An image-guided brain biopsy

Mr Ranjeev Bhangoo explains what happens during an image-guided brain biopsy.

Here at LNP it’s common for us to perform a brain biopsy for patients who have a lesion on the brain. A biopsy is performed by removing a small sample of tissue and sending it to a lab where it can be determined exactly what type of lesion it is and therefore how it can be treated. 

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Undergoing an MRI scan is a fantastic and innovative way of producing clear-cut images of the brain and spinal cord in specific sequences. This will be able to initially pick up a lesion protruding on the brain and supply layered images.

The patient will be asleep during the procedure which means the they will not be able to feel a thing. There are different types of brain biopsies and the surgeon will be able to decipher which one is best for the patients’ lesion.

  • a biopsy as part of the operation to remove the tumour

  • image-guided biopsy

  • an open biopsy

  • a neuroendoscopy

Open biopsy: Some lesions can lay near the surface of the skull, using image-guidance a small incision will be made in the skull and a piece of the tissue  is take to be examined under the microscope.

Image-guided Biopsy: A small hole will be made and a small needle will be guided in to the tumour to take a sample.

Neuroendoscopy: A endoscope will be used to take tissue from in or around the ventricles of the brain. The ventricles are fluid-filled spaces in the brain.

Robotic technology for brain tumour biopsy – ROSA Robot

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 We currently use a new type of robotic surgery called ROSA Robot, it is a highly specialised stereotatic technique and is used for lesions that are in a sensitive part of the brain. ROSA has a robotic arm that reproduces the movements of a human arm but without the ‘tremor’ a human hand may give and can perform precise surgical gestures. The robot will follow the exact instruction from the controlling surgeon and will be about to provide high-definition 3D images of the surgical site on a screen in the theatre

It provides increased safety and precision for the patients and is a lot less invasive, hosting a quicker recovery time and reduced risk of infection and pain.

Once a small piece of the lesion has been removed, the sample will be taken to the labs where it will be put under a microscope. As mentioned, this will tell us exactly what this is and how we can treat it going forward.

The patient will be called back in for a consultation with the surgeon so he/she can check the wound is healing ok and go through the biopsy results, this will happen 5-7 days after the procedure. The surgeon will then discuss the treatment options in the MDT in collaboration with the oncologists and radiotherapists in order to determine the ideal treatment which may include a combination of surgery, chemotherapy, radiotherapy, immunotherapy or entering into a trial. 

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.