Плоскодетекторная компьютерная томография: новые возможности нейронавигации в режиме реального времени при проведении стереотаксической биопсии новообразований головного мозга

Kurnosov, I. A., Balakhnin, P. V., Gulyaev, D. A., Subbotina, D. R., Malkevich, V. I., Muravtseva, A. L., Shmelev, A. S., Chirkin, V. Y., Burovik, I. A., Sergey Sergeevich, B., & Belyaev , A. M. (2025). Flat-Detector Computed Tomography: Advancing Real-Time Neuronavigation for Stereotactic Brain Tumor Biopsy. Voprosy Onkologii, 71(6), OF–2310. https://doi.org/10.37469/0507-3758-2025-71-6-OF-2310

Abstract

Introduction. Stereotactic brain tumor biopsy (STB) currently relies on two primary navigation technologies: frame-based and frameless systems. A significant limitation of both approaches is the inability to visualize the target tumor and biopsy needle in real-time during needle insertion.

Aim. To evaluate the technical efficacy, safety, advantages, and limitations of performing STB under real-time flat-panel detector computed tomography (FDCT) guidance.

Materials and Methods. Between December 2021 and December 2024, 99 patients (46 men, 53 women; median age 56 [46; 68] years) underwent FDCT-guided STB. Procedures were performed using an Artis Zee Floor angiographic system (Siemens, Germany) equipped with a 16-bit digital detector (40 × 30 cm) and utilizing various contrast enhancement techniques. The acquired FDCT images were analyzed using the standard InSpace software package, and trajectory planning was conducted with the iGuide Needed Guidance application. Biopsy needle insertion was performed under two-projection laser guidance and augmented fluoroscopy control. Post-procedural FDCT scans were obtained to confirm technical success and diagnose potential complications.

Results. The median target tumor volume was 6.9 [2.4; 16.6] ml, with a median targeting path length of 47.5 [38; 56] mm. Histological material was successfully obtained in 98% of cases, yielding diagnoses of 62 gliomas, 25 lymphomas, 5 demyelinating processes, 3 encephalitis cases, one adenocarcinoma metastasis of unknown primary, and one case of Erdheim-Chester disease. The median procedure duration was 53 [43; 65] minutes. Complications occurred in 3 (3%) patients, including two cases of intracranial hemorrhage (promptly diagnosed and managed during the procedure) and one case of persistent neurological deficit. No mortality was recorded.

Conclusion. This study demonstrates high diagnostic efficacy and safety of FDCT-guided STB. This technique overcomes the principal limitations of frame-based and frameless STB by providing reliable intraoperative trajectory planning, high-quality real-time neuroimaging and neuronavigation, and immediate complication detection with potential for timely intervention.

https://doi.org/10.37469/0507-3758-2025-71-6-OF-2310

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