Journal Article

Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases

Monaco, Bernardo A., Cordeiro, Joacir G., Trippel, Michael, Lopez, William Omar Contreras, Furlanetti, Luciano L.

2015

Overview

•The use of stereotactic frame in young children remains controversial in the literature.•99 frame-based surgeries in patients younger than seven years-old were analyzed.•The overall complication rate related to frame fixation was 5%. No neurological deficit.•Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients.•Experience in the adjustment of the frame in children is crucial to reducing complications. Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Age / Biopsy - methods / Brain Neoplasms - pathology / Brain Neoplasms - surgery / Catheters / Child / Child, Preschool / Cysts / Electrodes, Implanted - microbiology / Embolisms / Endoscopy / Epidemiology / Female / Fractures / Frame-based stereotaxy / Humans / Imaging, Three-Dimensional - methods / Infant / Infections / Male / Neurology / Neurosurgery / Neurosurgical Procedures - methods / Patients / Pediatric neurosurgery / Pediatrics / Radiation therapy / Retrospective Studies / Safety / Skull Pins / Stereotaxic Techniques / Surgery / Universities