Computed tomogram-guided stereotactic brain biopsy in the pediatric patient.

Experience with computed tomogram-guided stereotactic biopsy is described with special reference to technical considerations important to the application of the Brown-Roberts-Wells system in pediatric patients. Eleven procedures were performed in 9 patients aged 9 months to 16 years of age. In all cases, the lesion was either deep seated or related to deficit prone areas making open biopsy hazardous. Since the stereotactic frame may interfere with intubation, it is important to apply it only after the patient has been anesthetized and intubated. In very small children, special attention is required to avoid over tightening of the fastening pins and to avoid excessive pressure when making the calvarial opening. In an effort to reduce the risk of hemorrhage, vasculature at the entry site was visualized and avoided by making a standard burr hole opening. Improved imaging of the vasculature at the deep biopsy site was obtained in most cases by intra-arterial contrast enhancement. No complications of the procedure were encountered and a diagnosis was obtained in all cases, although in 2 cases the procedure was repeated before adequate tissue was obtained. In 3 cases the procedure was therapeutic as well as diagnostic in that a tumor cyst or abscess could be drained.