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CT diagnosed brain stem malignant lesions were in the past almost always treated with radiation therapy (RT). Eventually this turned out to be a grave mistake. With stereotactic serial biopsies of all brain stem expanding lesions we have been able to verify the histological nature in all cases but two and to prevent a blind therapeutic approach. In 24 patients bearing CT diagnosed expansive lesions into the brain stem 68 samples were taken during 24 stereotactic procedures. In 8 patients surgical removal of the expanding lesion was attempted after stereotactic biopsy.

We have developed a stereotactic computer graphic system with brain maps that runs on a personal computer. This system consists of three parts: 1. firmware for dizitizing radiological films with a TV camera or scanner (when digital image is not directly obtained from floppy disks); 2. software for introducing or processing brain maps by matching them with CT or NMR images; 3. hardware. Our system is designed to: 1. recognize the relevant frame points and calculate targets, their volume and surgical instrument trajectory; 2. match between brain maps of an ideal brain and patient's CT or NMR images with visible and invisible pathology; 3. monitor during surgery the position of the surgical instrument or target modification. The whole procedure and processed images are stored in a data-base for further study.