PMC4287898_01
PMC4287898_02
PMC4287898_03
PMC4287898_04
Neuronavigation screenshots demonstrating the capability of multiplanar image reconstruction, which allows for a 3D view of the lesion and needle pathway with image fusion of the CT skull anatomy (foramen ovale) with the MRI image of the lesion, soft tissues, and vessels (carotid artery)
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F1
The transoval biopsy as described was performed under neuronavigation and fluoroscopic real-time guidance [Figure 1].
Intraoperative phases: (a) evaluation of best entry angle by neuronavigation assistance, (b) intra-cavernous needle localization double confirmation by RX and neuronavigation, (c) neuronavigated frontal cut biopsy
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F2
The neuronavigation needle (Sure track system) [Figure 2] was inserted percutaneously and advanced under fluoroscopic [Figure 3] and frameless stereotactic guidance until the foramen ovale was entered.
Intraoperative RX control confirming: (a) needle tip correct localization in Meckel's cave and (b) needle tip within the lesion
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F3
The neuronavigation needle (Sure track system) [Figure 2] was inserted percutaneously and advanced under fluoroscopic [Figure 3] and frameless stereotactic guidance until the foramen ovale was entered.
Neuronavigation needle (Sure track system) and coaxial frontal tip-cut 17 gauge needle (Biopince; Angiotech)
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F4
A coaxial frontal tip-cut 17 gauge needle (Biopince; Angiotech, Vancouver, BC, Canada) [Figure 4] was inserted through the needle canula to a pre-calculated depth.
Histological evaluation of a tumor specimen obtained through transoval biopsy describing: (a) rests of epithelial cells in a mesenchymal stroma, forming circular cavities (H and E, x40); (b) strong CK7 cytokeratine immunoreactivity. The histological diagnosis was of metastasis of adenocarcinoma of unknown primary tumor
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F5
All the tissue samples were cut and stained with hematoxylin and eosin for optical microscope evaluation at neuropathology laboratory [Figure 5].