4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0140Surgical approaches for benign craniovertebral tumours in paediatric patients:
A local experience analysis
Mei Sin LIM1, Fadzlishah JOHANABAS1, Azmi Bin ALIAS1
1

Neurosurgery HKL, Hospital Kuala Lumpur, Petaling Jaya, Malaysia

Introduction : Paediatric patients with lesions at the craniovertebral junction pose unique challenges
in neurosurgery. We provide a comprehensive analysis of microsurgical resection either far lateralof midline suboccipital approach in the pediatric population, focusing on indications, methodology,
surgical outcomes, and critical discussions.
Material & Methods : We report our surgical experience in the treatment of 6 consecutive patientswith benign craniovertebral junction (CVJ) tumour with the mean age of 11 years (range of 5 to 18
years) who underwent microsurgical resection in our neurosurgical department from January 2021
to September 2023. We had treated 3 cervicomedullary ependymoma, 1 cervicomedullary pilocytic
astrocytoma and a singular foramen magnum meningiomas. All patients underwent preoperative
neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI).
Results : 2 far-lateral and 3 midline suboccipital with cervical laminoplasty approaches were
performed. Gross total removal was achieved in 4 cases (80%) and subtotal removal in 2 patient(20%). None of the patients required occipitocervical fusion. Radiological follow-up showed norecurrence in cases totally removed. Postoperative complications included CSF leaks (n=1) andsurgical site infections (n=1), which were managed successfully.
Conclusions : The selection of surgical approaches and the extent of bone resection in neurosurgery
are pivotal decisions, intricately tied to the precise characteristics of individual tumors. It is
important to emphasize that preoperative neuroradiological assessments, coupled with a thoroughunderstanding of the presumptive tumor type, play a pivotal role in guiding the surgeon’s strategy.
These enable the tailoring of surgical techniques and the provision of optimal exposure for various
lesions.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0081
Unusual presentation of Dandy walker syndrome as cervico-thoracic syrinx|
Case report and literature review.
Abdulrazaq ALOJAN1, Wael ALFAQAAWY1, Reem ALMARSHAD1, Alreem ALSHEHRI2
1

Neurosurgery Department, Imam Abdulrahman Bin Faisal University, Eastren Province/Khobar, Saudi Arabia,
Neurosurgery Department, King Faisal University, Eastren Province/Al-Ahsaa, Saudi Arabia

2

Introduction : Dandy walker syndrome (DWS) is an uncommon congenital malformation
characterized by hypoplasia of the Cerebellar vermis and cystic enlargement of the 4th ventricle
that results in upward displacement of the tentorium and trocula. It is presumed that the underlying
embryological cause is described by imperforation of Blake’s pouch during intrauterine brain
development of the roof of the fourth ventricle and cerebellar vermis.
Material & Methods : We outline a case of an 11 years old boy with an unusual presentation of neckpain and stiffness associated with multiple episodes of vomiting, occipital headache, along with gait
abnormalities all over the course of one month. NeuroImaging was consistent with Dandy walker
malformation and hydrocephalus plus a cervico-thoracic syrinx.
Results : The patient was admitted for a surgical intervention to relieve the intracranial pressure (ICP)as his imaging confirmed the association of hydrocephalus. A cysto-peritoneal shunt (CPS) was
placed followed by an immediate relieve of the patient’s symptoms and resolution of his neck pain
and stiffness as well. Consent was obtained from the parents for publishing this case.
Conclusions : Our case highlights a rare association of DWS with syringomyelia. It has a poorly
understood pathogenesis representing an impairment of CSF circulation. The outcome of the surgicalintervention was satisfying with immediate relief of the ICP.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0181
A case of intractable hydrocephalus due to choroid plexus hyperplasia
associated with 9p tetrasomy/hexasomy mosaic
Takumi YAMANAKA2, Tamaki MORISAKO1, Satoshi HISAOKA1, Yuta OI1, Ichita TANIYAMA1,
Naoya HASHIMOTO1
1

Neurosurgery, Graduate School Of Medical Science, Kyoto Prefectural University Of Medicine, Kyoto, Japan,
Neurosurgery, JCHO Kobe Central Hospital, Kobe, Japan

2

Introduction : Choroid plexus hyperplasia has been reported as a complication of trisomy
and tetrasomy of chromosome 9p and cause hydrocephalus. We report a case of intractablehydrocephalus with 9p tetrasomy/hexasomy mosaic who required ventriculoperitoneal shunting (VPS),
choroid plexus cauterization (CPC), and staged bilateral choroid plexectomy (CP).
Material & Methods : A 10-month-old girl.
Results : From the time of her birth, she had a peculiar facial appearance, cardiovascular anomalies,
mildly enlarged lateral ventricles, and increased size of choroid plexus. Chromosome examination
revealed a marker chromosome of unknown origin. At around 8 months of age, hydrocephalus
gradually worsened, so she was admitted to our hospital at 10 months of age. On the fourth day ofadmission, right VPS and CPC were performed. Two days after surgery, abdominal distention due
to ascites accumulation became prominent and required placement of an abdominal drain. Since
the cerebrospinal fluid (CSF) production did not decrease, right CP was performed on the 28th
day of admission, followed by left CP on day 41. VPS was reinserted on the left side, and she wasdischarged on day 96 of hospitalization without any subsequent symptoms. FISH and microarray
chromosome analysis revealed 9p tetrasomy/hexasomy mosaic (47,XY,+der(9)t(9;9)(p24;q13)[10]/48,XX,+der(9)t(9;9)(p24;q13 ),+idic(9)(q13)[10]).
Conclusions : In previous reports, hydrocephalus due to choroid plexus hyperplasia with 9p
duplication required additional surgical treatment on VPS implantation. This is the first case of 9p
tetrasomy/hexasomy mosaic, nevertheless the relationship between the number of 9p duplications
and CSF production is unclear. Cases with high number of 9p duplications may require multiple
treatment modalities.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0084
Limited dorsal myeloschisis associated with intramedullary infantile
hemangioma in the conus medullaris: a case report
Yoko NAKANISHI1, Noritsugu KUNIHIRO2, Ryoko UMABA2, Hiroaki SAKAMOTO2
1

Department Of Neurological Surgery, Wakayama Medical University, Wakayama, Japan,
Departments Of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan

2

Introduction : Limited dorsal myeloschisis (LDM) and intramedullary infantile hemangioma rarely
coexist in the spinal cord.
Material & Methods : We report the case of a 3-month-old girl who, despite lacking neurologicalsymptoms or signs, had a cigarette burn-like mark at the lumbosacral area and skin dimpling in thegluteal area.
Results : Magnetic resonance imaging showed a low-set conus due to a thickened filum and anabnormal subcutaneous stalk connected to the conus medullaris. In combination with the skinlesions, these findings strongly implied nonsaccular-type LDM. Magnetic resonance imaging also
showed an intramedullary mass homogenously enhanced with iso intensity on T1- and T2-weighted
images in the conus medullaris. We prophylactically untethered the spinal cord and partially removed
the intramedullary mass, which had no clear borders, for a safe surgical dissection. Histologically,
the intramedullary mass was an infantile hemangioma, and the subcutaneous stalk was a lesion
associated with LDM. The patient remained neurologically intact after surgery, and then two years
later, there was spontaneous regression of the residual tumor.
Conclusions : Although rare, nonsaccular type LDM may appear concurrently with intramedullary
infantile hemangioma at the conus medullaris. We hypothesized that the secondary neurulation might
be associated with the occurrence of the intramedullary infantile hemangioma in the conus medullarisand the LDM with the subcutaneous stalk penetrating the interspinous ligament below the S1–2 level.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0068A case of Alagille syndrome associated with craniosynostosis
Toyo SHIMIZU1, Atsuko HARADA1, Shigeo KYUTOKU2, Kouichi UEDA3
1

Neurosurgery, Takatsuki Hospital, Takatsuki, Japan,
Division Of Reconstructive Plastic Surgery, Nara City Hospital, Nara, Japan,
3
Plastic And Reconstructive Surgery, Osaka Medical And Pharmaceutical University, Takatsuki, Japan
2

Introduction : Alagille syndrome is well known to pediatricians an autosomal-dominant hereditarydisease with hepatic dysfunction causes intrahepatic cholestasis, that is usually diagnosed by someaccompanied abnormalities such as cardiovascular, ocular, vertebral, and facial abnormalities, inaddition. Incidence of craniosynostosis (CS) is reported in 0.9% of Alagille syndrome.The case of
Alagille syndrome with CS is discussed.
Material & Methods : The case involved a 6 years and 5 months old boy. His mother and sister,
respectively, had been clinically and genetically diagnosed with Alagille syndrome. He had beenclinically diagnosed of the syndrome in infancy, following hepatic damage, mild pulmonary arterystenosis, and characteristic inborn facial features. The boy has not received any treatment, grown
uneventfully. Due to severe headache and vomiting one week prior to the visit, Magnetic ResonanceImaging showed cerebellar tonsillar herniation to the C1 level. The patient was then referred to ourdepartment. Computed Tomography was performed because of dolichocephalic cranial distortion,and illustrated bilateral lambdoid and sagittal synostosis, and head radiography revealed severe
digital impression. Ophthalmologic assessments found bilateral papilledema and vision loss. Whenblood tests showed no coagulopathies, hepatobiliary enzymes were mildly increased. revealed fatty
liver is proved by abdominal ultrasound sonography.
Results : A semi-urgent extended suturectomy was performed without blood transfusion and with nocomplications. Headache, vomiting, papilledema, and vision loss had shortly disappeared.
Conclusions : Even late-onset intracranial hypertension symptoms in CS associated with Alagillesyndrome could be expected to improve with earlier surgical intervention.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0082
Helmet Therapy for brachycephaly
Hironori YAMADA1, Masahiro KAMEDA1, Kenichirou EZA1, Akihiro KAMBARA1, Ryokichi YAGI1,
Ryo HIRAMATSU1, Naosuke NONOGUCHI1, Motomasa FURUSE1, Shinji KAWABATA1,
Toshihiro TAKAMI1, Akinori ASAKA2, Shigeo KYUUTOKU3, Masahiko WANIBUCHI1
1

Neurosurgery, Osaka Medical And Pharmaceutical University, Takatsuki-shi, Japan,
Plastic Surgery, Osaka Medical And Pharmaceutical University, Takatsuki-shi, Japan,
3
Plastic Surgery, Nara City Hospital, Nara-shi, Japan
2

Introduction : We started helmet therapy for cranial deformity in infants last year using a helmet
manufactured by Japan Medical Company. Thirty-one patients have started helmet treatment sincethen. Brachycephaly is known to be more difficult to improve with helmet therapy than plagiocephaly.
In this study, we investigated the therapeutic effect of helmet therapy for brachycephaly.
Material & Methods : We assessed the severity of brachycephaly using the cephalic index (CI). The
severity was graded on a scale of 5 (CI: 94-97, 97-100, 100-103, 103+, corresponding to level 2, 3, 4,5). We evaluated the severity of brachycephaly in 5 patients who had level 2 or higher brachycephalicshape and completed 6 months of helmet therapy.
Results : We observed an improvement of 2 or more levels in all patients. The severity ofbrachycephaly at the end of treatment was improved to a level that is not actively recommended forhelmet therapy. One of the five patients had undergone suturectomy for coronal synostosis.
Conclusions : Helmet therapy is effective in brachycephaly. We also confirmed a good result in thepatient with coronal synostosis who underwent postoperative molding helmet therapy.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0155INTRINSIC BRAINSTEM EPIDERMOID CYST. A rare case report.
Dat TRAN1, Van He DONG1
1

Department Of Neurosurgery, VietDuc Hospital, Hanoi, Vietnam, Hanoi, Vietnam

Introduction : Brainstem epidermoid cysts are rare among all brainstem lesions, and they are
exceptionally uncommon in pediatric. We present a rare case of a purely cystic brainstem epidermoid
cyst in a 4-year-old child. Initially, the brain MRI suggested a low-grade brainstem glioma or a cystic
lesion in the brainstem. The patient underwent surgery, and the final diagnosis of an epidermoid cyst
was confirmed through histopatholoy.
Material & Methods : A 4 year – old girl presented with clinical symptoms of dysphagia, weakness
on the right side, ataxia for five months prior to admission. Her brain’s MRI suggested a 28mm cystic
mass located in the pons,no evidence of gadolium enhancement, suggested a low-grade glioma ora cystic lesion in the brainstem. The patient was scheduled for surgery, underwent a retrosigmoid
approach. Intraoperatively, the tumor was located anterior to the brainstem, enveloped within thearachnoid membrane, revealed a homogeneous, opaque fluid tissue, we completely aspirated
the contents within the tumor capsule and made efforts to achieve maximal resection of the tumor
capsuleResults : Postoperatively, the patient was completely recovered, and no complication was reported.
Histopathological examination revealed the epidermoid cyst. MRI performed three days post-op
demonstrated complete tumor removal without any signs of bleeding. Subsequent MRI follow-up at
one month, one year after the surgery showed no evidence of tumor recurrence
Conclusions : An epidermoid cyst is an exceptionally rare benign lesion found in the brainstem.
Surgery is indicated when the patient presents with clinical symptoms in conjunction with imaging
diagnosis, and the gold standard for a definitive diagnosis is histopathology.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0021
Radiologic Follow-up of Ruptured Arachnoid Cysts With or Without Hemorrhage
Tae-Young JUNG1, Ga-Eun KIM1, Su-Jee PARK1, Yeong Jin KIM1, Seul-Kee KIM2
1

Department Of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam, Korea, Republic of,
Department Of Radiology, Chonnam National University Hwasun Hospital, Chonnam, Korea, Republic of2

Introduction : Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts
may occasion[1]ally rupture because of minor head trauma. We describe the radiologic follow-up of 5
patients with ruptured arachnoid cysts featuring spontaneous resolution, subdural hygroma formation,and cystic and subdural hemorrhage.
Material & Methods : From January 2004 through July 2020, 5 patients (1.3%) with ruptured
arachnoid cysts were encountered out of a total of 388 patients with arachnoid cysts managed at our
institution. The 5 patients were all male, and they ranged in age from 6–17 years (median, 12 years).
The median duration of radiologic follow-up was 3.5 years (range, 2.3–10.1 years).
Results : All of the ruptured arachnoid cysts were overlying the temporal lobe with Galassi type II.
The median cyst diameter was 4.9 cm (range, 4.4–8.9 cm). Four patients had a history of recent
minor head trauma. There were no particular neurologic symptoms in their past medical history inall patients. In the follow-up, two patients’ cysts resolved spontaneously without hemorrhage. One
patient’s cyst resolved post-burr-hole drainage for chronic subdural hemorrhage. Another patient,whose cyst led to a hemorrhage and chronic subdural hemorrhage, recovered following a craniotomy,
hematoma removal, and cyst fenestration. Another patient, presenting with hygroma, cystic
hemorrhage, and chronic subdural hemorrhage, was treated with burr-hole drainage. Three patients
recovered postoperatively.
Conclusions : Arachnoid cysts rarely rupture, and surgical intervention is required for some cases
associated with hemorrhage. Postoperatively, all patients had good outcomes without complicationsin this series.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 1

A-0023
Surgical Management of Pediatric Middle Cranial Fossa Large Arachnoid Cyst
Associated with Hemiparesis: Case Report
Telaga BIROE1, Yosi SATRIA1
1

Neurosurgery, Dr Mintohardjo Navy Hospital, Jakarta, Jakarta, Indonesia

Introduction : Intracranial arachnoid cysts (IACs) are space occupying lesion containing fluid similar
to cerebrospinal fluid (CSF), they are benign and of congenital origin represent 1% of non-traumatic
intracranial masses. They were found mostly in children and commonly in the middle temporal fossa.
Most IACs are asymptomatic and may not show any symptoms throughout life, clinical manifestation
may vary depending on location and size of the IACs.
Material & Methods : We report a case of a 15-years old male with history of headache andprogressive right-side weakness since he was at 8 years old. He has history of seizure when he
was one year old and the last seizure occurred 6 months before admission, treated with divalproex
acid 250 mg daily. We found spasticity, atrophy and weakness in both right upper and lower
extremities with motor strength of 2/5. He was able to understand speech and speak fluently. A brain
computerized tomography (CT) scan performed revealed a non-enhanced cystic lesion in the left
frontotemporal regio connected to subarachnoid space with 8,3cm x 4,6cm x 9cm in dimension anddisplaced the left frontal and temporal lobe. We decided to perform a cyst peritoneal shunt to reduce
mass effect from the space occupying lesion cyst.
Results : On post operative follow up, the patient showed gradual improvement in motor strength anddiminishing spasticity.
Conclusions : Treatment of IACs is controversial to this day, in minds to achieved improvement stateof the clinical condition, we purposed the patient would benefit from surgical management to maintainand reduce enlargement of the cyst.

144

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0059Novel use of Gamma Knife Radiosurgery in the treatment of cerebral
Hepatoblastoma metastasis
Audrey TAN1, Enrica TAN2, Amos LOH3, Sharon LOW4, Gail CHUA5, Tseng Tsai YEO1,
Vincent NGA1, Bengt KARLSSON1
1

Neurosurgery, National University Hospital, Singapore, Singapore, Singapore,
Pediatric Hematology Oncology Service, KK Women’s And Children’s Hospital, Singaproe, Singapore,
3
Pediatric Surgery, KK Women’s And Children’s Hospital, Singapore, Singapore,4
Neurosurgery, KK Women’s And Children’s Hospital, Singapore, Singapore,
5
Radiation Oncology, National Cancer Centre, Singapore, Singapore
2Introduction : Hepatoblastoma is the most common pediatric liver malignancy1,2,3. 20% of patients
have advanced hepatoblastoma with distal metastasis at diagnosis1,4. Treatment is primarily throughsurgical resection and chemotherapy4. In this paper, we present a case report on the novel use
of Gamma Knife Radiosurgery (GKS) as a mode of treatment for hepatoblastoma brain metastasis
where surgical resection and chemoradiotherapy had failed to control the disease.
Material & Methods : A 2 year old boy was diagnosed with hepatoblastoma with lung, vascular andcerebral metastases. The liver, lung and vascular lesions were resected with no obvious recurrence.
The solitary brain metastasis was resected twice and treated alongside chemotherapy and linear
accelerator (LINAC) radiosurgery. Despite this, the cerebral metastasis still recurred. In view of thepresence of a solitary cerebral metastasis with no disease elsewhere and the dismal prognosis withuncontrolled disease, decision was made to trial treatment with GKS.
Results : The tumour was treated with GKS using a 18Gy treatment dose. There was an initial
reduction in tumour size sustained for a few months before eventual recurrence again. Treatment wastolerated well with no reported side effects. A review of current literature did not show any results onprior use of GKS on cerebral hepatoblastoma.
Conclusions : The use of Gamma Knife Radiosurgery in hepatoblastoma brain metastasis has shownpromising radiological results despite the eventual recurrence. More studies can be done to evaluate
and optimize the use of GKS in treatment of hepatoblastoma cerebral metastasis

145

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0075
Stag ed operation with Ommaya reser voir placement for cystic
craniophrayngioma
Sue-Jee PARK1, Tae-Young JUNG1
1

Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun, Korea, Republic of

Introduction : The surgery of craniopharyngioma (CP) is challenging and demand consideration due
to the tumor’s location in close proximity to critical neurovascular structures and hypothalamus. This
report aim to introduce a new surgical strategy to remove CP with maximal safe resection.
Material & Methods : An 8-year-old girl was admitted to the hospital with diplopia and decreased
visual acuity. Preoperative brain magnetic resonance imaging (MRI) revealed 10cm-sized large cystic
CP with fine calcification. Intraoperatively, the tumor capsule was too thin and adhered to surrounding
normal structures, making it difficult to remove safely. She underwent Ommaya reservoir placement
and received periodic cystic aspiration through reservoir for 1 year. On follow-up MRI, the cyst hadsignificantyl shrunk and the tumor-pial plane became more distinct. The capsule of the CP can be
sharply dissected and gently removed using scissors and a microbayonet and the tumor was nearlycompletely removed without damaging surrounding structures.
Results : Our results demonstrated that the surgical goal and maximal safe resection weresuccessfully achieved through the proposed staged surgical strategy. In addition, reducing thecyst size through Ommaya reservoir was associated with more easily dissection of tumor capsule, ashorter operative time, minimal bleeding, and a lower incidence of complications.
Conclusions : The staged surgical strategy with Ommaya reservoir placement represents a safe andeffective option for managing cystic CP in pediatrics.

146

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0107
Smooth Muscle Tumor post Ebstein Barr Virus infection in patient with likely
Primary Immunodeficiency Disorder
Alvernia Neysa UJAT1, Prabu Rau SRIRAM1
1

Neurosurgery, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia

Introduction : Smooth muscle tumor (SMT) following Ebstein Barr Virus (EBV) infection is a rareoncology entity. It occurs in immunocompromised patient such as patient of human immunodeficiency
virus infection or patients on immunosuppressant treatment. In paediatrics age group, this tumor canoccur in a patient with Primary Immunodeficiency Disorder (PID).
Material & Methods : NA
Results : A case of 9 years old girl presented with bilateral temporal headache for 4 months. The
headache was increasing in frequency associated with nocturnal awakening and restriction of neckmovement. She experienced constitutional symptoms of lethargy, reduce appetite and poor weightgain. Her neurological assessment was unremarkable and proceeded with CECT brain and neckwhere an extradural mass was seen at cervical region. MRI cervical was done and C1/C2 intradural
extramedullary mass seen with extradural component causing mass effect. Supplementary abdomen
USG revealed liver lesion. Neck USG guided biopsy done and histopathology examination (HPE)came back as round cell tumor. Patient developed progressive worsening in her neurology associatedwith neuropathic pain. She underwent c1-c3 laminectomy and tumor debulking. HPE result was
spindle cell lesion consistent with EBV associated related SMT. She is recovering and regained somemotor function. Repeated MRI whole spine showed tumor regrowth, and started on sirolimus, withplan for future re-operation. Based on HPE results and multifoci lesion, PID with immune dysregulation
was possible the likely diagnosis. Genetic study ongoing and pending result.
Conclusions : The pathogenesis of EBV+ SMTs remains largely unknown, but it is evident that an
immunocompromised host may present with this manifestation of PID.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0111High grade tumor mimicking vascular anomaly
Alvernia Neysa UJAT1, Prabu Rau SRIRAM1
1

Neurosurgery, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia

Introduction : High grade tumor with abnormal vasculature may present as vascular anomaly in early
imaging especially if patient presented with intracranial bleed. Abnormal cerebral vasculature can bea manifestation of a vascular malformation or a neoplastic process.
Material & Methods : NA
Results : a boy of 8 years old initially presented with sudden onset of headache and reduce
consciousness and multiple imaging done – CT brain, CTA Brain, MRI, MRA, MRV Brain; giving
diagnosis of intraparenchymal bleed (IPB) secondary to ruptured arteriovenous malformation(AVM). He was counselled for DSA however parents were not keen. He has multiple episode of
hospital admission for recurrent IPB. Family refuse for any invasive diagnositic imaging and surgicalmanagement. He presented 3 years later with worsening headache and vomiting episode. Urgent CT
brain done revealed a large intraparenchymal lesion. Proceeded with urgent MRI brain and revealed
a lesion suspicious of high grade with multiple serpangenous vessels seen. Parents was counselled
for DSA and surgery and they were agreeable. DSA done and reported as right temporal tumor.
Operation was done on the same day which was right craniectomy and debulking of tumor. Patient
recovered GCS to obeying command but subsequently succumbed to infection, recurrent bleedingtumor and aggressive tumor regrowth. Although rare, there have been a few reports of glioblastoma
mimicking vascular lesion in which initial imaging does not clearly distinguish between the two.
Conclusions : In conclusion, glial tumors can present in different forms and should be consideredin the differential diagnosis of intracranial hemorrhage, especially in the absence of predisposing
factors.

148

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0119Two case studies describing rapid growth of childhood intracranial teratoma
Erina ZAKARIA1, Dharmendra GANESAN1
1

Neurosurgery, University Of Malaya, Kuala Lumpur, Malaysia

Introduction : Teratoma is a type of non germinomatous germ cell tumour. It is an uncommon
paediatric brain tumour which frequently see in East Asian countries. It arise from differentiatedstages of embryonic development precursor of germ cell. Our case series portrayed the accelerated
growth of tumour which has been reported in only one case previously. This emphasizes the need ofurgent surgery.
Material & Methods : Our case series depicted an infant of 1.5 months old and 4 years old childwhich presented with symptoms of raise intracranial pressure secondary to acute hydrocephalus.
The infant who had normal detailed ultrasound scan antenatally was born healthy and well until the
point of diagnosis 1.5 month later. Meanwhile the boy initially presented with unexplained acutehydrocephalus showed large intra-axial tumour in repeated MRI after 5 months.
Results : Both child underwent surgery with total excision of tumour subsequently. Intraoperative
revealed mixture of cartilaginous tissue, bone and skin during surgery. Histopathology reported as
immature and mature teratoma respectively. Both child was healthy and well after surgery
Conclusions : Teratoma can be classified into three subtypes of immature, mature and somatic type.
MRI have the typical features of mixtures of cystic and solid, multilocularity and fatty tissue within.
Mature teratoma consist of fully differentiated tissue with minimal mitotic activity meanwhile immature
contained fetal like undifferentiated tissue with higher mitotic rate. Somatic have combination of bothwith necrosis within.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0139The invisible culprit: A case of unexplained communicating hydrocephalus in a
toddler as the first presentation of an intracranial teratoma
Erina ZAKARIA1, Dharmendra GANESAN1
1

Neurosurgery, University Of Malaya, Kuala Lumpur, Malaysia

Introduction : Teratoma is a rare tumour of non germinomatous germ cell tumour. It can be further
subtype into immature, mature and somatic type according to histology. It is more common in East
Asian countries with peak age of 0-2 and 13-19 years old.
Material & Methods : We report a case of symptomatic acute communicating hydrocephalus withnormal brain parenchyma on MRI. He developed progressive left hemiparesis. The repeat MRI brain
which was about 5 months after the ventriculoperitoneal shunt showed a large right thalamic lesion
measuring 4.5 x 3.5 cm. The tumour markers were negative. Interhemispheric approach and total
excision was achieved. There was no adjuvant therapy.The child was neurologically intact withimprovement in hemiparesis at 6 months. The MRI brain in 6 months showed no recurrence.
Results : In this case, the first presentation was acute communicating hydrocephalus where nolesion or intracranial oedema can be visualise which is peculiar. However in the repeated MRI 5
months apart, a huge lesion suddenly appeared. This was a rare event with only one reported similar
clinical and radiological findings of pineal region mature teratoma. However the lesion was only
discovered after a year and was initially diagnosed as functional aqueduct stenosis and treated withventriculoperitoneal shunt.
Conclusions : Communicating hydrocephalus may be the first presentation of teratoma with delayed
radiological findings of the lesion. Hence repeated MRI in unexplained communicating hydrocephalus
is justifiable. Diagnosis of teratoma required a correlation between clinical, radiological, CSF protein
marker, intraoperative findings and histology subtype to devise an appropriate treatment plan.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0179The Role of Heat Shock Protein 70 in Stemness and Drug Resistance ofMedulloblastoma
Shu-Mei CHEN1, Hsieng-Yun HUANG1, Samson SUN4, Nicole Salazar VELMESHEV3,
Ying-Ying LI2
1

Neurosurgery, Taipei Medical University, Taipei, Taiwan,
Department Of Veterans Affairs, Miami VA Healthcare System, Floria, United States,
3
Biological & Biomedical Sciences, North Carolina Central University, North Carolina, United States,
4
School Of Pharmacy, Nanjing University Of Chinese Medicine, Nanjing, China
2Introduction : Medulloblastoma (MB) is the most common children’s malignant brain tumor. Although
MB can be treated with conventional chemotherapies, chemoresistance has been frequently
developed and thereby hampers their therapeutic effectiveness. HSP70 has been found in cisplatinresistant colorectal cancer, bladder cancer, ovarian cancer, brain tumor, and certain cancer stem
cells (CSCs). Our preliminary data also confirmed high expression of HSP70 in MB CSCs (CD133+).
The purpose of this study is to verify the regulatory function of HSP70 in chemoresistance andstemness of MB.
Material & Methods : The levels of HSP70, its client proteins, and stemness makers were detectedusing immunoblotting and immunoprecipitation after the treatment of HSP70 inhibitor VER155008
or knockdown of HSP70 by siRNA in MB and MB CSCs. The antitumor effects of VER155008 or
knockdown of HSP70 on these cells were evaluated by MTT assay, Annexin V/PI analysis and sphere
formation assay.
Results : CD133+ MB CSCs possessed high levels of HSP70. Inhibition of HSP70 resulted in
reduced expression of stemness markers and sphere formation in CD133+ MB CSCs. Treatment
with VER155008 exhibited antitumor activity in CD133+ MB CSCs. Additionally, combination of
conventional chemotherapeutic agents and VER155008 yielded a synergistic effect on MB cells.
Conclusions : These results illustrated that inhibition of HSP70 could eliminate CSCs, and thereby
overcome resistance to chemotherapeutic agents in MB. Chemotherapies in combination with HSP70
blockade may be an emerging MB therapy in the future.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 2

A-0180Giant supratentorial brain tumours: case series from a Singapore children’s
hospital
Yilong WU1, Minli TEY1, Lee Ping NG1, David LOW2, Wan Tew SEOW1, Sharon LOW1
1

Neurosurgical Service, KK Women’s And Children’s Hospital, Singapore, Singapore,
Neurosurgery, National Neuroscience Institute, Singapore, Singapore

2Introduction : Giant supratentorial brain tumours (GSBT) in children are defined as intracranial
neoplasms with at least 5 cm diameter in size. Factors such as young patient age, life-threatening
symptoms of raised intracranial pressure, histopathological variability, intraoperative blood loss, andthe risk of poor long-term outcomes are difficulties faced by paediatric neurosurgeons. This study
is undertaken to review our institutional outcomes of patients diagnosed with GBST, in corroboration
with published literature.
Material & Methods : This is an ethics-approved, retrospective study based at the KK Women’s andChildren’s Hospital, Singapore. All patients aged less than 19 years and with a confirmed diagnosis
of supratentorial brain tumour of at least 5 cm in size are included. Variables of particular interest
include patient demographics, presenting symptoms, histological diagnosis, perioperative factors,
and functional outcomes. A corresponding literature review on GBST is performed.
Results : A total of 10 patients over a 6-year period were included in our study. Most of them werefemales (80%) and the median age was 5.98 years old. The average tumour volume was 178
cm2 (range 85 to 245.8 cm2). Three patients (30%) underwent either biopsy or subtotal resectionof their tumours followed by neoadjuvant chemotherapy before definitive resection. Histology
was heterogenous: 2 ependymoma, 2 astrocytomas, 1 choroid plexus carcinoma, 2 sarcomas, 1embryonal tumour, 1 malignant melanoma and 1 craniopharyngioma. All patients achieved GOS-E
Peds 1 to 2 postoperatively and there was no associated mortality.
Conclusions : GBSTs in children are extremely challenging entities. An individualised approach by
an experienced multi-disciplinary, patient-centric team is essential for optimal outcomes.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 3

A-0145
Surgical management of drug-refractory epilepsy associated with GATOR1
variation related malformation of cortical development
Yu SUN1, Ruofan WANG1, Yu HAO1, Chang LIU1, Yao WANG1, Yi WANG1, Taoyun JI1,
Shuang WANG1, Qingzhu LIU1, Xiaoyan LIU1, Ye WU1, Yuwu JIANG1, Lixin CAI1
1

Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China

Introduction : To investigate the clinical features and surgical outcome of GATOR1 variation-related
malformation of cortical development (MCD).
Material & Methods : A total of 35 MCD children with GATOR1 mutation admitted to the PediatricEpilepsy Center of Peking University First Hospital from January 2015 to December 2020 werestudied. The genetic characteristics, clinical features, surgical procedure and surgical outcome wereretrospectively analyzed.
Results : The proportion of patients with GATOR1 variant were DEPDC5 71.43%, NPRL2 11.43%
and NPRL3 17.14%. The incidence of simple focal seizure was 65.71%. Epileptic lesions involving
frontal lobe were the most common (n=23, 65.71%), while occipital lobe lesions were the rarest (n=3,
8.57%). The surgical procedure includes focal resection, mono/multiple lobe disconnection surgery,or hemispherotomy. The postoperative pathology was mainly FCDIIa (n=20, 58.82%). Until the last
follow-up, the seizure-free rates of patients with DEPDC5, NPRL2 and NPRL3 variants were 88%, 75%
and 33.33%, respectively. Kaplan-Meier survival curve was used to evaluate postoperative seizurefree rate, and the surgical outcomes of patients with DEPDC5 mutation was significantly better thanthat of patients with NPRL2 and NPRL3 mutation (p=0.0055).
Conclusions : Radical surgical treatment of epilepsy is an effective method for the managementof drug-resistant epilepsy in children caused by MCD related to GATOR1 mutation. The surgicaloutcome is best in patients with DEPDC5 mutation and poor in patients with NPRL3 variant.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 3

A-0105
Child with unexplained visual loss – Rare vascular compression on anterior
optic pathway
Alvernia Neysa UJAT1, Prabu Rau SRIRAM1
1

Neurosurgery, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia

Introduction : Visual loss following a vascular compression to the anterior optic pathway is rareoccurring incident. Few cases has been reported and most of the cases occurs among the adults
and elderly population.
Material & Methods : NA
Results : We are discussing on a case where a 7 year old boy came with a sudden onset loss ofvision on the right eye and progressively worsening involving left eye. Multiple investigations done
to determine the cause of the visual loss including visual assessment, hormonal study, visual evoke
potential and MRI brain and orbit. His visual assessment gradual worsen over 3 months duration,
where right eye visual assessment progressed from hand movement to no perception of light and left
eye visual assessment progressed from 6/24 to 6/60. Otherwise, other ophthalmology assessment,
blood parameters and hormonal panels were unremarkable. MRI brain and orbit revealed
supraclinoid portion of right ICA compressing on lateral portion of optic chiasm and right intracranial
portion of ICA with no abnormal morphology of the vascular structure. He underwent microvasculardecompression and post-operatively, recovered well.
Conclusions : In conclusion, diagnosis of vascular compression should be entertained when patientpresented with unexplained sudden onset and rapidly progressing visual loss.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 3

A-0054
A case of ruptured pediatric cervical perimedullary arteriovenous fistula treatedwith endovascular embolization.
Yoshinori KADONO1, Kazushige MAENO1, Masami KURAMOTO1, Toyo SHIMIZU1,
Ayaka ICHISE1, Atsuko HARADA2
1
2

Neurosurgery, Takatsuki General Hospital, Takatsuki, Japan,
Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Japan

Introduction : We report a boy with a ruptured cervical perimedullary arteriovenous fistula (PAVF)
treated with endovascular embolization with a literature review.
Material & Methods : A 10-year-old boy with no abnormalities in his upbringing or family history,
on the morning of admission, complained of posterior neck pain. In the afternoon, he developed
paralysis in his upper limbs, which later progressed to his extremities. After transport to the first
hospital, he developed consciousness and respiratory disturbance and was transferred to our PICU.
Head MRI showed edema in the medulla and dilated veins in the posterior cranial fossa. Contrastenhanced spinal CT showed an intramedullary hematoma centered on C4, extensive edema fromthe medulla to Th3, a buried contrasted mass in the posterior cord of C4, and dilated drainers.
Angiography was performed under general anethsecia and a diagnosis of varix rupture of PAVF withright C4 dorsal root artery and right ascending cervical artery as feeders. Endovascular embolization
was performed using 33% NBCA from a microcatheter placed just after the fistula and the shunt wasgone.
Results : Postoperatively, after tracheotomy, he was weaned off the ventilator with rehabilitationand showed improvement in spinal cord disability, such as eating with his hands and walking witha walker. After a month, the follow-up angiography showed the disappearance of PAVF. He wasdischarged 8 months after and returned to school 11 months after onset.
Conclusions : In this case, we were able to approach the ruptured varix beyond the fistula through adilated feeder and to treat the PAVF in a single endovascular surgery.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 3

A-0157Massive Intracerebral Hemorrhage Caused by a Cavernous Malformation
JUNKYEUNG KO1, Chang Hwa CHOI1, Young Soo KIM1
1

Neurosurgery, Pusan National University Hospital, Busan, Korea, Republic of

Introduction : Cavernous malformations have an annual bleeding incidence of 0.2-2.3%. Most
hemorrhages attributable to cavernous malformations are characterized by microhemorrhages andare seldom catastrophic or fatal. Most notably, supratentorial cavernous malformations leading tomassive, life-threatening hemorrhages are rare entities.
Material & Methods : In this report, we describe a case with a supratentorial cavernous malformation
resulting in a life-threatening, massive hemorrhage.
Results : A 17-year-old female presented with a 3-week history of declining mental status. Braincomputed tomography and magnetic resonance imaging revealed a sizable intracranial hemorrhage,
within the right occipital region, associated with a small nodule at the hematoma’s posterior margin.
An emergency operation removed the entire hematoma and nodule. Histological examination of thenodule was compatible with a diagnosis of cavernous malformation. The patient’s post-operative
course was uneventful.
Conclusions : We presented the case of a massive intracerebral hematoma caused by a small,superficially-located supratentorial cavernous malformation with clinical features and a review of theliterature.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0099A Case of traumatic orbital roof fracture with a good outcome in young children
due to stick of traditional small hand drum(percussion instrument)
You-Nam CHUNG1, Jisoon HUH1, Jongkook RHIM1, Jinduk JOO1
1

Department Of Neurosurgery, Jeju National University Hospital,Jeju National University School Of Medicine,
Jejucity, Korea, Republic of

Introduction : Orbital roof fractures are a less common but serious problem of cranium and orbit.
Intraorbital injury may warrant surgical treatment to remove impinging bony fragments, repair dura orreconstruct the orbital roof.
Material & Methods : Four year old girl was admitted to hospital due to eyelid laceration on left
side by stab injury because of the stick of traditional small hand drum during playing music inkindergarten. There was no abnormality in the eyeball motion and visual acuity performed except
eyelid laceration with swelling in the emergency room. Cranial and maxillo-facial CT scans showed
unusual features of orbital roof fracture with parenchymal injury. The shape of the orbital roof fracture
occurred in the vertical direction and caused dura tear and brain tissue damage. She underwent
emergency operation by bicoronal frontal craniotomy and orbital roof reconstruction using autologous
bone (fractured bone fragment) with duroplasty.
Results : The patient recovered completely after the operation. Follow-up test results after one year
there was no optic problem and no evidence of neurological deficits and no growing fractures of theorbital roof. By depending on the case, in young children play with sticks as toys may cause orbital
damage and head injury, so caution is necessary. The fracture of the skull of the child is causedby the thin nature of the depressed fracture. However, after the damage to the brain is often good
resilience.
Conclusions : Author report a case of unusual features orbital roof fracture with a good outcome inyoung children due to stick of traditional small hand drum.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0147
Case report : management of traumatic supra and infra tentorial epidural
hematoma in pediatric case
Telaga BIROE1, Yosi SATRIA1
1

Neurosurgery, Dr Mintohardjo Navy Hospital, Jakarta, Jakarta, Indonesia

Introduction : Epidural hematoma (EDH) in pediatrics is a neurosurgical emergency, accountingfor 2-3% of head injuries in the pediatric population. Traumatic supra- and infra-tentorial epidural
hematoma (TSIEDH) is a rare complication <2% of all EDH cases. Until now only a few articles havereported the incidence of TSIEDH.
Material & Methods : We report a case of traumatic supra- and infra-tentorial EDH at Dr Mintohardjo
Navy Hospital Jakarta on September 27 2022. a 6 years old female admitted with headache on theback of her head, drowsyness, and irritable since 24 hours before, her parents claimed she fell withback of her head to the floor 2 days before admission and the Glassglow coma scale (GCS) score is13, during palpation swelling and pain on occipital region with observable hematom.
Results : Computed tomography (CT) scan shows epidural bleeding fills the right occipitocerebellar
concavity accompanied by an occipital region hematoma, with obliteration of the IV ventricle by theright cerebellar hemisphere. We performed emergency craniotomy with two burr hole method toevacuate the hematom.
Conclusions : Diagnosis and management are carried out as early as possible because the clinicalmanifestations of TSIEDH are non-specific and sudden deterioration might occured. This case usinga CT scan is the main choice for making a diagnosis. We found out early diagnosis​​
and intervention
to evacuate a hematoma with surgery is an important factor that affects the prognosis and outcome in
TSIEDH case.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0057
Huge intracranial abscess causing significant mass effect and neurologic
deficit with lumbar spine extension after ENT sinusectomy
Tee Tau ERIC NYAM1
1

Neurosurgical, Chi Mei Medical Center, Tainan, Taiwan

Introduction : Pediatric brain abscess is a serious medical condition which can lead to significant
neurological deficits and even life-threatening complications. Significant decline in mortality rate
has been noted in recent years but remains a potentially fatal central nervous system infection if notpromptly diagnosed and treated.
Material & Methods : A 8-year-old girl was brought to our ER due to intermittent high fever andvomiting. Progressive drowsiness was noted, with the worse GCS being E2V2M4. She underwent
a left sinusectomy about 1.5 months ago to treat her chronic sinusitis. Her dad felt that her generalcondition changed slightly about 2 weeks ago where mild general weakness was observed andshe even urinates/defecates without telling, and was punished for that. Emergent brain was CT
was ordered and showed a 7cm cystic, enhancing mass at left frontal region with significant masseffect. Abscess was favored and surgical intervention was proposed and performed smoothly withendoscope assist.
Results : She was sent to ICU after taht where she regained her consciousness gradually. However,significant left leg weakness was observed, spine MRI was ordered which showed a lumbosacral
epidural abscess. We continued with antibiotics treatment and regular rehab without further
deterioration. She was discharged home 2 months later.
Conclusions : Early diagnosis, prompt treatment, and comprehensive medical care are crucial forachieving the best possible outcome for affected children. It’s vital to obtain as many information,
especially recent treatment history, in any child displaying symptoms suggestive of a brain abscesswhere immediate medical intervention could be given.

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0199Surgical Nuance of Lumbosacral Lipomyelocystocele with Tethered Cord in
6-Month-Old Patient
Kadek Dede Frisky WIYANJANA1, Sri MALIAWAN1
1

Neurosurgery, Udayana University, Denpasar, Indonesia

Introduction : Lumbosacral lipomyelocystocele (LLMC) with tethered cord syndrome (TCS) is acomplex congenital spinal anomaly characterized by a fatty mass, neural tissue malformation, and anabnormally positioned spinal cord. LLMC with TCS is considered a rare condition, with an estimatedincidence of approximately 1 in 100,000 live births.
Material & Methods : Lumbosacral lipomyelocystocele (LLMC) with tethered cord syndrome (TCS)
is a complex congenital spinal anomaly characterized by a fatty mass, neural tissue malformation,
and an abnormally positioned spinal cord. LLMC with TCS is considered a rare condition, with anestimated incidence of approximately 1 in 100,000 live births.
Results : LLMC with TCS typically presents in infancy or early childhood with a wide spectrum of
neurological symptoms and physical deformities. Common clinical manifestations include motor
deficits, sensory abnormalities, urinary and postural issues, and even cutaneous stigmata such as
dimples, skin tufts, or lipomas over the lower back.
Conclusions : Tethered cord release without additional neurological deficit and Cerebrospinal Fluid
leakage are major goal of lipomyelocystocele surgery. Careful layer by layer tissue dissection andidentification of every single cele component are paramount in order to avoid iatrogenic myelum andnerve root injury during tethered cord release and to get sufficient amount dura and surrounding
tissue to achieve water-tight wound closure160

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0156BIOPSY IN DIFFUSE BRAINSTEM GLIOMA: RESULTS OF 15 CASES AT VIET
DUC HOSPITAL
Dat TRAN1, Van He DONG1, Duy Hung NGUYEN2
1
2

Department Of Neurosurgery, VietDuc Hospital, Hanoi, Vietnam, Hanoi, Vietnam,
Department Of Radiology, Hanoi Medical University, Hanoi, Vietnam

Introduction : Biopsy of diffuse brain stem gliomas has been controversial. We conducted a study toprovide indications, procedures, and evaluation of the results of surgical biopsy of diffuse brain stem
glioma, conducted at Viet Duc Hospital, Hanoi, Vietnam
Material & Methods : A retrospective and prospective descriptive study, including 15 patients withdiffuse brain stem glioma who underwent surgical biopsy of the tumor under microsurgery throughcraniotomy during the period from January 2020 to August 2022
Results : There were a total of 15 patients: 11 patients were children (73.3%), and 4 patients were
adults. All patients were admitted to the hospital due to localized neurological symptoms anddeficits cranial nerves. 12 patients were diagnosed with DIPG (80%), while 3 patients had diffuse
glioma spreading to the medulla oblongata (20%). Preoperative tumor grade diagnosis based on
MRI revealed that 5 patients were diagnosed with low-grade tumors (33.3%), 4 high-grade brainstem
gliomas (26.7%), and in 6 patients, the exact grade of the tumor could not be definitively determined(40%). Of the 11 pediatric patients, the postoperative pathological indicated high-grade glioma(Grade IV) in all cases. Early postoperative complications: 1 patient required intensive care unit (ICU)
admission and mechanical ventilation due to minimal bleeding at the surgical site, another patient
required ventriculoperitoneal shunt placement due to postoperative cerebral edema. There were no
immediate postoperative fatalities
Conclusions : The biopsy of diffuse brain stem glioma is a feasible, safe, and meaningful surgicalprocedure for accurate diagnosis. However, further research on a larger patient population isnecessary.

161

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Poster session 4

A-0062
Robot-guided stereotactic biopsy - results of a single centre experience
Aaron FOO1, Vincent NGA1
1

Neurosurgery, National University Hospital Singapore, Singapore, Singapore

Introduction : Needle biopsy of intracranial lesions is a regular procedure in most neurosurgicalunits. Initially, these procedures relied on stereotactic frames and three-dimensional coordinates
to localize the lesion in the brain. The introduction of magnetic resonance imaging (MRI) guided
neuro-navigation enabled biopsy trajectories to be based on individual MRIs rather than a general
stereotactic atlas; subsequently, the advent of frameless navigation further streamlined procedural
efficiency by obviating the need for stereotactic frames. The latest modification to this procedure is
the introduction of robotic guidance (Stealth AutoguideTM), which facilitates hassle-free actuation ofplanned biopsy trajectories via an automated system. Here we present our series of needle biopsies
performed using the Stealth AutoguideTM system.
Material & Methods : A total of 10 robot-guided needle biopsy cases were performed at our
institution since January 2023. A compilation of the patient characteristics and surgical outcomes ofthese cases were compiled into a surgical series.
Results : Our series comprised of 2 patients with brain abscesses and 8 patients with brain tumors.
There were no immediate perioperative complications in our surgical series. In all patients, biopsies
were diagnostic, with none requiring repeat biopsy. Histological diagnosis was inconclusive for1 patient, but biopsy samples sent for flow cytometry were diagnostic of lymphoma. Median total
anesthesia and surgical times for the procedure were 199+39.5 and 91.5+23.5 minutes respectively.
Conclusions : Our study provides pilot data for safety and efficacy of robot-guided needle biopsies.
Further trials examining robot-guided versus conventional frameless stereotactic needle biopsies canbe performed to compare outcomes between the two.

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