at the point from –9 mm to +1 mm. The trajectory is expected to pass through the IC and VIM, but the amplitude is increased at the point from –7 mm to –5 mm, thus suggesting that the electrode penetrated the putamen (Put). World Neurosurgery 2013 79, 207.e1-207.e5DOI: (10.1016/j.wneu.2010.05.028) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 3 A T2-weighted MRI at the time of patient admission revealed a brain tumor in the thalamus with a tumor hemorrhage (A). A T2-weighted MRI 1 month after the stereotactic operation shows the actual biopsy point (B). The relationship between the trajectory and the surrounding nuclei is demonstrated on a stereotactic map (C). The green cross represents the biopsy point, and the green dotted line depicts the trajectory. The red line indicates the shifted putamen and globus pallidus due to the presence of the tumor and hematoma. World Neurosurgery 2013 79, 207.e1-207.e5DOI: (10.1016/j.wneu.2010.05.028) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 4 The tentative target is located in the center of the STN on a stereotactic map. The trajectory is expected to pass through the IC, STN, ZI, and SNr. The neuronal discharges do not increase at the point of the tentative target, thus suggesting that the STN is not located in the target. The increased discharges from +2 mm to +5 mm indicate the STN, the decreased discharges at +6 mm are in the ZI, and the increased discharges from +7 mm represent the SNr. World Neurosurgery 2013 79, 207.e1-207.e5DOI: (10.1016/j.wneu.2010.05.028) Copyright © 2013 Elsevier Inc. Terms and Conditions

Figure 5 A T2-weighted MRI at the time of patient admission shows a brain tumor in the right midbrain (A), and an MRI 1 month after the stereotactic operation shows the actual biopsy point (B). The relationship between the trajectory and surrounding nuclei is demonstrated in the sagittal (C) and coronal (D) sections. The green cross indicates the biopsy point, and the green dotted line is the trajectory. The red line indicates the shifted STN. World Neurosurgery 2013 79, 207.e1-207.e5DOI: (10.1016/j.wneu.2010.05.028) Copyright © 2013 Elsevier Inc. Terms and Conditions