A 52-year-old woman was brought to the clinic due to personality change and leg weakness. She used to be lively and talkative but now she is always quiet and staring into space (“tulala”). Brain MRI showed a “butterfly glioma,” a tumor that has this distinct appearance because it involves the right and left sides of the brain. Since the tumor was extensive and unsafe to remove entirely, an image-guided biopsy was done. 

In image-guided surgery, we use neuronavigation, a type of technology that lets us know where we are in the brain. First, a brain MRI with a special protocol must be done, and then the MRI images are loaded into the computer of the neuronavigation system. Special software is then used to process the images so that they can be used during surgery. 

In image-guided biopsy, only a small bone opening is drilled in the skull. A needle is then inserted with the help of computer guidance, and small pieces of tissue are obtained for biopsy purposes. 

The patient underwent image-guided biopsy with no complications. The biopsy result was GBM, so she underwent chemotherapy and radiation therapy to treat the tumor.