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Mahakul DJ, Agarwal J. Fluorescence Assisted Stereotactic Biopsy of Contrast-Enhancing Brain Lesions: Can YELLOW 560-nm Filter Substitute Frozen Section? World Neurosurg 2024; 184:e737-e742. [PMID: 38342168 DOI: 10.1016/j.wneu.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The factors on which the accuracy of stereotactic brain biopsy depends are the competence of the neurosurgeon in obtaining a representative sample and the ability of the neuropathologist to make a histological diagnosis from a minuscule sample. Over the years intraoperative frozen section has enhanced the diagnostic yield of this minimally invasive procedure. Use of fluorescence in achieving a greater extent of resection is well-established in contemporary neurosurgical practice. This ability of brain tumors to take up the fluorescein sodium dye and glow under the YELLOW 560-nm filter has been utilized in a handful of studies to increase the diagnostic accuracy of stereotactic biopsy. METHODS We performed a prospective study where the fluorescein sodium dye was injected at a low dose and fluorescence of the biopsied core was compared with that of a tissue obtained from the normal parenchyma. Sample was labeled 'truly fluorescent' only when the glow was more than that of the tissue from normal parenchyma. RESULTS On cross-tabulating the index test (true fluorescence status) and the reference standard test (final histopathological report) the sensitivity of acquiring a representative sample was found to be 94.74%, specificity was 100%. The positive predictive value and negative predictive value were calculated to be 100% and 50% respectively. The diagnostic yield was comparable to that of the intraoperative frozen section. CONCLUSION The use of the YELLOW 560-nm filter can make stereotactic biopsy faster, safer, less cumbersome, and more cost-effective, and can be used as a substitute for the frozen section in resource-constrained centers.
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Affiliation(s)
- Dibya Jyoti Mahakul
- Department of Neurosurgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
| | - Jaya Agarwal
- Department of HPB and Solid Organ Transplant, Amrita Hospital, Faridabad, India
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Singh M, Ahamed TPW, Maurya VP, Gupta P, Bhaisora KS, Srivastava AK, Verma PK, Das KK, Kumar A, Dikshit P, Mehrotra A, Jaiswal AK, Behari S, Kumar R. Stereotactic biopsy for brain lesions: Doing more with less. J Neurosci Rural Pract 2024; 15:95-102. [PMID: 38476427 PMCID: PMC10927046 DOI: 10.25259/jnrp_258_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/17/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis. Materials and Methods Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion. Results The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded. Conclusion Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.
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Affiliation(s)
- Mayank Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - T. P. Waseem Ahamed
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pragya Gupta
- Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Patel A, More B, Rege I, Ranade D. Clinical diagnosis and management of multiple cerebral ring-enhancing lesions-study of 50 patients at a tertiary healthcare center. J Cancer Res Ther 2024; 20:112-117. [PMID: 38554307 DOI: 10.4103/jcrt.jcrt_1456_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/04/2022] [Indexed: 04/01/2024]
Abstract
AIM OF THE STUDY Multiple ring-enhancing lesions are commonly experienced group of brain pathologies which we come across in day-to-day practice. Clinical symptoms in these lesions are quite non-specific, and hence, it is difficult to reach a final diagnosis. However, these lesions have a varied group of differential diagnosis and it is sometimes difficult to have an accurate diagnosis on conventional MRI. This article was written with the objective of discussing the demographical study and etiology, clinical diagnosis and management for these patients. MATERIALS AND METHODS It is a prospective study carried out at the Department of Neurosurgery, Dr. D Y Patil Medical College and Hospital, Pune, from September 2019 to August 2022 and included 50 patients who presented to us multiple ring-enhancing brain lesions. RESULTS In our study, 50 patients between age (1-70 years) with multiple ring-enhancing lesions were analyzed. Majority of the patients were between age group 30-39 years. Males (76%) were majority in our study than females (24%). Most common pathology was primary neoplasm (glioma) and metastasis, followed by nine patients of pyogenic abscess and tuberculosis each. Neurocysticercosis was seen in eight patients and three patients were diagnosed with CNS lymphoma. Most of our patients presented with headache (38 patients) and a subset of patients had associated seizures (28 patients). Two patients with primary neoplasm were diagnosed to have WHO grade 3 glioma and seven patients were diagnosed to have WHO grade 4 glioma. Glioblastoma multiforme presented as multifocal and multicentric lesions. Among the patients with primary neoplasm, three patients underwent stereotactic biopsy for diagnosis and the rest of seven patients underwent maximum safe resection followed by chemotherapy and radiotherapy. Ten patients were diagnosed with metastatic lesions, among them six patients underwent stereotactic biopsy for histopathological diagnosis and immunohistochemistry, and rest of the patients were managed on the basis of the primary lesion. Five patients were immune-compromised, among them two patients presented with abscess and three patients presented with primary neoplastic lesion. Thirty-six patients underwent biopsy, among them seven patients underwent frameless, seven patients underwent frame stereotactic biopsy, and the rest 22 patients underwent excision biopsy. CONCLUSION Multiple ring-enhancing lesions of brain pose a challenge in terms of achieving an accurate diagnosis and planning further treatment. It is of utmost importance to have a diagnosis in mind based on radiological investigations, so that surgical intervention can be planned accordingly be it by invasive or minimal invasive techniques. An idea toward the diagnosis also helps in prognosticating these patients which could avoid costly whole-body scans and unnecessary surgical intervention.
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Affiliation(s)
- Ankit Patel
- Department of Neurosurgery, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India
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Lau BL, Idris Z, Abdullah JM, Bujang MA, Wong ASH. Introduction of a newly created AW stereotactic frame: a phantom-based accuracy evaluation and an initial experience in clinical usage. Br J Neurosurg 2023; 37:1572-1579. [PMID: 33191803 DOI: 10.1080/02688697.2020.1837728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A new stereotactic frame was created in 2015, based on a linear algorithm. It is called Albert Wong (AW) frame. A simple AW stereo-calculator was also designed based on Excel® (Microscoft Corporation, Redmond, WA) programme for the frame. OBJECTIVE The aim of this study is to test the accuracy of the AW frame by a direct head to head comparison with CRW® frame (Integra Life Sciences, Plainsboro, NJ) on a phantom. METHODS This is a prospective pilot cross-sectional phantom study with a total of 42 (21 for AW and 21 for CRW®) laboratory testings performed in 2017 at our institute to compare the accuracies of both frames in a consecutive manner. A phantom (BL phantom) was newly created, where targets can be placed at different heights and positions on a platform attached under the frame for accuracy testing comparing between the AW and CRW® frames. RESULTS A comparable accuracy testing results were observed between the AW and CRW® frames of 0.64 mm versus 1.07 mm respectively. Approval from the local ethics committee for a clinical trial was obtained. We report on three case illustrations who had the AW frame-based biopsies with definitive diagnoses and without any post-biopsy related complication. CONCLUSION AW frame successfully demonstrated a good accuracy of 0.64 mm in phantom testing using the BL phantom by a linear algorithmic calculation. The clinical trial with three patients demonstrated definitive diagnoses and safety with its use.
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Affiliation(s)
- Bik Liang Lau
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain Behaviour Cluster, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Brain Behaviour Cluster, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - Albert Sii Hieng Wong
- Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Jalan Hospital, Kuching, Sarawak, Malaysia
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Al-Saiari S, Al Orabi K, Abdoh MG, Basurrah AA, Albalawi SF, Farag AA. Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus: technical notes. Chin Neurosurg J 2023; 9:1. [PMID: 36624512 PMCID: PMC9830701 DOI: 10.1186/s41016-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus. METHODS We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope. RESULTS In the three patients, ventriculostomy and endoscopic biopsies were conducted. There was no death or morbidity throughout the 45-min procedure. All of the patients' histological findings were confirmed. Germinoma was diagnosed in two patients who recieved postoperative radiotherapy, and the third patient diagnosed with a pineocytoma. Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery. CONCLUSION Biportal endoscopic approach enables better visual control of both procedures. Furthermore, it allows the surgeon to safely pass the ventriculoscope via the foramen of monro, even if it is narrow. Moreover, during endoscopic tumor biopsy and third ventriculostomy, the intracranial pressure can be smoothly managed using the outlet tubes accessible. This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.
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Affiliation(s)
- Sultan Al-Saiari
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Khalid Al Orabi
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Mohammad Ghazi Abdoh
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Abdulaziz A. Basurrah
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Sultan Faez Albalawi
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
| | - Ahmed A. Farag
- grid.498593.a0000 0004 0427 1086Neurosurgery Department, King Abdullah Medical City, P.O 24246, Makkah, Saudi Arabia
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Machetanz K, Grimm F, Wang S, Schuhmann MU, Tatagiba M, Gharabaghi A, Naros G. Rediscovery of the transcerebellar approach: improving the risk-benefit ratio in robot-assisted brainstem biopsies. Neurosurg Focus 2022; 52:E12. [DOI: 10.3171/2021.10.focus21359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Conventional frame-based stereotaxy through a transfrontal approach (TFA) is the gold standard in brainstem biopsies. Because of the high surgical morbidity and limited impact on therapy, brainstem biopsies are controversial. The introduction of robot-assisted stereotaxy potentially improves the risk-benefit ratio by simplifying a transcerebellar approach (TCA). The aim of this single-center cohort study was to evaluate the risk-benefit ratio of transcerebellar brainstem biopsies performed by 2 different robotic systems. In addition to standard quality indicators, a special focus was set on trajectory selection for reducing surgical morbidity.
METHODS
This study included 25 pediatric (n = 7) and adult (n = 18) patients who underwent 26 robot-assisted biopsies via a TCA. The diagnostic yield, complication rate, trajectory characteristics (i.e., length, anatomical entry, and target-point location), and skin-to-skin (STS) time were evaluated. Transcerebellar and hypothetical transfrontal trajectories were reconstructed and transferred into a common MR space for further comparison with anatomical atlases.
RESULTS
Robot-assisted, transcerebellar biopsies demonstrated a high diagnostic yield (96.2%) while exerting no surgical mortality and no permanent morbidity in both pediatric and adult patients. Only 3.8% of cases involved a transient neurological deterioration. Transcerebellar trajectories had a length of 48.4 ± 7.3 mm using a wide stereotactic corridor via crus I or II of the cerebellum and the middle cerebellar peduncle. The mean STS time was 49.5 ± 23.7 minutes and differed significantly between the robotic systems (p = 0.017). The TFA was characterized by longer trajectories (107.4 ± 11.8 mm, p < 0.001) and affected multiple eloquent structures. Transfrontal target points were located significantly more medial (−3.4 ± 7.2 mm, p = 0.042) and anterior (−3.9 ± 8.4 mm, p = 0.048) in comparison with the transcerebellar trajectories.
CONCLUSIONS
Robot-assisted, transcerebellar stereotaxy can improve the risk-benefit ratio of brainstem biopsies by avoiding the restrictions of a TFA and conventional frame-based stereotaxy. Profound registration and anatomical-functional trajectory selection were essential to reduce mortality and morbidity.
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Affiliation(s)
- Kathrin Machetanz
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Florian Grimm
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie Wang
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Martin U. Schuhmann
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
| | - Alireza Gharabaghi
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
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Lara-Almunia M, Hernández-Vicente J. Related factors with diagnostic yield and intracranial hemorrhagic complications in frame-based stereotactic biopsy. Review. NEUROCIRUGIA (ENGLISH EDITION) 2021; 32:285-294. [PMID: 34743826 DOI: 10.1016/j.neucie.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/08/2020] [Indexed: 06/13/2023]
Abstract
The frame-based stereotactic biopsy is a minimally invasive technique that allows us to obtain a sample of brain tissue for subsequent diagnosis and treatment. The scope of this article is to review the published data related to the factors that could condition its diagnostic yield, and the appearance of post-biopsy hemorrhagic complications. PubMed search, last updated June 2020, was conducted using the terms "stereotactic biopsy", "diagnostic yield" and "intracranial post-biopsy hemorrhage". A total of 38 studies, that showed descriptive or analytical results, were included, and reviewed. Our literature review show that some characteristics of the lesion and surgical procedure peculiarities are significantly related with the effectiveness and safety of the technique. In this way, they must be taken into account in order to optimize its results.
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Affiliation(s)
- Mónica Lara-Almunia
- Servicio de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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Kubovsky S, Khriesh A, Moscovici S, Paldor I. Fusion of Preoperative and Postoperative Imaging May Predict the Diagnostic Yield of Stereotactic Needle Brain Biopsies. World Neurosurg 2021; 157:e441-e447. [PMID: 34688935 DOI: 10.1016/j.wneu.2021.10.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Stereotactic needle brain biopsy is a commonly used neurosurgical procedure. However, up to 15% of biopsies result in undiagnostic pathology reports. Repeat biopsy or continued management without a diagnosis are often considered after undiagnostic biopsies. There have been no reports about the role of postoperative imaging in predicting the diagnostic yield of stereotactic biopsies. METHODS We retrospectively assessed all stereotactic biopsies performed over an 11-year period. We performed fusion of immediate postoperative computed tomography (CT) with preoperative MRI, to document whether the air bubble in the postoperative CT was located within the targeted lesion. We then evaluated the association of this fusion-based accuracy assessment with the diagnostic yield of the biopsy. RESULTS Fewer than 5% of biopsies did not have an air bubble on postoperative CT. A total of 226 biopsies were performed for 219 patients. In our sample, 213 of 226 biopsies were accurate (94.2% accuracy rate), and 203 of 226 biopsies gave a definitive diagnosis (89.8% diagnostic rate). In those cases where the fusion was accurate, the diagnostic rate was 93.9%. When the fusion was inaccurate, the diagnostic rate was only 23.1% (odds ratio 51.5, 95% confidence interval 12.6-210.44, P < 0.001). Of all patient, imaging, surgical, and admission parameters, the only parameter that correlated with diagnostic outcome of the biopsy was the fusion construct accuracy. CONCLUSIONS Fusion of immediate postoperative CT with preoperative imaging is predictive of the diagnostic rate. In cases where the pathology report following a biopsy is not diagnostic, this fusion may be useful in making decisions regarding repeat biopsy or considering other diagnostic options.
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Affiliation(s)
- Shoham Kubovsky
- The Faculty of Medicine, the Hebrew University, Ein Kerem Campus, Jerusalem, Israel
| | - Amir Khriesh
- The Department of Neurosurgery, Rambam (Maimonides) Health Care Campus, Haifa, Israel
| | - Samuel Moscovici
- The Faculty of Medicine, the Hebrew University, Ein Kerem Campus, Jerusalem, Israel; The Department of Neurosurgery, Hadassah Medical Center, Ein Kerem Campus, Jerusalem, Israel
| | - Iddo Paldor
- The Department of Neurosurgery, Rambam (Maimonides) Health Care Campus, Haifa, Israel; The Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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Plowman RS, Varma H. Prognostic factors in Tumefactive demyelinating lesions: A retrospective study. J Neurol Sci 2021; 428:117591. [PMID: 34333380 DOI: 10.1016/j.jns.2021.117591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined. METHODS We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course. RESULTS An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC. CONCLUSIONS We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.
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Affiliation(s)
- R Skipper Plowman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Diffusion histology imaging differentiates distinct pediatric brain tumor histology. Sci Rep 2021; 11:4749. [PMID: 33637807 PMCID: PMC7910493 DOI: 10.1038/s41598-021-84252-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/08/2021] [Indexed: 11/08/2022] Open
Abstract
High-grade pediatric brain tumors exhibit the highest cancer mortality rates in children. While conventional MRI has been widely adopted for examining pediatric high-grade brain tumors clinically, accurate neuroimaging detection and differentiation of tumor histopathology for improved diagnosis, surgical planning, and treatment evaluation, remains an unmet need in their clinical management. We employed a novel Diffusion Histology Imaging (DHI) approach employing diffusion basis spectrum imaging (DBSI) derived metrics as the input classifiers for deep neural network analysis. DHI aims to detect, differentiate, and quantify heterogeneous areas in pediatric high-grade brain tumors, which include normal white matter (WM), densely cellular tumor, less densely cellular tumor, infiltrating edge, necrosis, and hemorrhage. Distinct diffusion metric combination would thus indicate the unique distributions of each distinct tumor histology features. DHI, by incorporating DBSI metrics and the deep neural network algorithm, classified pediatric tumor histology with an overall accuracy of 85.8%. Receiver operating analysis (ROC) analysis suggested DHI’s great capability in distinguishing individual tumor histology with AUC values (95% CI) of 0.984 (0.982–0.986), 0.960 (0.956–0.963), 0.991 (0.990–0.993), 0.950 (0.944–0.956), 0.977 (0.973–0.981) and 0.976 (0.972–0.979) for normal WM, densely cellular tumor, less densely cellular tumor, infiltrating edge, necrosis and hemorrhage, respectively. Our results suggest that DBSI-DNN, or DHI, accurately characterized and classified multiple tumor histologic features in pediatric high-grade brain tumors. If these results could be further validated in patients, the novel DHI might emerge as a favorable alternative to the current neuroimaging techniques to better guide biopsy and resection as well as monitor therapeutic response in patients with high-grade brain tumors.
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Lara-Almunia M, Hernández-Vicente J. Related factors with diagnostic yield and intracranial hemorrhagic complications in frame-based stereotactic biopsy. Review. Neurocirugia (Astur) 2021; 32:S1130-1473(20)30135-4. [PMID: 33446460 DOI: 10.1016/j.neucir.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 11/28/2022]
Abstract
The frame-based stereotactic biopsy is a minimally invasive technique that allows us to obtain a sample of brain tissue for subsequent diagnosis and treatment. The scope of this article is to review the published data related to the factors that could condition its diagnostic yield, and the appearance of post-biopsy hemorrhagic complications. PubMed search, last updated June 2020, was conducted using the terms "stereotactic biopsy", "diagnostic yield" and "intracranial post-biopsy hemorrhage". A total of 38 studies, that showed descriptive or analytical results, were included, and reviewed. Our literature review show that some characteristics of the lesion and surgical procedure peculiarities are significantly related with the effectiveness and safety of the technique. In this way, they must be taken into account in order to optimize its results.
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Affiliation(s)
- Mónica Lara-Almunia
- Servicio de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
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Zanello M, Roux A, Debacker C, Peeters S, Edjlali-Goujon M, Dhermain F, Dezamis E, Oppenheim C, Lechapt-Zalcman E, Harislur M, Varlet P, Chretien F, Devaux B, Pallud J. Postoperative intracerebral haematomas following stereotactic biopsies: Poor planning or poor execution? Int J Med Robot 2021; 17:e2211. [PMID: 33345461 DOI: 10.1002/rcs.2211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/14/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Postoperative intracerebral haematomas represent a serious complication following stereotactic biopsy. We investigated the possible underlying causes - poor planning or poor execution - of postoperative intracerebral haematomas following stereotactic biopsies. METHODS We performed a technical investigation using a retrospective single-centre consecutive series of robot-assisted stereotactic biopsies for a supratentorial diffuse glioma in adults. Each actual biopsy trajectory was reviewed to search for a conflict with an anatomical structure at risk. RESULTS From 379 patients, 12 (3.2%) presented with a postoperative intracerebral haematoma ≥20 mm on postoperative CT-scan (3 requiring surgical evacuation); 11 of them had available intraoperative imaging (bi-planar stereoscopic teleangiography x-rays at each biopsy site). The actual biopsy trajectory was similar to the planned biopsy trajectory in these 11 cases. In 72.7% (8/11) of these cases, the actual biopsy trajectory was found to contact a structure at risk (blood vessel and cerebral sulcus) and identified as the intracerebral haematoma origin. CONCLUSIONS Robot-assisted stereotactic biopsy is an accurate procedure. Postoperative intracerebral haematomas mainly derive from human-related errors during trajectory planning.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Myriam Edjlali-Goujon
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Frédéric Dhermain
- Département d'Oncologie Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Edouard Dezamis
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Emmanuèle Lechapt-Zalcman
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Marc Harislur
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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13
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Zanello M, Roux A, Senova S, Peeters S, Edjlali M, Tauziede-Espariat A, Dezamis E, Parraga E, Zah-Bi G, Harislur M, Oppenheim C, Sauvageon X, Chretien F, Devaux B, Varlet P, Pallud J. Robot-Assisted Stereotactic Biopsies in 377 Consecutive Adult Patients with Supratentorial Diffuse Gliomas: Diagnostic Yield, Safety, and Postoperative Outcomes. World Neurosurg 2021; 148:e301-e313. [PMID: 33412330 DOI: 10.1016/j.wneu.2020.12.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple biopsy samples are warranted for the histomolecular diagnosis of diffuse gliomas in the current molecular era, which possibly increases morbidity. OBJECTIVE We assessed diagnostic yield, safety, and risk factors of postoperative morbidity after robot-assisted serial stereotactic biopsy sampling along 1 biopsy trajectory for diffuse gliomas. METHODS Observational retrospective analysis of consecutive magnetic resonance imaging-based robot-assisted stereotactic biopsies performed at a single institution to assess the diagnosis of nonresectable newly diagnosed supratentorial diffuse gliomas in adults (2006-2016). RESULTS In 377 patients, 4.2 ± 1.9 biopsy samples were obtained at 2.6 ± 1.2 biopsy sites. The histopathologic diagnosis was obtained in 98.7% of cases. Preoperative neurologic deficit (P = 0.030), biopsy site hemorrhage ≥20 mm (P = 0.004), and increased mass effect on postoperative imaging (P = 0.014) were predictors of a new postoperative neurologic deficit (7.7%). Postoperative neurologic deficit (P < 0.001) and increased mass effect on postoperative imaging (P = 0.014) were predictors of a Karnofsky Performance Status decrease ≥20 points postoperatively (4.0%). Increased intracranial pressure preoperatively (P = 0.048) and volume of the contrast-enhanced area ≥13 cm3 (P = 0.048) were predictors of an increased mass effect on postoperative imaging (4.4%). Preoperative Karnofsky Performance Status <70 (P = 0.045) and increased mass effect on postoperative imaging (P < 0.001) were predictors of mortality 1 month postoperatively (2.9%). Preoperative neurologic deficit (P = 0.005), preoperative Karnofsky Performance Status <70 (P < 0.001), subventricular zone contact (P = 0.004), contrast enhancement (P = 0.018), and steroid use (P = 0.003), were predictors of the inability to discharge to home postoperatively (37.0%). CONCLUSIONS Robot-assisted stereotactic biopsy sampling results in high diagnostic accuracy with low complication rates. Multiple biopsy sites and samples do not increase postoperative complications.
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Affiliation(s)
- Marc Zanello
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France
| | - Suhan Senova
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France; Neurosurgery Department, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Henri-Mondor Albert-Chenevier, PePsy Department, Créteil, France; INSERM IMR, Université de Paris, Faculté de Médecine, Créteil, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Myriam Edjlali
- Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France; Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
| | - Arnault Tauziede-Espariat
- Université de Paris, Paris, France; Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France
| | - Gilles Zah-Bi
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France
| | - Marc Harislur
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France; Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Xavier Sauvageon
- Université de Paris, Paris, France; Department of Neuro-Anaesthesia and Neuro-Intensive Care, GHU site Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Paris, France; Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Bertrand Devaux
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France
| | - Pascale Varlet
- Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France; Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Université de Paris, Paris, France; Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, IMA-BRAIN, Paris, France.
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14
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Shetty P, Yeole U, Singh V, Moiyadi A. Real-Time 2D Ultrasound Guided Frameless Biopsy of a Multifocal Glioma: Improving Accuracy and Diagnostic Yield. Neurol India 2021; 69:1551-1553. [DOI: 10.4103/0028-3886.333481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Birski M, Furtak J, Krystkiewicz K, Birska J, Zielinska K, Sokal P, Rusinek M, Paczkowski D, Szylberg L, Harat M. Endoscopic versus stereotactic biopsies of intracranial lesions involving the ventricles. Neurosurg Rev 2020; 44:1721-1727. [PMID: 32827050 PMCID: PMC8121744 DOI: 10.1007/s10143-020-01371-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/08/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
Stereotactic biopsies of ventricular lesions may be less safe and less accurate than biopsies of superficial lesions. Accordingly, endoscopic biopsies have been increasingly used for these lesions. Except for pineal tumors, the literature lacks clear, reliable comparisons of these two methods. All 1581 adults undergoing brain tumor biopsy from 2007 to 2018 were retrospectively assessed. We selected 119 patients with intraventricular or paraventricular lesions considered suitable for both stereotactic and endoscopic biopsies. A total of 85 stereotactic and 38 endoscopic biopsies were performed. Extra procedures, including endoscopic third ventriculostomy and tumor cyst aspiration, were performed simultaneously in 5 stereotactic and 35 endoscopic cases. In 9 cases (5 stereotactic, 4 endoscopic), the biopsies were nondiagnostic (samples were nondiagnostic or the results differed from those obtained from the resected lesions). Three people died: 2 (1 stereotactic, 1 endoscopic) from delayed intraventricular bleeding and 1 (stereotactic) from brain edema. No permanent morbidity occurred. In 6 cases (all stereotactic), additional surgery was required for hydrocephalus within the first month postbiopsy. Rates of nondiagnostic biopsies, serious complications, and additional operations were not significantly different between groups. Mortality was higher after biopsy of lesions involving the ventricles, compared with intracranial lesions in any location (2.4% vs 0.3%, p = 0.016). Rates of nondiagnostic biopsies and complications were similar after endoscopic or stereotactic biopsies. Ventricular area biopsies were associated with higher mortality than biopsies in any brain area.
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Affiliation(s)
- Marcin Birski
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland.
| | - Jacek Furtak
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland
| | - Kamil Krystkiewicz
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland
| | - Julita Birska
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland
| | - Karolina Zielinska
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcin Rusinek
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dariusz Paczkowski
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Lukasz Szylberg
- Department of Clinical Pathomorphology, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.,Department of Tumor Pathology and Pathomorphology, Oncology Center, Bydgoszcz, Poland.,Department of Pathomorphology, 10th Military Research Hospital, Bydgoszcz, Poland
| | - Marek Harat
- Neurosurgery Department, 10th Military Research Hospital, ul. Powstancow Warszawy 5, 85-681, Bydgoszcz, Poland
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16
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Lara-Almunia M, Hernandez-Vicente J. Symptomatic intracranial hemorrhages and frame-based stereotactic brain biopsy. Surg Neurol Int 2020; 11:218. [PMID: 32874721 PMCID: PMC7451146 DOI: 10.25259/sni_102_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/05/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the emergence of postbiopsy symptomatic intracranial hemorrhage. Based on our findings, we suggest recommendations to improve its usual clinical practice. Methods: We made a retrospective study of 429 cases with stereotactic biopsies performed in the past 37 years. The surgical procedure-was adapted in terms of the stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs available in the hospital. Fifty-three variables were analyzed for each patient (SPSS.23). Results: The diagnostic yield was 90.7%. Forty-one patients (9.5%) suffered a symptomatic postbiopsy hemorrhage; only 17 (3.9%) had permanent morbidity. The mortality was 0.93% (n = 4). A postsurgical CT scan was requested only in 99 patients (23%) of our series. Lesion mass effect, cystic component, contrast enhancement, histological nature, or number of targets were not associated with a greater risk of symptomatic postbiopsy hemorrhage (P > 0.05). On the other hand, the biopsies made by nonexpert neurosurgeons (P = 0.01) or under general anesthesia (P = 0.02) resulted in a greater risk of symptomatic postbiopsy hemorrhage. Anesthetic type was the clearest predictive factor of bleeding with this technique (OR: 0.24). Conclusion: Stereotactic biopsy is a very valuable tool. To optimize its safety and minimize the risk of intracranial bleeding, it requires both a knowledge of stereotactic techniques and very careful surgical planning. While the patient’s stay in intensive vigilance units after the procedure is a useful strategy, the request for control CT scans should be conditioned by the clinical evolution of each patient.
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Affiliation(s)
- Monica Lara-Almunia
- Department of Neurosurgery, Jimenez Diaz Foundation University Hospital, Madrid
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17
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Ye Z, Price RL, Liu X, Lin J, Yang Q, Sun P, Wu AT, Wang L, Han RH, Song C, Yang R, Gary SE, Mao DD, Wallendorf M, Campian JL, Li JS, Dahiya S, Kim AH, Song SK. Diffusion Histology Imaging Combining Diffusion Basis Spectrum Imaging (DBSI) and Machine Learning Improves Detection and Classification of Glioblastoma Pathology. Clin Cancer Res 2020; 26:5388-5399. [PMID: 32694155 DOI: 10.1158/1078-0432.ccr-20-0736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/01/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Glioblastoma (GBM) is one of the deadliest cancers with no cure. While conventional MRI has been widely adopted to examine GBM clinically, accurate neuroimaging assessment of tumor histopathology for improved diagnosis, surgical planning, and treatment evaluation remains an unmet need in the clinical management of GBMs. EXPERIMENTAL DESIGN We employ a novel diffusion histology imaging (DHI) approach, combining diffusion basis spectrum imaging (DBSI) and machine learning, to detect, differentiate, and quantify areas of high cellularity, tumor necrosis, and tumor infiltration in GBM. RESULTS Gadolinium-enhanced T1-weighted or hyperintense fluid-attenuated inversion recovery failed to reflect the morphologic complexity underlying tumor in patients with GBM. Contrary to the conventional wisdom that apparent diffusion coefficient (ADC) negatively correlates with increased tumor cellularity, we demonstrate disagreement between ADC and histologically confirmed tumor cellularity in GBM specimens, whereas DBSI-derived restricted isotropic diffusion fraction positively correlated with tumor cellularity in the same specimens. By incorporating DBSI metrics as classifiers for a supervised machine learning algorithm, we accurately predicted high tumor cellularity, tumor necrosis, and tumor infiltration with 87.5%, 89.0%, and 93.4% accuracy, respectively. CONCLUSIONS Our results suggest that DHI could serve as a favorable alternative to current neuroimaging techniques in guiding biopsy or surgery as well as monitoring therapeutic response in the treatment of GBM.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Price
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Xiran Liu
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Joshua Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital, Yangpu District, Shanghai, China
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony T Wu
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Liang Wang
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chunyu Song
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Sam E Gary
- Medical Scientist Training Program, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Diane D Mao
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Jian L Campian
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jr-Shin Li
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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18
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Role of endoscopic surgical biopsy in diagnoses of intraventricular/periventricular tumors: review of literature including a monocentric case series. Acta Neurol Belg 2020; 120:517-530. [PMID: 32107717 DOI: 10.1007/s13760-020-01299-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/09/2020] [Indexed: 12/28/2022]
Abstract
The intra- and periventricular location tumor (IPVT) of a brain remains a hard challenge for the neurosurgeon because of the deep location and eloquent anatomic associations. Due to this high risk of iatrogenic injury, many surgeons elect to perform biopsies of such lesions to establish a diagnosis. On the one hand, stereotaxic needle biopsy (SNB) is a minimally invasive procedure but with a significant risk of complications and a high risk of lack of tissue for molecular analyses for this region [Fukushima in Neurosurgery 2:110-113 (1978)]; on the other hand, the use of endoscopic intraventricular biopsy (EIB) allows for diagnosis with minimal surgical intervention [Iwamoto et al. in Ann Neurol 64(suppl. 6):628-634 (2008)]. IPVTs and related CSF pathway obstructions can be safely and effectively treated with endoscopic techniques. It is not possible to compare EIB with diagnoses made by any other method or with the established treatment. We aim to analyze the accuracy of EIB results by comparing them with results of biopsies performed later, in other methods and thereby evaluating the treatment evolution considering our personal experience. The difficulties and complications encountered are presented and compared with those reported in the literature to obtain the best review possible for this topic. A systematic review of literature was done using MEDLINE, the NIH Library, PubMed, and Google Scholar yielded 1.951 cases for EIB and 1912 for SNB, according to standard systemic review techniques. Review was conducted on 50 studies describing surgical procedures for lesions intra- and para-ventricular. The primary outcome measure was a diagnostic success. We also consider 20 patients with IPVT treated in our department. Clinical characteristics and surgical outcome were evaluated and a systematic review of the literature was performed. Overall, all our biopsies were diagnostic, with a positive histologic sample in 100% of our patients. 8 patients underwent a concurrent endoscopic third ventriculostomy. 4 patients underwent a concurrent ventriculostomy combined with septostomy. For 1 patient was necessary the only septostomy combined with biopsy. Every case has obtained a histological diagnosis. The percentage of complications was very low with only 1 case of post-operative infection and 1 case of hemorrhage. It was impossible to create a specific comparison from literature data of IPVTs between a stereotactic and endoscopic procedure, it presents only the collection of pineal gland tumor [Kelly in Neurosurgery 25(02):185-194 (1989); Quick-Weller in World Neurosurgery 96:124-128 (2016)] or unknown location of the lesion in major review [Marenco-Hillembrand et al. in Front Oncol 8:558 (2018)]. The present study aims to report our experience with the surgical management of IPVTs. The EIB sample yields an accurate histologic diagnosis tumor, with a positive histologic sample in 87, 95% of patients. The choice of the appropriate procedure should consider not only the preference and the experience of the neurosurgeon but also the several other variables as the location. While some periventricular lesions are better approached by endoscopic techniques, others are more suited for stereotactic-guided approaches. The ability to perform an EIB and relieve tumor-associated hydrocephalus by neuroendoscopy is considered to be a benefit of this procedure since this is less invasive than other treatments.
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19
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César de Almeida J, Dellaretti M, Piaulino Benvindo Ferreira PH, Ferreira TA, Marques do Nascimento L, Faria MP. Evaluation of Accuracy and Reliability of a Smartphone Stereotactic Coordinates Checking Application. World Neurosurg 2020; 141:e324-e333. [PMID: 32445896 DOI: 10.1016/j.wneu.2020.05.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical assistance applications for smartphones have the potential to be used in daily practice; however, regular reviews of these tools are required. StereoCheck (Mevis, São Paulo, São Paulo, Brazil) is a mobile application (app) designed to compute stereotactic coordinates as a checking tool. The present study evaluated the accuracy and reliability of the StereoCheck app. METHODS The present observational and prospective study included 26 patients who had undergone frame-based stereotactic brain biopsy. A standard stereotactic planning software (Framelink, version 5.0 [Medtronic, Minneapolis, Minnesota, USA]) was used to define the target coordinates. The surgical planning images were transferred to StereoCheck using 2 image input methods: photographs of the screen monitor and digitally exported images of the screen monitor. Five examiners performed the target coordinate definitions using StereoCheck on 2 occasions. The accuracy and reliability of the app were evaluated in tests that compared the planning methods (app vs. standard software), multiple examiners, and sequential tests. RESULTS The StereoCheck accuracy using photographs of the screen was 2.71 ± 0.86 mm (95% confidence interval, 2.37-3.06). Using the digitally exported images, it was 0.82 ± 0.61 mm (95% confidence interval, 0.58-1.07). The accuracy between the 2 methods was greater using the exported images (P < 0.01) and was not affected by the clinical and radiological features. The accuracy of StereoCheck among multiple examiners and in sequential tests showed a mean distance between the targets and coordinates of <1.00 mm. Thus, an excellent level of reliability for the StereoCheck coordinates (intraclass correlation coefficient ≥0.8) was verified in all contexts. CONCLUSION StereoCheck showed satisfactory accuracy and reliability. The use of photographs to compute the coordinates could lead to a significant decrease in the accuracy of the app.
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Affiliation(s)
- Júlio César de Almeida
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
| | - Marcos Dellaretti
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcello Penholate Faria
- Department of Neurosurgery, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
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20
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Cuello JF, Saenz A, Liñares JM, Martinez P, Ruiz C, Argañaraz R, Bailez MM, Mantese B. Low-Cost Stereotactic Brain Biopsy Simulation Model. World Neurosurg 2020; 138:285-290. [PMID: 32200018 DOI: 10.1016/j.wneu.2020.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Simulation training improves technical skills in a safe environment. Stereotactic techniques are widely used in neurosurgery for different kinds of procedures. The objective of the study was to describe a combined cadaveric and synthetic low-cost stereotactic simulation model and its validation by neurosurgeons. METHODS The brain was made using self-supporting gel with solid and cystic lesions. We used imaging scans to calculate x, y, and z target coordinates. A standard frame needle biopsy was performed. We calculated the number of mistakes and time needed to accomplish the task, and we evaluated the frame assembly and biopsy performance. Wilcoxon signed rank was used to analyzed the data; we considered a P value <0.05 as statistically significant. RESULTS The median initial number of mistakes was 32 (interquartile range [IQR]: 27.5-37) and after repeated training and feedback the final median number was 3.5 (IQR: 2-6) (P < 0.001). The median time needed to finish the exercises before training was 1020.5 seconds (IQR: 908-1125.5) and after using the model the final median time was 479 seconds (IQR: 423-503) (P < 0.0001). CONCLUSIONS We presented a stereotactic simulation model with immediate haptic feedback. The model can be easily handmade in any neurosurgical laboratory. This model allows neurosurgeons in training to acquire and improve stereotactic techniques, reducing the number of surgical mistakes and time needed to finish the task.
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Affiliation(s)
- Javier Francisco Cuello
- Neurosurgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina.
| | - Amparo Saenz
- Neurosurgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Juan Manuel Liñares
- Neurosurgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Patricia Martinez
- Center of Simulation, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Carolina Ruiz
- Center of Simulation, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Romina Argañaraz
- Neurosurgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María Marcela Bailez
- Center of Simulation, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Beatriz Mantese
- Neurosurgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
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21
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Maragkos GA, Penumaka A, Ahrendsen JT, Salem MM, Nelton EB, Alterman RL. Factors Affecting the Diagnostic Yield of Frame-Based Stereotactic Intracranial Biopsies. World Neurosurg 2019; 135:e695-e701. [PMID: 31883483 DOI: 10.1016/j.wneu.2019.12.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Frame-based stereotactic biopsy (FSB) remains the "gold standard" for obtaining diagnostic samples of intracranial lesions to guide therapy. Nevertheless, diagnostic yield is highly variable. This study aims to provide an analysis of diagnostic yield, surgical complications, and factors associated with obtaining nondiagnostic samples in a contemporary FSB series. METHODS A retrospective cohort study was conducted of all adult patients with imaging-documented lesions undergoing FSB at our institution between 2013 and 2018. Diagnostic accuracy, lesion characteristics associated with nondiagnostic biopsy, and surgical complications were evaluated. A biopsy was considered nondiagnostic if all frozen samples and the final pathology yielded normal brain tissue or nonspecific reactive tissue unless the "reactive" pathology was consistent with radiation injury from prior therapy. RESULTS Our search identified 198 FSB patients. Mean (standard deviation) age was 62 ± 17 years, and 44.2% were female. Median procedure time was 32 minutes. A definitive histologic diagnosis was established in 187 cases (94.4% diagnostic yield). Mean lesion diameter was 31.9 ± 16.8 mm. Multivariable logistic regression revealed only lesion diameter to be significantly associated with diagnostic result (odds ratio for nondiagnostic result: 0.94 per mm diameter decrease, 95% confidence interval 0.87-0.99, P = 0.028). On univariable analysis, diagnosis of central nervous system lymphoma appeared to increase the risk of a nondiagnostic biopsy (P = 0.025), but this association disappeared when controlling for lesion size and steroid administration before biopsy. Eight patients (4.0%) developed postoperative hemorrhagic complications, 3 of whom required reoperation, and another expired. CONCLUSIONS This study demonstrates that diagnostic yield from contemporary FSB is high and depends predominantly on lesion size.
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Affiliation(s)
- Georgios A Maragkos
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anirudh Penumaka
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jared T Ahrendsen
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Neurological Pathology Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohamed M Salem
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Emmalin B Nelton
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ron L Alterman
- Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Neurological Surgery, Harvard Medical School, Boston, Massachusetts, USA.
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22
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Miki K, Natori Y, Kai Y, Yamada T, Mori M, Noguchi N. Neuroport ® makes brain biopsy less invasive and easy even in eloquent areas. Br J Neurosurg 2019:1-3. [DOI: 10.1080/02688697.2019.1630557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kenji Miki
- Department of Neurosurgery, Aso Iizuka Hospital, Iizuka, Japan
| | | | - Yasutoshi Kai
- Department of Neurosurgery, Aso Iizuka Hospital, Iizuka, Japan
| | | | - Megumu Mori
- Department of Neurosurgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Naoki Noguchi
- Department of Neurosurgery, Aso Iizuka Hospital, Iizuka, Japan
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23
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Sciortino T, Fernandes B, Conti Nibali M, Gay LG, Rossi M, Lopci E, Colombo AE, Elefante MG, Pessina F, Bello L, Riva M. Frameless stereotactic biopsy for precision neurosurgery: diagnostic value, safety, and accuracy. Acta Neurochir (Wien) 2019; 161:967-974. [PMID: 30895395 DOI: 10.1007/s00701-019-03873-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era. METHODS One hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide® frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated. RESULTS The overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5 days (IQR 4-8) with mean surgical time of 60.77 min (± 23.12) and 137.44 ± 24.1 min of total occupation time of the operative room. CONCLUSIONS Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
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Affiliation(s)
- Tommaso Sciortino
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Bethania Fernandes
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Marco Conti Nibali
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Lorenzo G Gay
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Marco Rossi
- Università degli Studi di Milano, Milan, Italy
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Egesta Lopci
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Anna E Colombo
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Maria G Elefante
- Unit of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
| | - Federico Pessina
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano (MI), Italy
| | - Lorenzo Bello
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Riva
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy.
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.
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24
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Kani Y, Cecere TE, Lahmers K, LeRoith T, Zimmerman KL, Isom S, Hsu FC, Debinksi W, Robertson JL, Rossmeisl JH. Diagnostic accuracy of stereotactic brain biopsy for intracranial neoplasia in dogs: Comparison of biopsy, surgical resection, and necropsy specimens. J Vet Intern Med 2019; 33:1384-1391. [PMID: 30990928 PMCID: PMC6524398 DOI: 10.1111/jvim.15500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/03/2019] [Indexed: 01/07/2023] Open
Abstract
Background Stereotactic brain biopsy (SBB) is a technique that allows for definitive diagnosis of brain lesions. Little information is available regarding the diagnostic utility of SBB in dogs with intracranial diseases. Objective To investigate the diagnostic accuracy (DA) of SBB in dogs with brain tumors. Animals Thirty‐one client‐owned dogs that underwent SBB followed by surgical resection or necropsy examinations. Methods Retrospective observational study. Two pathologists blinded to SBB and reference standard diagnoses reviewed histologic specimens and typed and graded tumors according to World Health Organization and revised canine glioma classification criteria. Agreement between tumor type and grade from SBB were compared to reference standards and assessed using kappa statistics. Patient and technical factors associated with agreement also were examined. Results Stereotactic brain biopsy specimens were obtained from 24 dogs with gliomas and 7 with meningiomas. Tumor type agreement between SBB and the reference standard was observed in 30/31 cases (κ = 0.95). Diagnostic concordance was perfect for meningiomas. Grade agreement among gliomas was observed in 18/23 cases (κ = 0.47). Stereotactic brain biopsy underrepresented the reference standard glioma grade in cases with disagreement. The DA of SBB was 81%, with agreement noted in 56/69 biopsy samples. Smaller tumors and fewer SBB specimens obtained were significantly associated with diagnostic discordance. Conclusions and Clinical Importance The DA of SBB readily allows for the diagnosis of common brain tumors in dogs. Although glioma grade discordance was frequent, diagnoses obtained from SBB are sufficient to currently inform therapeutic decisions. Multiple SBB specimens should be collected to maximize DA.
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Affiliation(s)
- Yukitaka Kani
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, Virginia
| | - Thomas E Cecere
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Kevin Lahmers
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Kurt L Zimmerman
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Waldemar Debinksi
- Cancer Biology, Comprehensive Cancer Center and Brain Tumor Center of Excellence, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - John L Robertson
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, Virginia.,Cancer Biology, Comprehensive Cancer Center and Brain Tumor Center of Excellence, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - John H Rossmeisl
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia Tech, Blacksburg, Virginia.,Cancer Biology, Comprehensive Cancer Center and Brain Tumor Center of Excellence, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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25
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Lara-Almunia M, Hernandez-Vicente J. WITHDRAWN: Frame-Based Stereotactic Brain Biopsy and Symptomatic Intracranial Hemorrhages: Associated Factors in a Series of 407 Patients. World Neurosurg 2019:S1878-8750(19)30154-8. [PMID: 30684698 DOI: 10.1016/j.wneu.2019.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Monica Lara-Almunia
- Department of Neurosurgery, Son Espases University Hospital, Mallorca, Spain
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26
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Bishokarma S, Shrestha P, Koirala S, Raut M, Gongal DN. Venture in 101 Cranial Punctures: A Comparative Study between Frame-based versus Frameless Biopsy of 101 Intracranial Space Occupying Lesion. Asian J Neurosurg 2019; 14:175-180. [PMID: 30937031 PMCID: PMC6417303 DOI: 10.4103/ajns.ajns_137_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Presumptive diagnosis based solely on the clinical picture and imaging is not sufficient to provide appropriate treatment with certainty and hence histopathological confirmation of intracranial space occupying lesion (ICSOL) is essential. Needle biopsy via stereotactic frame-based or frameless neuronavigation technique is efficient procedure. The objective of this study is to compare their accuracy and efficacy and safety. Methods: This is a retrospective comparative study conducted among 101 biopsies of ICSOL. Patients data were retrieved from medical record. Data were analyzed in SPSS ver. 20. P value of <0.05 was considered significant. Results: Out of 101 patients, Frame-based stereotactic biopsy was done among 55 patients (54.4%) while 46 patients (45.6%) underwent frameless stealth neuronavigation guided biopsy. Male to female ration was 2.1:1. Age ranged from 5 to 82 years. 54.5% (55 patients) have deeper location of tumor while 45.5% (46 patients) have lobar location of tumor. Frontal (16.8%) and Thalamic (13.8%) were the common site. Mean size of tumor was 3.09±0.85cms. There was statistically significant difference in operative duration among study groups. Overall Diagnostic yield was 89.1%. Glioma was the most common (50.5%) diagnosis. Glioblastoma WHO Grade IV was 37.6% followed by lymphoma (12.8%). Conclusion: Needle biopsy via stereotactic frame-based or neuronavigation frameless technique is a safe and efficient procedure having high diagnostic yield. Reasons for negative biopsy could be missed target or retrieval of gliotic tissue.
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Affiliation(s)
- Suresh Bishokarma
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Pratyush Shrestha
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Sagar Koirala
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Manita Raut
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Dinesh Nath Gongal
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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Akay A, Rüksen M, Islekel S. Magnetic Resonance Imaging-guided Stereotactic Biopsy: A Review of 83 Cases with Outcomes. Asian J Neurosurg 2019; 14:90-95. [PMID: 30937016 PMCID: PMC6417362 DOI: 10.4103/ajns.ajns_81_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The purpose of this study was to determine the relationship between the radiological and histopathological distribution of the cerebral lesions diagnosed with stereotactic biopsy (STB) procedure and its outcomes. Materials and Methods: In the current study, a retrospective analysis of 83 patients that underwent the STB in our clinic from January 2011 to December 2015 was made. T1-weighted contrast-enhanced cranial magnetic resonance imaging examinations were performed on patients on whom Leksell stereotactic frame system was installed. The histopathological and the radiological data derived from the STB procedure were classified. Results: In terms of localization, glial tumor (56.6%) was the most common lesion in all regions, except for the multifocal lesions. Contrary to the common knowledge, lymphoma (14.4%) was found to be the most common lesion among multifocal lesions. The success of obtaining positive STB samples in the current series was 95.2% and the complication rate was 3.6%. Conclusion: Had a routine computed tomography scan been performed on each patient in this series, the number of clinically insignificant small intracerebral hematomas would have probably been higher. Nevertheless, the rate of the STB sampling accuracy and the complication rate were similar to those reported in the relevant literature.
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Affiliation(s)
- Ali Akay
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Mete Rüksen
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Sertaç Islekel
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
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28
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Patil AD, Singh V, Sukumar V, Shetty PM, Moiyadi AV. Comparison of outcomes of free-hand 2-dimensional ultrasound-guided versus navigated 3-dimensional ultrasound-guided biopsy for supratentorial tumours: a single-institution experience with 125 cases. Ultrasonography 2018; 38:255-263. [PMID: 30779873 PMCID: PMC6595123 DOI: 10.14366/usg.18036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/08/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the relative utility and benefits of free-hand 2-dimensional intraoperative ultrasound (FUS) and navigated 3-dimensional intraoperative ultrasound (NUS) as ultrasound-guided biopsy (USGB) techniques for supratentorial lesions. Methods All patients who underwent USGB for suspected supratentorial tumours from January 2008 to December 2017 were retrospectively analyzed. The charts and electronic medical records of these patients were studied. Demographic, surgical, and pathological variables were collected and analyzed. The study group consisted of patients who underwent either FUS or NUS for biopsy. Results A total of 125 patients (112 adults and 13 children) underwent USGB during the study period (89 FUS and 36 NUS). NUS was used more often for deep-seated lesions (58% vs. 18% for FUS, P<0.001). The mean operating time for NUS was longer than for FUS (156 minutes vs. 124 minutes, P=0.001). Representative yield was found in 97.7% of biopsies using FUS and in 100% of biopsies using NUS (diagnostic yield, 93.6% and 91.3%, respectively). The majority of lesions (89%) were high-grade gliomas or lymphomas. Postoperative complications were more common in the NUS group (8.3% vs. 1.2%), but were related to the tumour location (deep). Conclusion Despite the longer operating time and higher rate of postoperative complications, NUS has the benefit of being suitable for biopsies of deep-seated supratentorial lesions, while FUS remains valuable for superficial lesions.
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Affiliation(s)
- Aditya D Patil
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vivek Sukumar
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prakash M Shetty
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar V Moiyadi
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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de Quintana-Schmidt C, Leidinger A, Teixidó JM, Bertrán GC. Application of a Thrombin-Gelatin Matrix in the Management of Intractable Hemorrhage During Stereotactic Biopsy. World Neurosurg 2018; 121:180-185. [PMID: 30326309 DOI: 10.1016/j.wneu.2018.10.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/05/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Few studies have been published about percutaneous techniques for management of surgical bed hemorrhage during a stereotactic biopsy, a serious complication that may affect patient outcome. We describe the injection of a thrombin-gelatin matrix through the biopsy cannula as an effective method to arrest surgical bed bleeding that does not respond to conventional methods of hemostasis. METHODS We prospectively documented image-guided stereotactic brain biopsy procedures in 30 awake patients between July 2014 and July 2017 at our center. Among patients presenting with intractable surgical bed bleeding, a thrombin-gelatin matrix injection through the biopsy cannula was performed. Details of the injection technique, surgical outcome, and complications were recorded. RESULTS Among 30 documented stereotactic brain biopsies, 3 (10%) had intractable surgical bed bleeding during the procedure. In all 3 cases, thrombin-gelatin matrix was injected, and an immediate arrest of hemorrhage was achieved. None of the patients required a craniotomy or further invasive measure to achieve hemostasis. No postoperative complications were recorded. CONCLUSIONS Our preliminary results suggest that thrombin-gelatin matrix injection is a simple, safe, and effective stereotactic practice to manage persistent surgical bed bleeding that cannot be arrested by standard, conventional hemostatic methods.
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Affiliation(s)
| | - Andreas Leidinger
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joan Molet Teixidó
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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30
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Bulduk EB, Aslan A, Öcal Ö, Emmez ÖH, Kurt G, Aykol Ş. Stereotactic biopsy of the brain mass lesions: a tertiary hospital experience. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.457233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fluorescein-assisted stereotactic needle biopsy of brain tumors: a single-center experience and systematic review. Neurosurg Rev 2018; 42:309-318. [DOI: 10.1007/s10143-018-0947-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 01/21/2023]
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32
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Valentini MC, Mellai M, Annovazzi L, Melcarne A, Denysenko T, Cassoni P, Casalone C, Maurella C, Grifoni S, Fania P, Cistaro A, Schiffer D. Comparison among conventional and advanced MRI, 18F-FDG PET/CT, phenotype and genotype in glioblastoma. Oncotarget 2017; 8:91636-91653. [PMID: 29207673 PMCID: PMC5710953 DOI: 10.18632/oncotarget.21482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/30/2017] [Indexed: 12/20/2022] Open
Abstract
Glioblastoma (GB) is a highly heterogeneous tumor. In order to identify in vivo the most malignant tumor areas, the extent of tumor infiltration and the sites giving origin to GB stem cells (GSCs), we combined positron emission tomography/computed tomography (PET/CT) and conventional and advanced magnetic resonance imaging (MRI) with histology, immunohistochemistry and molecular genetics. Prior to dura opening and tumor resection, forty-eight biopsy specimens [23 of contrast-enhancing (CE) and 25 of non-contrast enhancing (NE) regions] from 12 GB patients were obtained by a frameless image-guided stereotactic biopsy technique. The highest values of 2-[18F]-fluoro-2-deoxy-D-glucose maximum standardized uptake value (18F-FDG SUVmax), relative cerebral blood volume (rCBV), Choline/Creatine (Cho/Cr), Choline/N-acetylaspartate (Cho/NAA) and Lipids/Lactate (LL) ratio have been observed in the CE region. They corresponded to the most malignant tumor phenotype, to the greatest molecular spectrum and stem cell potential. On the contrary, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in the CE region were very variable. 18F-FDG SUVmax, Cho/Cr and Cho/NAA ratio resulted the most suitable parameters to detect tumor infiltration. In edematous areas, reactive astrocytes and microglia/macrophages were influencing variables. Combined MRI and 18F-FDG PET/CT allowed to recognize the specific biological significance of the different identified areas of GB.
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Affiliation(s)
| | - Marta Mellai
- Research Center/Policlinico di Monza Foundation, 13100 Vercelli, Italy
| | - Laura Annovazzi
- Research Center/Policlinico di Monza Foundation, 13100 Vercelli, Italy
| | - Antonio Melcarne
- Department of Neurosurgery, A.O.U. Città della Salute e della Scienza, 10126 Turin, Italy
| | - Tetyana Denysenko
- Research Center/Policlinico di Monza Foundation, 13100 Vercelli, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Cristina Casalone
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, 10154 Turin, Italy
| | - Cristiana Maurella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, 10154 Turin, Italy
| | - Silvia Grifoni
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d’Aosta, 10154 Turin, Italy
| | - Piercarlo Fania
- Positron Emission Tomography Center IRMET S.p.A, Euromedic Inc., 10136 Turin, Italy
| | - Angelina Cistaro
- Positron Emission Tomography Center IRMET S.p.A, Euromedic Inc., 10136 Turin, Italy
- Institute of Cognitive Sciences and Technologies, National Research Council, 00185 Rome, Italy
| | - Davide Schiffer
- Research Center/Policlinico di Monza Foundation, 13100 Vercelli, Italy
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Benediktsson H, Andersson T, Sjölander U, Hartman M, Lindgren PG. Ultrasound Guided Needle Biopsy of Brain Tumors Using an Automatic Sampling Instrument. Acta Radiol 2016. [DOI: 10.1177/028418519203300602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
All ultrasound (US) guided needle biopsies of brain tumors performed during an 8-year period were reviewed. Tissue samples were obtained in 112 of 115 biopsy procedures, and a histologic diagnosis was established in 99 cases (88.4%). The rate of major complications was 8.0%. The mortality is similar as in reports on stereotactic and CT-guided biopsy procedures while the morbidity is higher in our material. There are no large series available on US guided intracranial biopsy with adequate reports of complications. A modified biopsy technique is introduced here using a cutting needle and an automatic sampling instrument. The modified technique, which has been used in all cases since 1985, yielded diagnostic material in 91.5%. This method consistently provides a tissue core which is essential for a confident histopathologic diagnosis.
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Abstract
Nearly four decades after the invention of the N-localizer, its origin and history remain misunderstood. Some are unaware that a third-year medical student invented this technology. The following conspectus accurately chronicles the origin of the N-localizer, presents recently discovered evidence that documents its history, and corrects misconceptions related to its origin and early history.
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Wani AA, Wani MA, Ramzan AU, Nizami FA, Malik NK, Shafiq S, Ahmad R, Kumar A, Lone I, Makhdoomi R. Combination of needle aspiration and core needle biopsy: A new technique of stereotactic biopsy. Asian J Neurosurg 2016; 11:94-7. [PMID: 27057212 PMCID: PMC4802960 DOI: 10.4103/1793-5482.145188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The study aims at describing the results of using a new technique to acquire the tissue sample in stereotactic biopsy of brain lesions. Materials and Methods: The study was performed in 19 patients over a period of 5 years in which we used the new technique, i.e., Abrar and Afzal technique (AT) of obtaining tissue biopsy. It is a combination of core tissue biopsy and needle aspiration techniques. The technique was devised to acquire greater amount of tissue for pathologic study. Results: While we could give pathologic diagnosis in 18 patients out of 19 (94.7%), in one patient, the tissue sample revealed only inflammatory cells and definitive diagnosis could not be reached. There was no significant morbidity or any mortality in the series. Conclusion: Abrar and Afzal technique is a reasonably accurate technique of acquiring larger tissue sample in stereotactic brain biopsy without any additional risks. It can be done with little modification of the conventional equipment available with the stereotactic system.
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Affiliation(s)
- Abrar Ahad Wani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - M Afzal Wani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf U Ramzan
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Furqan A Nizami
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil K Malik
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - S Shafiq
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rais Ahmad
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Ashish Kumar
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Iqbal Lone
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rumana Makhdoomi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Lundberg J, Johansson CB, Jonsson S, Holmin S. Access to the brain parenchyma using endovascular techniques and a micro-working channel. J Neurosurg 2016; 126:511-517. [PMID: 27015400 DOI: 10.3171/2016.1.jns152543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several older studies report a low risk for parenchymal access to the CNS by surgical techniques. In more recent studies, including those with post-puncture CT scans, there are indications that the risk of bleeding might approach 8%. New therapies, such as those that use viral vectors, modified mRNA, or cell transplantation, will probably warrant more parenchymal access to the CNS. Other minimally invasive routes might then be tempting to explore. This study was designed in 2 parts to address the possibility of using the endovascular route. The first aim was to test the ability to create a parenchymal micro-working channel to the CNS in macaque monkeys through the vessel wall. Second, the biocompatibility of a device-associated, detached, distal securing plug that was made of nitinol was investigated in swine for 1 year. METHODS Trans-vessel wall intervention in the middle cerebral artery and associated cerebral parenchyma was performed in 4 rhesus macaque monkeys using a full clinical angiography suite. A contrast agent and methylene blue were injected to test the working channel and then detached at the distal end to act as a securing plug through the vessel wall. One-year follow-ups were also performed using angiography and histological analysis in 10 swine with 24 implants that were distributed in the external carotid artery tree. RESULTS The cerebral interventions were performed without acute bleeding. Both the contrast agent and methylene blue were infused into the brain parenchyma and subarachnoidal space via the endovascular micro-working channel (7 injections in 4 animals). In the 1-year follow-up period, the implant that was left in the external carotid vessel wall in the swine was covered by the endothelium, which was followed by dislodgement just outside the blood vessel with thin capsule formation. No stenosis in the artery was detected on 1-year angiography. The animals showed normal behavior and blood sample results during the follow-up period. This is the first histological demonstration of nitinol biocompatibility when the implant is positioned through an arterial wall and indicates that the trans-vessel wall technique is not comparable with stent placement and its ability to induce intimal hyperplasia and restenosis. CONCLUSIONS This study demonstrates that the trans-vessel wall technique is applicable to brain intervention in macaque monkeys, providing a micro-working channel for delivery or sampling. The long-term follow-up study of the detached device in swine showed no clinical or biochemical complications and a normal angiography appearance.
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Affiliation(s)
- Johan Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet.,Department of Neuroradiology, Karolinska University Hospital, Stockholm
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials, Science, Sahlgrenska Academy, Institute of Odontology, University of Gothenburg, Sweden; and
| | - Stefan Jonsson
- Department of Materials Science and Engineering, Royal Institute of Technology, Stockholm, Sweden
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet.,Department of Neuroradiology, Karolinska University Hospital, Stockholm
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Abstract
Nearly four decades after the invention of the N-localizer, its origin and history remain misunderstood. Some are unaware that a third-year medical student invented this technology. The following conspectus accurately chronicles the origin and early history of the N-localizer and corrects some misconceptions related to both.
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Gracia I, Perelló L, Valero R, Hervías A, Perdomo J, Pujol R, González J, Hurtado P, de Riva N, Tercero FJ, Carrero E, Ferrer E, Fàbregas N. Eficacia diagnóstica y manejo posoperatorio de los pacientes sometidos a biopsia cerebral en un hospital universitario. Neurocirugia (Astur) 2015; 26:23-31. [DOI: 10.1016/j.neucir.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 01/22/2023]
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Chen CC, White NS, Farid N, Kobalka P, Hansen L, Pearn M, Dale AM. Pre-operative cellularity mapping and intra-MRI surgery: potential for improving neurosurgical biopsies. Expert Rev Med Devices 2014; 12:1-5. [DOI: 10.1586/17434440.2015.975118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balossier A, Blond S, Touzet G, Lefranc M, de Saint-Denis T, Maurage CA, Reyns N. Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience. Neurochirurgie 2014; 61:146-54. [PMID: 25312672 DOI: 10.1016/j.neuchi.2014.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/17/2014] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Pineal tumours account for 1% to 4% of brain tumours in adults and for around 10% in children. Except in a few cases where germ cell markers are elevated, accurate histological samples are mandatory to initiate the treatment. Open surgery still has a high morbidity and is often needless. Biopsies can either be obtained by endoscopic or stereotactic procedures. METHODS Following an extensive review of the literature (PubMed 1970-2013; keywords pineal tumour, biopsy; English and French), 33 studies were analysed and relevant data compared regarding the type of procedure, diagnosis rate, cerebrospinal fluid diversion type and rate, perioperative mortality, morbidity. RESULTS Endoscopic and stereotactic biopsies showed a diagnosis rate of 81.1% (20%-100%) and 93.7% (82%-100%), respectively. Endoscopic biopsies involved 21.0% of minor and 2.0% of major complications whereas stereotactic biopsies involved 6.4% of minor and 1.6% of major complications. The most frequently reported complication was haemorrhage for both endoscopic and stereotactic procedures, accounting for 4.8% and 4.3%, respectively. Mortality rate was low for both endoscopic and stereotactic procedures, equal to 0.4% and 1.3%, respectively. Local experience of stereotactic biopsies was also reported and corroborated the previous data. CONCLUSIONS The difference between both procedures is not statistically significant (p>0.05) across large series (≥20patients). Nevertheless, tissue diagnosis appears less accurate with endoscopic procedures than with stereotactic procedures (81.1% versus 93.7%, weighted mean across all series). In our opinion, the neuroendoscopic approach is the best tool for managing hydrocephalus, whereas stereotactic biopsies remain the best way to obtain a tissue diagnosis with accuracy and low morbidity.
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Affiliation(s)
- A Balossier
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France; Service de neurochirurgie, CHU de Caen, 14000 Caen, France.
| | - S Blond
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France.
| | - G Touzet
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
| | - M Lefranc
- Service de neurochirurgie, CHU d'Amiens, 80000 Amiens, France
| | | | - C-A Maurage
- Laboratoire d'anatomo-pathologie, CHRU de Lille, 59037 Lille, France
| | - N Reyns
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
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Nishihara M, Takeda N, Harada T, Kidoguchi K, Tatsumi S, Tanaka K, Sasayama T, Kohmura E. Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy. Surg Neurol Int 2014; 5:S421-6. [PMID: 25289174 PMCID: PMC4173323 DOI: 10.4103/2152-7806.140211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/17/2014] [Indexed: 11/05/2022] Open
Abstract
Background: We compared the diagnostic yield and morbidity by frame-based computed tomography-guided stereotactic biopsy (CTSTB) with Brown-Roberts-Wells (BRW) unit and by neuronavigation-guided frameless stereotactic biopsy (NSTB) using magnetic resonance imaging (MRI). Methods: The subjects’ age range was 15-83 years. CTSTB with BRW unit was performed for 59 tumors (58 cases, 1988-2007). NSTB was performed for 38 tumors (35 cases, 2007-2013) with the needle sheath attached to the head holder. By NSTB, target locations of sampling points and trajectories were confirmed by using MRI. Diffusion tensor imaging-based fiber tractography was used to achieve safe trajectories. STB by using BRW did not visualize the trajectory virtually; however, the planning images for NSTB were able to show the trajectory virtually before the procedure. Results: Histological diagnoses were established for 93 tumors at the first biopsy. The diagnostic yield was 94.9% by CTSTB and 97.4% by NSTB (P = 0.944). The morbidity rate was 5.1% by CTSTB and 0% by NSTB (P = 0.417). The absolute risk reduction was 23.1% by NSTB when the targets were basal ganglia (putamen, globus pallidus) or thalamus. In the cases of glioma for which the targets were basal ganglia (putamen, globus pallidus) or thalamus, the absolute risk reduction by NSTB was 30%. Conclusions: There was no significant difference between CTSTB and NSTB concerning the diagnostic yield and morbidity. However, when the target is the basal ganglia (putamen, globus pallidus) or thalamus and glioma is suspected, NSTB by using MRI with virtual trajectory is preferable to CTSTB concerning morbidity.
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Affiliation(s)
| | - Naoya Takeda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Tomoaki Harada
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Keiji Kidoguchi
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | | | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Mottolese C, Szathmari A, Beuriat PA. Incidence of pineal tumours. A review of the literature. Neurochirurgie 2014; 61:65-9. [PMID: 25113513 DOI: 10.1016/j.neuchi.2014.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 01/13/2014] [Accepted: 01/24/2014] [Indexed: 11/25/2022]
Abstract
The knowledge of the incidence of pineal tumours is important not only for diagnostic care but also for its therapeutic programme. We reviewed the incidence of pineal tumours reported in literature in an attempt to establish if a difference existed between pineal gland tumours and the pineal region tumours as different authors use both expressions to indicate the same thing. The rate of frequency of these tumours is useful to guide the therapeutic choice for patients as the decisional tree is completely different for either germ cell tumours, pineal gland tumours or pineal gliomas and eventually papillary tumours of the pineal region. According to the French Register of pineal tumours, true pineal tumours represent: 27% pineal parenchymal tumours (PPT), 27% germ cell tumours, 17% gliomas, 8% papillary tumours. True pineal gland tumours are represented by: pineocytomas - (13%), pineal parenchymal tumours with intermediary differentiation PTT-ID - (66%) and pinealoblastomas - (21%). There was no statistical difference found between the French register and the Lyon series concerning histological diagnosis. It seemed to us important to discover its true incidence by comparing the data published in the literature and to stress the utility of the French Register for these uncommon tumours not only for recording new histological cases but also to document clinical symptomatology, therapeutic programmes, length of follow-up and clinical results for each patient treated. A better understanding of their natural history and improved evaluation of different treatments and their complications should contribute to improve clinical results.
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Affiliation(s)
- C Mottolese
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France.
| | - A Szathmari
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France
| | - P-A Beuriat
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France
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Lu Y, Yeung C, Radmanesh A, Wiemann R, Black PM, Golby AJ. Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques. World Neurosurg 2014; 83:261-8. [PMID: 25088233 DOI: 10.1016/j.wneu.2014.07.043] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/09/2014] [Accepted: 07/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the diagnostic yield and safety profiles of intraoperative magnetic resonance imaging (MRI)-guided needle brain biopsy with 2 traditional brain biopsy methods: frame-based and frameless stereotactic brain biopsy. METHODS A retrospective analysis was performed of 288 consecutive needle brain biopsies in 277 patients undergoing stereotactic brain biopsy with any of the 3 biopsy methods at Brigham and Women's Hospital from 2000-2008. Variables including age, sex, history of radiation and previous surgery, pathology results, complications, and postoperative length of hospital stay were analyzed. RESULTS Over the course of 8 years, 288 brain biopsies were performed. Of these, 253 (87.8%) biopsies yielded positive diagnostic tissue. Young age (<40 years old) and history of brain radiation or surgery were significant negative predictors for a positive biopsy diagnostic yield. Excluding patients with prior radiation or surgeries, no significant difference in diagnostic yield was detected among the 3 groups, with frame-based biopsies yielding 96.9%, frameless biopsies yielding 91.8%, and intraoperative MRI-guided needle biopsies yielding 89.9% positive diagnostic yield. Serious adverse events occurred 19 biopsies (6.6%). Intraoperative MRI-guided brain biopsies were associated with less serious adverse events and the shortest postoperative hospital stay. CONCLUSIONS Frame-based, frameless stereotactic, and intraoperative MRI-guided brain needle biopsy techniques have comparable diagnostic yield for patients with no prior treatments (either radiation or surgery). Intraoperative MRI-guided brain biopsy is associated with fewer serious adverse events and shorter hospital stay.
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Affiliation(s)
- Yi Lu
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Cecil Yeung
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alireza Radmanesh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Wiemann
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M Black
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Stidd DA, Wewel J, Ghods AJ, Munich S, Serici A, Keigher KM, Theessen H, Moftakhar R, Lopes DK. Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration. J Neurosurg 2014; 121:745-50. [PMID: 25036204 DOI: 10.3171/2014.6.jns132386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers. METHODS A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm. RESULTS The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection. CONCLUSIONS This is the first example of frameless neuronavigation based on 3D catheter angiography registered by only the surface anatomy data contained within the 3D DSA image set. This is an easily applied technique that is beneficial for accurately locating vascular pathological entities and reducing the dissection burden of vascular lesions.
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Rey-Dios R, Hattab EM, Cohen-Gadol AA. Use of intraoperative fluorescein sodium fluorescence to improve the accuracy of tissue diagnosis during stereotactic needle biopsy of high-grade gliomas. Acta Neurochir (Wien) 2014; 156:1071-5; discussion 1075. [PMID: 24770732 DOI: 10.1007/s00701-014-2097-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stereotactic needle biopsy is valuable for tissue diagnosis of suspected high-grade gliomas, but limited by a sampling error that can lead to inappropriate grading of the tumor or failure to provide diagnosis. Increasing the number of biopsy attempts can increase morbidity. The authors designed a protocol to increase safety and efficiency of the procedure. METHODS Six consecutive patients with suspected high-grade gliomas who were not candidates for cytoreductive surgery underwent fluorescein-guided stereotactic needle biopsy. All received an injection of 3 mg/kg fluorescein sodium during anesthesia induction. Samples were obtained and observed under a microscope-integrated fluorescent module. If the initial specimens were fluorescent, the procedure was complete if the pathologist confirmed diagnostic tissue. Additional specimens were obtained only at the pathologist's request. An independent neuropathologist later analyzed and graded samples for diagnostic value, tumor, and necrosis. This information was correlated to the degree of intraoperative fluorescent signal in biopsy samples. RESULTS During six biopsy procedures, 26 specimens were obtained: 15 (58 %) fluorescent and 11 (42 %) nonfluorescent. All fluorescent specimens contained diagnostic tissue appropriate for tumor grading. Of 11 nonfluorescent specimens, four (36 %) did not contain tumor, three (27 %) contained minor hypercellularity or gliosis, and four (36 %) contained tumor with a high proportion of necrosis. All six tumors were diagnosed as glioblastoma multiforme. The sensitivity and specificity for fluorescein fluorescence was 79 % and 100 %, respectively. CONCLUSIONS Fluorescein fluorescence may improve diagnostic accuracy and expedite stereotactic biopsy procedures.
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Affiliation(s)
- Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA,
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Manoj N, Arivazhagan A, Bhat DI, Arvinda HR, Mahadevan A, Santosh V, Devi BI, Sampath S, Chandramouli BA. Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review. J Neurosci Rural Pract 2014; 5:32-9. [PMID: 24741247 PMCID: PMC3985354 DOI: 10.4103/0976-3147.127869] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children. MATERIALS AND METHODS The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed. RESULTS Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series. CONCLUSION Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
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Affiliation(s)
- N Manoj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - D I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - V Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - S Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B A Chandramouli
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Hawasli AH, Buckley RT, Gao F, Limbrick DD, Smyth MD, Leonard JR, Santiago P, Stewart TJ, Park TS, Grubb RL, Dowling JL, Leuthardt EC, Rich KM, Zipfel GJ, Dacey RG, Chicoine MR. Biopsy of the superficial cortex: predictors of effectiveness and outcomes. Neurosurgery 2014; 73:224-31; discussion 231-2; quiz 232. [PMID: 23632761 DOI: 10.1227/01.neu.0000430310.63702.3e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brain biopsies of superficial cortex are performed for diagnosis of neurological diseases, but preoperative predictors of successful diagnosis and risks are lacking. OBJECTIVE We evaluated effectiveness and outcomes of superficial cortical biopsies and determined preoperative predictors of diagnosis, outcomes, morbidities, and mortality. METHODS A single-institution retrospective analysis of 170 patients who underwent open brain biopsies of superficial cortex was performed. Clinical predictors of effectiveness and outcomes were determined using univariate/multivariate analyses and a system for risk-benefit stratification was created and tested. RESULTS Brain biopsies led to successful diagnosis in 122 of 170 (71.8%) and affected management in 97 of 170 (57.1%) cases. Factors increasing the odds of diagnostic pathology included age older than 45 years (odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.34-5.27, P < .01), previous cancer diagnosis (OR: 3.64, 95% CI: 1.69-7.85, P < .001), focal (OR: 3.90, 95% CI: 1.91-8.00, P < .001) and enhancing (OR: 5.03, 95% CI: 2.41-10.52, P < .001) lesions on magnetic resonance imaging, biopsy of specific lesions on magnetic resonance imaging (OR: 9.34, 95% CI: 4.29-20.33, P < .001), and use of intraoperative navigation (OR: 6.59, 95% CI: 3.04-14.28, P < .001). Brain biopsies led to symptomatic intracranial hemorrhage, seizures, other significant morbidities, and perioperative mortality in 12.4%, 16.2%, 37.1%, and 8% of cases, respectively. Risk of postoperative intracranial hemorrhage was increased by a history of aspirin use (OR: 2.51, 95% CI: 1.23-5.28, P < .05) and age older than 60 years (OR: 2.66, 95% CI: 1.36-5.18, P < .01). CONCLUSION Effectiveness and risk of morbidity/mortality can be estimated preoperatively for patients undergoing open brain biopsies of the superficial cortex. Older age and specific imaging characteristics increase the odds of diagnostic biopsy. Conversely, older age and aspirin use increases the risk of postoperative complications.
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Affiliation(s)
- Ammar H Hawasli
- Departments of Neurosurgery and Biostatistics, Washington University School of Medicine, St. Louis, Missouri
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Feletti A, Marton E, Fiorindi A, Longatti P. Neuroendoscopic aspiration of tumors in the posterior third ventricle and aqueduct lumen: a technical update. Acta Neurochir (Wien) 2013; 155:1467-73. [PMID: 23709004 DOI: 10.1007/s00701-013-1763-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/08/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Small soft ventricular tumors are good candidates for complete removal by a purely endoscopic technique. This approach is particularly interesting for lesions located in the posterior third ventricle and aqueductal lumen. METHODS We present our method of endoscospic aspiration through direct contact between the tumor and the working channel of a flexible scope. RESULTS Aspiration without the intermediate use of cannulas is safe and has proved to be effective in the apparently total or partial removal of three soft tumors of different pathologies located in the third ventricle or aqueductal lumen. In one case, a second neuroendoscopy a few months later to repeat endoscopic third ventriculostomy (ETV) offered a unique opportunity to observe the absence of the tumor and the restored anatomy. CONCLUSIONS Neuroendoscopy provides a safe, effective way to radically resect small soft tumors in these troublesome locations and can be a valuable alternative to microsurgery.
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Affiliation(s)
- Alberto Feletti
- Department of Neurosurgery, Treviso Hospital, University of Padova, Piazzale Ospedale, 1, 31100 Treviso, Italy.
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Woodworth G, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD. Accuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen. Neurol Res 2013; 27:358-62. [PMID: 15949232 DOI: 10.1179/016164105x40057] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Tissue heterogeneity and rapid tumor progression may decrease the accuracy a prognostic value of stereotactic brain biopsy in the diagnosis of gliomas. Correct tumor grading is therefore dependent on the accuracy of biopsy needle placement. There has been a dramatic increase in the utilization of frameless image-guided stereotactic brain biopsy; however, its accuracy in the diagnosis of glioma remains unstudied. METHODS The diagnoses of 21 astrocytic brain tumors were derived using image-guided stereotactic biopsy (12 frame-based, nine frameless) and followed by open resection of the lesion 1.5 (0.5-4) months later. The histologic diagnoses yielded by the biopsy were compared with subsequent histologic diagnosis from open tumor resection. RESULTS Histology of 21 stereotactic biopsies accurately represented the greater lesion at open resection a median of 45 days later in 16 (76%) cases and correctly guided therapy in 19 (91%) cases. Biopsy accuracy of frameless versus frame-based stereotaxis was similar (89 versus 66%, p=0.21). In three (14%) cases, biopsy specimens were adequate to diagnose glioma; however, histology was insufficient for definitive tumor grading. Anaplastic oligodendroglioma (ODG) was under-graded as low-grade ODG in one (5%) case. Biopsy of new onset glioblastoma multiforme (GBM) yielded necrosis/gliosis and was termed non-diagnostic in one patient. Tumors <50 cm(3) were 8-fold less likely to accurately represent the grade of the entire lesion at resection compared with lesions <50 cm(3) (OR, 8.8; 95% CI, 0.9-100, p=0.05). DISCUSSION Both frameless and frame-based MRI-guided stereotactic brain biopsy are safe and accurately represent the larger glioma mass sufficiently to guide subsequent therapy. Large tumor volume had a higher incidence of non-concordance. Increasing the number of specimens taken through the long dimension of large tumors may improve diagnostic accuracy.
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Affiliation(s)
- Graeme Woodworth
- Departments of Neurosurgery and Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Reithmeier T, Lopez WO, Doostkam S, Machein MR, Pinsker MO, Trippel M, Nikkhah G. Intraindividual comparison of histopathological diagnosis obtained by stereotactic serial biopsy to open surgical resection specimen in patients with intracranial tumours. Clin Neurol Neurosurg 2013; 115:1955-60. [PMID: 23769864 DOI: 10.1016/j.clineuro.2013.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/16/2013] [Accepted: 05/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are concerns in the literature about the accuracy of histopathological diagnosis obtained by stereotactic biopsy in patients with brain tumours. The aim of this study was to analyse intraindividually the histopathological accuracy of stereotactic biopsies of intracerebral lesions in comparison to open surgical resection. MATERIALS AND METHODS Between 2007 and 2011 a total of 635 patients underwent stereotactic serial biopsy in our department. Among these patients we identified 51 patients, who underwent magnetic resonance (MR) based stereotactic biopsy and subsequent open resection within 30 days. Mortality and morbidity data as well as final histopathological diagnoses of both procedures were compared with regard to tumour grade and tumour cell type. Patients with discrepancies between the histological diagnosis obtained by biopsy and open resection were classified into three subgroups (same cell type but different grading; same grading but different cell type and different grading as well as different cell type). RESULTS The mean number of tissue samples taken by stereotactic serial biopsy from each patient was 12 (range 7-21). Minor morbidity was 6% and major morbidity was 14% after open surgery compared to no morbidity after stereotactic biopsy. Mortality was 2% after stereotactic biopsy (one patient died after stereotactic biopsy as a result of a fatal bleeding) compared to 0% in the resection group. Silent bleeding rate without any clinical symptoms was 8% in the biopsy group. A complete correlation of histopathological findings between the biopsy group and the resection group was achieved in 76% and was increased to 90% by analyzing clinical and neuroradiological information. In patients with recurrence the correlation was higher (94%) than for patients with primary brain lesions (67%). The discrepancies between the open resection group and biopsy group were analysed. CONCLUSION Stereotactic MR guided serial biopsy is a minimal invasive procedure with low morbidity and high diagnostic accuracy for diagnosis and grading of brain tumours. Diagnostic accuracy of stereotactic biopsy can be enhanced further by careful interpretation of neuroradiological and clinical information.
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Affiliation(s)
- T Reithmeier
- Division of Stereotactic and Functional Neurosurgery, Department of General Neurosurgery, University Freiburg - Medical Center, Breisacher Straße 64, 79106 Freiburg, Germany.
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