Image-guided stereotactic biopsy of pineal region tumour using CT venography in patient with a pacemaker: a technical note.

Image-guided stereotactic biopsy of pineal region tumours requires careful appreciation of neuroanatomy and avoidance of the deep cerebral venous system. A patient with a pineal region lesion obstructing the third ventricle and causing obstructive hydrocephalus required stereotactic biopsy after cerebrospinal fluid (CSF) diversion. The presence of a pacemaker precluded MR Venography. Fine-cut CT Venography was performed in its stead and merged with image guidance software, and a trajectory was planned avoiding the venous anatomy. Stereotactic biopsy was successfully performed without complication, revealing a pineocytoma.