Efficacy of neuronavigation guided biopsy in deep seated brain lesions

Localisation of brain lesions and prevention of damage to vital structures are important goals in the operation of brain pathologies, which can be aimed after the development of many techniques (e.g. angiography, MRI, sonography, frame base stereotaxy). In spite of current developments in radiological imaging techniques, accurate histological diagnosis is required to determine the appropriate treatment methods for intracranial lesions. The study was conducted in the Department of Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, over a period of 18 months. Descriptive statistics (frequencies and percentages) were used to interpret the collected data. After editing, data was entered into SPSS free versions for statistical studies. The results from various sites of the biopsy were compared based on sensitivity, specificity, positive and negative predictive values. In this study, 4 patients were found to be below 20 years, 7 patients in the 20 – 40 years age group, 10 patients in the age group of 40 to 60 years and 4 patients were above sixty years. 22 (88%) patients were found to have positive yield when the biopsy was taken from the core area while 3 (12%) patients were not having any positive results from the biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of various sites of the biopsy were calculated Sensitivity of the periphery came out to be 68.2 % while specificity was 67.7%. The positive predictive value of the periphery was found to be 93.8 % while the negative predictive value was 22.2%. The sensitivity of the contrast-enhanced area came out to be 72.7 %, with specificity being 67.7%. The positive predictive value of periphery in such cases was found to be 94.1 % and the negative predictive value was 25%. The most common system-related complication was the inability to show choline peak properly, which was present in 7 patients. Hence, it can be concluded safely that the use of neuronavigation is beginning to have a vital role in a variety of intracranial procedures with precise localisation of both intracranial as well as spinal lesions and prevention of damage to vital structures intraoperatively thereby significantly reducing procedure-related morbidity and mortality