Surg-08. the clearpoint array® frame: a novel mri compatible system that supports non-craniotomy, multi-trajectory (ncmt) stereotactic procedures

Abstract BACKGROUND With continued evolution in stereotactic techniques and an expanding armamentarium of therapeutic options, non-craniotomy stereotactic procedures in neuro-oncology are becoming increasingly complex, often requiring multi-trajectory approaches. Here we demonstrate that the ClearPoint SmartFrame Array®, a second-generation MRI-compatible stereotactic frame, supports such non-craniotomy, multi-trajectory (NCMT) stereotactic procedures. METHODS Through a case report, we previously established the feasibility of NCMT through the ClearPoint SmartFrame Array®. Here we prospectively followed the next ten consecutive patients who underwent such multi-trajectory procedures to establish procedural safety and clinical utility. RESULTS Ten patients underwent complex, multi-trajectory stereotactic procedures, including combinations of needle biopsy + cyst drainage and laser interstitial thermal therapy (LITT) targeting geographically distinct regions of neoplastic lesions under the same anesthetic event. For each intended target, the maximal radial error of stereotaxis ranged 0.1-2.7 mm (with a median of 1.0 mm). In all cases, definitive diagnosis was achieved, and >90% of the intended targets were ablated. The average stereotaxis time (time required to establish the trajectories) for the multi-trajectory procedure was 119 + 22.2 minutes, which is not statistically different from our published results for single-trajectory procedures (80 + 9.59 minutes, p = 0.125). There were no procedural complications. Post-procedure, the neurologic condition of one patient improved, while the remaining nine patients remained stable. All patients were discharged home, with a median hospital stay of one day (range: 1-12 days). With a median follow-up of 376 days (range: 155-1438 days), there were no 30-day readmission or wound complications. There were two 90-day readmissions (a patient with hydrocephalus and another with new spine metastasis) unrelated to the procedures performed. CONCLUSION Geographically distinct regions of a brain cancer can be safely and accurately accessed through the ClearPoint Array® frame in NCMT stereotactic procedures.