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Stereotactic Procedures In Mumbai

Expert Stereotactic Brain Biopsy and Deep Brain Stimulation (DBS) for Parkinson's Disease, Essential Tremor, and Dystonia at Shree Hospitals

Stereotactic procedures use a precise three-dimensional coordinate system - derived from brain imaging (MRI and CT) - to guide surgical instruments to specific targets deep within the brain with millimetre accuracy, without the need for wide open craniotomy. At Shree Hospitals, our specialist neurosurgeons perform two primary categories of stereotactic procedures: stereotactic brain biopsy - obtaining tissue samples from deep-seated or eloquent-region brain lesions where open surgery is not safe, providing the diagnosis that guides treatment; and deep brain stimulation (DBS) - implanting electrodes into precisely targeted deep brain nuclei to treat Parkinson's disease, essential tremor, and dystonia - the most effective surgical treatment for movement disorders.

What are Stereotactic Neurosurgical Procedures?

Stereotaxis (from the Greek "stereos" - three-dimensional, and "taxis" - arrangement) refers to the use of a three-dimensional coordinate system to locate a target within the brain precisely from imaging data. By registering a patient's brain MRI or CT to a stereotactic frame (or frameless neuronavigation system), every point within the brain can be assigned exact x, y, and z coordinates. A surgical instrument - biopsy needle, electrode, or laser fibre - can then be guided to any target point along a pre-planned trajectory, passing through the safest possible corridor of brain tissue (avoiding eloquent cortex, blood vessels, and ventricles) with millimetre accuracy.

Stereotactic brain biopsy uses this system to obtain a small tissue sample (1 to 3mm cores) from a deep-seated or eloquent brain lesion that cannot be safely approached by open surgery. Common targets include: deep-seated gliomas in the thalamus, basal ganglia, or brainstem; CNS lymphoma (which is exquisitely sensitive to chemotherapy but must be distinguished histologically from other tumours); inflammatory or demyelinating lesions (MS, CNS vasculitis, sarcoidosis); infectious lesions (cerebral abscess, tuberculoma, toxoplasmosis); and any brain lesion where the tissue diagnosis will change management but open resection is not indicated.

Deep brain stimulation (DBS) is a neurosurgical procedure in which thin, multi-contact electrodes are implanted into specific deep brain nuclei and connected to an implantable pulse generator (IPG) - a programmable pacemaker-like device implanted under the skin of the chest wall or abdomen. Electrical stimulation delivered through the electrodes at specific parameters modulates the abnormal firing patterns of the target nucleus, suppressing the motor symptoms of Parkinson's disease (tremor, rigidity, bradykinesia, on-off fluctuations), essential tremor (disabling hand tremor), and dystonia (sustained abnormal postures and involuntary movements).

Who Needs a Stereotactic Procedure?

Stereotactic biopsy is indicated for:

• Any deep-seated brain lesion (thalamus, basal ganglia, brainstem, corpus callosum, internal capsule) that cannot be safely resected but needs histological diagnosis
• CNS lymphoma - strongly suspected on MRI (homogeneous enhancement, periventricular, restricted diffusion) but must be biopsied before any treatment including steroids (steroids can temporarily eliminate lymphoma, causing a false-negative biopsy)
• Multiple small ring-enhancing lesions - differential includes metastases, lymphoma, infection, demyelination - biopsy resolves the diagnosis
• Radiological diagnosis uncertainty - where the MRI appearance does not permit confident clinical diagnosis

DBS is indicated for:

• Parkinson's disease: motor fluctuations and dyskinesias despite optimised dopaminergic therapy, with preserved cognitive function and good response to levodopa
• Essential tremor: disabling hand tremor not controlled by propranolol, primidone, or other medications
• Dystonia: generalised or focal dystonia causing significant disability

Is a Stereotactic Procedure Right for You?

Stereotactic biopsy is the right choice when:

• The tissue diagnosis is essential for treatment planning (you cannot treat a brain tumour without knowing its type)
• Open resection is not safe or not indicated for the lesion (e.g., diffuse brainstem glioma, thalamic tumour)
• Steroids have not yet been given (for suspected CNS lymphoma)

DBS is the right choice for Parkinson's when:

• You have had Parkinson's disease for 5 or more years and medications are no longer providing adequate control
• You have a good response to levodopa (the therapeutic response test confirms DBS suitability - if levodopa does not significantly improve your symptoms, DBS is unlikely to help)
• You have preserved cognition on neuropsychological testing (DBS is not recommended for patients with significant dementia)
• You do not have significant depression or other psychiatric comorbidity that DBS might worsen
• Your movement disorder neurologist has confirmed DBS candidacy after thorough assessment

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Our Approach to Stereotactic Procedures at Shree Hospitals

At Shree Hospitals, stereotactic brain biopsy and DBS surgery are performed by a specialist team that combines neurosurgical precision with advanced intraoperative imaging and neurophysiology to achieve the best diagnostic and therapeutic outcomes.

Stereotactic Brain Biopsy

Planning and Trajectory Selection For stereotactic brain biopsy, the key to diagnostic success and safety is meticulous trajectory planning. The target is identified on the pre-operative MRI and mapped in the stereotactic coordinate system. A biopsy trajectory (the angle of approach of the biopsy needle) is then selected that passes through the safest corridor of brain tissue: avoiding the eloquent cortex, the corticospinal tract (motor tract), major sulci and vessels, the lateral ventricles, and the deep venous structures. For enhancing lesions, the biopsy target is placed at the most enhancing point (highest cellularity tumour).

Stereotactic Brain Biopsy

Technique and Safety Stereotactic biopsy is performed under local anaesthesia (scalp and burr hole site) with mild sedation, or under general anaesthesia in patients who cannot cooperate or where the target location requires a more complex approach. A burr hole (1.5 to 2cm circular opening) is made with a twist drill through the skull at the planned entry point. The biopsy cannula is advanced along the stereotactic arc to the target depth. Multiple cores are taken with a side-cutting biopsy needle (Sedan or similar).

DBS Surgery

Target Selection and Electrode Placement For DBS, target selection is diagnosis-dependent: the subthalamic nucleus (STN) is the primary target for Parkinson's disease (best overall motor benefit and greatest reduction in medication requirement); the ventral intermediate nucleus of the thalamus (VIM) is the preferred target for essential tremor (immediate and dramatic tremor suppression); the globus pallidus internus (GPi) is used for Parkinson's with prominent dyskinesias and for dystonia.

Top Neurosurgeons in Mumbai

Every specialist at Shree Hospitals is MCh Neurosurgery board-certified with over 15 years of clinical experience in awake craniotomy, brain tumour surgery, neuronavigation, fluorescence-guided resection, functional brain mapping, and neuro-oncology.

Neurosurgery Services at Shree Hospitals

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