Stereotactic Resection of the Brain Tumor Using 'Tailed Bullets': Technical Note

Cho, Kyung Gi; Ahn, Young Hwan

Abstract

The interactive image-guided stereotactic system can provide a real-time surgical localization and guidance for complete removal of the tumor. However, this system has limitation with respect to the resection of deepseated tumors because once the tumor is removed, the brain and the margin of tumors shift toward the area previously occupied by the tumor. We present a new operative technique for determining the resection margin of deep-seated tumors using a visual marker called a 'tailed bullet' to overcome the problem mentioned above. Preoperative enhanced computed tomograms or magnetic resonance imagings were performed with the aid of the Leksell frame. The enhancing margin of the tumor was defined as a resection margin. Several points(10-15) of the tumor margin on the enhanced imaging were chosen and localized. After usual craniotomy, multiple tailed bullets were inserted into the target point just before the opening of the dura. As the tumor was removed, the brain began to move along with the tailed bullets, thus enable us to continue tracking the tumor margin by following the bullet's location. There are substantial benefits of this surgical technique. It can be easily applied to any kind of stereotactic frame without incurring other expenses and it is more cost-efficient than the neuronavigation system. This surgical procedure is also safe and simple to use for overcoming the limitation of neuronavigation system, since the movement of the bullets with the brain can be easily traced thus lowering the mortality and morbidity of brain tumor resection. This surgical technique is especially useful in glioma surgery.