Biopsy and ablation of an H3K27 glioma using the skull-mounted Smartframe® device: a technical case report

ABSTRACT Background Clearpoint Smartframe® is an MRI compatible stereotactic system often used to perform MRI-guided biopsies. The system is typically mounted on the scalp through screws that pierce the skin and penetrate the outer-table of the cranium. However, the frame can also be configured to be mounted directly onto the skull. Case Description Here, we describe the clinical context well-suited for a skull-mount Clearpoint Smartframe® surgery. The patient suffered from a sub-centimeter right para-fourth ventricular contrast enhancing (CE) lesion with hydrocephalus and underwent a right suboccipital needle biopsy followed by an occipital ventriculoperitoneal shunt (VPS). While the hydrocephalus resolved with VPS, the biopsy sample proved non-diagnostic. The patient underwent a second procedure during which the Clearpoint Smartframe® was mounted onto the skull through space dissected free during the previous surgery. Diagnostic biopsy (H3K27 glioma) was performed followed by stereotactic laser ablation (SLA) of the lesion. Conclusions We describe a case where skull mount Clearpoint Smartframe® was used to biopsy and ablate a midline H3K27 glioma.