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Kreatsoulas DC, Vignolles-Jeong J, Ambreen Y, Damante M, Akhter A, Lonser RR, Elder JB. Surgical Characteristics of Intracranial Biopsy Using a Frameless Stereotactic Robotic Platform: A Single-Center Experience. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00966. [PMID: 37976149 DOI: 10.1227/ons.0000000000000999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cranial robotics are a burgeoning field of neurosurgery. To date, all cranial robotic systems described have been computerized, arm-based instruments that take up significant space in the operating room. The Medtronic Stealth Autoguide robot has a smaller operating room footprint and offers multiaxial, frame-based surgical targeting. The authors set out to define the surgical characteristics of a novel robotic platform for brain biopsy in a large patient cohort. METHODS Patients who underwent stereotactic biopsy using the Stealth Autoguide cranial robotic platform from July 2020 to March 2023 were included in this study. Clinical, surgical, and histological data were collected and analyzed. RESULTS Ninety-six consecutive patients (50 female, 46 male) were included. The mean age at biopsy was 53.7 ± 18.0 years. The mean target depth was 68.2 ± 15.3 mm. The biopsy diagnostic tissue acquisition rate was 100%. The mean time from incision to biopsy tissue acquisition was 15.4 ± 9.9 minutes. Target lesions were located throughout the brain: in the frontal lobe (n = 32, 33.3%), parietal lobe (n = 21, 21.9%), temporal lobe (n = 22, 22.9%), deep brain nuclei/thalamus (n = 13, 13.5%), cerebellum (n = 7, 7.3%), and brainstem (n = 1, 1.0%). Most cases were gliomas (n = 75, 78.2%). Patients were discharged home on postoperative day 0 or 1 in 62.5% of cases. A total of 7 patients developed postoperative complications (7.2%). CONCLUSION This cranial robotic platform can be used for efficient, safe, and accurate cranial biopsies that allow for reliable diagnosis of intracranial pathology in a minimally invasive setting.
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Affiliation(s)
- Daniel C Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Joshua Vignolles-Jeong
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Yamenah Ambreen
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Asad Akhter
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
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2
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Wårdell K, Klint E, Milos P, Richter J. One-Insertion Stereotactic Brain Biopsy Using In Vivo Optical Guidance-A Case Study. Oper Neurosurg (Hagerstown) 2023; 25:176-182. [PMID: 37083519 PMCID: PMC10313274 DOI: 10.1227/ons.0000000000000722] [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: 11/23/2022] [Accepted: 02/21/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Stereotactic neurosurgical brain biopsies are afflicted with risks of inconclusive results and hemorrhage. Such complications can necessitate repeated trajectories and prolong surgical time. OBJECTIVE To develop and introduce a 1-insertion stereotactic biopsy kit with direct intraoperative optical feedback and to evaluate its applicability in 3 clinical cases. METHODS An in-house forward-looking probe with optical fibers was designed to fit the outer cannula of a side-cutting biopsy kit. A small aperture was made at the tip of the outer cannula and the edges aligned with the optical probe inside. Stereotactic biopsies were performed using the Leksell Stereotactic System. Optical signals were measured in millimeter steps along the preplanned trajectory during the insertion. At the region with the highest 5-aminolevulinic acid (5-ALA)-induced fluorescence, the probe was replaced by the inner cannula, and tissue samples were taken. The waiting time for pathology diagnosis was noted. RESULTS Measurements took 5 to 10 minutes, and the surgeon received direct visual feedback of intraoperative 5-ALA fluorescence, microcirculation, and tissue gray-whiteness. The 5-ALA fluorescence corroborated with the pathological findings which had waiting times of 45, 50, and 75 minutes. Because only 1 trajectory was required and the patient could be prepared for the end of surgery immediately after sampling, this shortened the total surgical time. CONCLUSION A 1-insertion stereotactic biopsy procedure with real-time optical guidance has been presented and successfully evaluated in 3 clinical cases. The method can be modified for frameless navigation and thus has great potential to improve safety and diagnostic yield for both frameless and frame-based neurosurgical biopsy procedures.
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Affiliation(s)
- Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Elisabeth Klint
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Peter Milos
- Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Richter
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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3
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Lim DH, Kim SY, Na YC, Cho JM. Navigation Guided Biopsy Is as Effective as Frame-Based Stereotactic Biopsy. J Pers Med 2023; 13:jpm13050708. [PMID: 37240878 DOI: 10.3390/jpm13050708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Stereotactic biopsy is a standard procedure for brain biopsy. However, with advances in technology, navigation-guided brain biopsy has become a well-established alternative. Previous studies have shown that frameless stereotactic brain biopsy is as effective and safe as frame-based stereotactic brain biopsy is. In this study, the authors evaluate the diagnostic yield and complication rate of frameless intracranial biopsy. MATERIALS AND METHODS We reviewed data from biopsy performed patients between March 2014 and April 2022. We retrospectively reviewed medical records, including imaging studies. Various intracerebral lesions were biopsied. Diagnostic yield and post-operative complications were compared with those of frame-based stereotactic biopsy. RESULTS Forty-two frameless navigation-guided biopsy were performed, and the most common pathology was primary central nervous system lymphoma (35.7%), followed by glioblastoma (33.3%), and anaplastic astrocytomas (16.7%), respectively. The diagnostic yield was 100%. Post-operative intracerebral hematoma occurred in 2.4% of cases, but it was not symptomatic. Thirty patients underwent frame-based stereotactic biopsy, and the diagnostic yield was 96.7%. There was no difference in diagnostic rates between two methods (Fisher's exact test, p = 0.916). CONCLUSIONS Frameless navigation-guided biopsy is as effective as frame-based stereotactic biopsy is, without causing further complications. We consider that frame-based stereotactic biopsy is no longer needed if frameless navigation-guided biopsy is used. A further study will be needed to generalize our results.
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Affiliation(s)
- Dae Hyun Lim
- Department of Neurosurgery, International St Mary's Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - So Yeon Kim
- Department of Neurosurgery, International St Mary's Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - Young Cheol Na
- Department of Neurosurgery, International St Mary's Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
| | - Jin Mo Cho
- Department of Neurosurgery, International St Mary's Hospital, Catholic Kwandong University, Incheon 22711, Republic of Korea
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4
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A Multi-Disciplinary Approach to Diagnosis and Treatment of Radionecrosis in Malignant Gliomas and Cerebral Metastases. Cancers (Basel) 2022; 14:cancers14246264. [PMID: 36551750 PMCID: PMC9777318 DOI: 10.3390/cancers14246264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation necrosis represents a potentially devastating complication after radiation therapy in brain tumors. The establishment of the diagnosis and especially the differentiation from progression and pseudoprogression with its therapeutic implications requires interdisciplinary consent and monitoring. Herein, we want to provide an overview of the diagnostic modalities, therapeutic possibilities and an outlook on future developments to tackle this challenging topic. The aim of this report is to provide an overview of the current morphological, functional, metabolic and evolving imaging tools described in the literature in order to (I) identify the best criteria to distinguish radionecrosis from tumor recurrence after the radio-oncological treatment of malignant gliomas and cerebral metastases, (II) analyze the therapeutic possibilities and (III) give an outlook on future developments to tackle this challenging topic. Additionally, we provide the experience of a tertiary tumor center with this important issue in neuro-oncology and provide an institutional pathway dealing with this problem.
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5
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Feasibility of freehand CT and 3-T MR guided brain aspiration biopsies with 18/20-gauge coaxial needles. Jpn J Radiol 2022; 40:740-748. [PMID: 35233651 DOI: 10.1007/s11604-022-01257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE An accurate histopathological examination with minimal neuronal damage is essential for optimizing treatment strategies of central nervous system lesions. We investigated the feasibility and safety of CT and 3-tesla (3 T) MR-guided freehand brain aspiration biopsies with 18/20-gauge coaxial needles in performing a single imaging unit. MATERIALS AND METHODS We reviewed CT and 3 T-MR guided freehand aspiration biopsies with 18/20-gauge coaxial needles of 33 patients (11-female and 22-male, mean and median ages: 53 years, min-max 21-79 years) in our tertiary hospital within an 8-year-period were included in this retrospective study. Lesion sizes, diagnostic yield, morbidity, and mortality rates of these biopsies without a scalp incision, surgical burr-hole, or stereotactic-instrumentation/neuro-navigation guidance were assessed. All biopsies were performed with local anesthesia and sedation within a single imaging unit of our radiology department. All free-hand biopsies were done as in-patient procedures and the patients were closely observed after the biopsies. RESULTS The mean diameter of the lesions was 27 mm (median 25; range 15-46 mm). The diagnostic yield of all free-hand brain biopsies was 88% [one inconclusive result (90%) for 3 T-MR; three inconclusive results (87%) for CT]. There was no major hemorrhage or hematoma, no clinical deterioration, or no infection in our patients on early- and late-phase examinations. Postprocedural minor hemorrhage with a ≤ 2 cm diameter was observed in two patients. The morbidity rate of the study population is 6%. There was no procedure-related infection or mortality in the post-procedural 3 weeks. CONCLUSIONS Freehand CT or 3 T-MR guided aspiration biopsy was a safe and feasible method for pathological diagnosis of intracranial lesions. Biopsy workflow was simplified with this technique. It could be considered a valuable alternative for stereotaxic biopsies, especially for centers that do not have stereotaxic equipment or experience.
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6
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Chavaz L, Davidovic A, Meling TR, Momjian S, Schaller K, Bijlenga P, Haemmerli J. Evaluation of the precision of navigation-assisted endoscopy according to the navigation tool setup and the type of endoscopes. Acta Neurochir (Wien) 2022; 164:2375-2383. [PMID: 35764694 PMCID: PMC9427865 DOI: 10.1007/s00701-022-05276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECT Preoperative image-based neuronavigation-assisted endoscopy during intracranial procedures is gaining great interest. This study aimed to analyze the precision of navigation-assisted endoscopy according to the navigation setup, the type of optic and its working angulation. METHODS A custom-made box with four screws was referenced. The navigation-assisted endoscope was aligned on the screws (targets). The precision on the navigation screen was defined as the virtual distance-to-target between the tip of the endoscope and the center of the screws. Three modifiers were assessed: (1) the distance D between the box and the reference array (CLOSE 13 cm - MIDDLE 30 cm - FAR 53 cm), (2) the distance between the tip of the endoscope and the navigation array on the endoscope (close 5 cm - middle 10 cm - far 20 cm), (3) the working angulation of the endoscope (0°-endoscope and 30°-endoscope angled at 90° and 45° with the box). RESULTS The median precision was 1.3 mm (Q1: 1.1; Q3: 1.7) with the best setting CLOSE/close. The best setting in surgical condition (CLOSE/far) showed a distance-to-target of 2.3 mm (Q1: 1.9; Q3: 2.5). The distance D was correlated to the precision (Spearman rho = 0.82), but not the distance d (Spearman rho = 0.04). The type of optic and its angulation with the box were also correlated to the precision (Spearman rho = - 0.37). The best setting was the use of a 30°-endoscope angled at 45° (1.4 mm (Q1: 1.0; Q3: 1.9)). CONCLUSION Navigated-assisted endoscopy is feasible and offers a good precision. The navigation setup should be optimized, reducing the risk of inadvertent perifocal damage.
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Affiliation(s)
- Lara Chavaz
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Torstein R Meling
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Karl Schaller
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Philippe Bijlenga
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Julien Haemmerli
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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Kwan C, Kang MS, Nuara SG, Gourdon JC, Bédard D, Tardif CL, Hopewell R, Ross K, Bdair H, Hamadjida A, Massarweh G, Soucy JP, Luo W, Del Cid Pellitero E, Shlaifer I, Durcan TM, Fon EA, Rosa-Neto P, Frey S, Huot P. Co-registration of Imaging Modalities (MRI, CT and PET) to Perform Frameless Stereotaxic Robotic Injections in the Common Marmoset. Neuroscience 2021; 480:143-154. [PMID: 34774970 DOI: 10.1016/j.neuroscience.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
The common marmoset has emerged as a popular model in neuroscience research, in part due to its reproductive efficiency, genetic and neuroanatomical similarities to humans and the successful generation of transgenic lines. Stereotaxic procedures in marmosets are guided by 2D stereotaxic atlases, which are constructed with a limited number of animals and fail to account for inter-individual variability in skull and brain size. Here, we developed a frameless imaging-guided stereotaxic system that improves upon traditional approaches by using subject-specific registration of computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) data to identify a surgical target, namely the putamen, in two marmosets. The skull surface was laser-scanned to create a point cloud that was registered to the 3D reconstruction of the skull from CT. Reconstruction of the skull, as well as of the brain from MR images, was crucial for surgical planning. Localisation and injection into the putamen was done using a 6-axis robotic arm controlled by a surgical navigation software (Brainsight™). Integration of subject-specific registration and frameless stereotaxic navigation allowed target localisation specific to each animal. Injection of alpha-synuclein fibrils into the putamen triggered progressive neurodegeneration of the nigro-striatal system, a key feature of Parkinson's disease. Four months post-surgery, a PET scan found evidence of nigro-striatal denervation, supporting accurate targeting of the putamen during co-registration and subsequent surgery. Our results suggest that this approach, coupled with frameless stereotaxic neuronavigation, is accurate in localising surgical targets and can be used to assess endpoints for longitudinal studies.
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Affiliation(s)
- Cynthia Kwan
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Min Su Kang
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada
| | - Stephen G Nuara
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Jim C Gourdon
- Comparative Medicine & Animal Resource Centre, McGill University, Montreal, QC, Canada
| | - Dominique Bédard
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Christine L Tardif
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Department of Biomedical Engineering, McGill University, Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Robert Hopewell
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Karen Ross
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Hussein Bdair
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Adjia Hamadjida
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Gassan Massarweh
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Jean-Paul Soucy
- McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | - Wen Luo
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; The Neuro's Early Drug Discovery Unit, McGill University, Montreal, QC, Canada
| | - Esther Del Cid Pellitero
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Movement Disorder Clinic, Division of Neurology, Department of Neuroscience, McGill University Health Centre, Montreal, QC, Canada
| | - Irina Shlaifer
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; The Neuro's Early Drug Discovery Unit, McGill University, Montreal, QC, Canada
| | - Thomas M Durcan
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; The Neuro's Early Drug Discovery Unit, McGill University, Montreal, QC, Canada
| | - Edward A Fon
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Movement Disorder Clinic, Division of Neurology, Department of Neuroscience, McGill University Health Centre, Montreal, QC, Canada
| | - Pedro Rosa-Neto
- McGill University Research Centre for Studies in Aging, Douglas Research Centre, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; McConnell Brain Imaging Centre, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada
| | | | - Philippe Huot
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Movement Disorder Clinic, Division of Neurology, Department of Neuroscience, McGill University Health Centre, Montreal, QC, Canada.
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8
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Carnevale JA, Imber BS, Winston GM, Goldberg JL, Ballangrud A, Brennan CW, Beal K, Tabar V, Moss NS. Risk of tract recurrence with stereotactic biopsy of brain metastases: an 18-year cancer center experience. J Neurosurg 2021; 136:1045-1051. [PMID: 34507279 DOI: 10.3171/2021.3.jns204347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic biopsy is increasingly performed on brain metastases (BrMs) as improving cancer outcomes drive aggressive multimodality treatment, including laser interstitial thermal therapy (LITT). However, the tract recurrence (TR) risk is poorly defined in an era defined by focused-irradiation paradigms. As such, the authors aimed to define indications and adjuvant therapies for this procedure and evaluate the BrM-biopsy TR rate. METHODS In a single-center retrospective review, the authors identified stereotactic BrM biopsies performed from 2002 to 2020. Surgical indications, radiographic characteristics, stereotactic planning, dosimetry, pre- and postoperative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM (Response Assessment in Neuro-Oncology Brain Metastases) criteria. RESULTS In total, 499 patients underwent stereotactic intracranial biopsy for any diagnosis, of whom 25 patients (5.0%) underwent biopsy for pathologically confirmed viable BrM, a proportion that increased over the time period studied. Twelve of the 25 BrM patients had ≥ 3 months of radiographic follow-up, of whom 6 patients (50%) developed new metastatic growth along the tract at a median of 5.0 months post-biopsy (range 2.3-17.1 months). All of the TR cases had undergone pre- or early post-biopsy stereotactic radiosurgery (SRS), and 3 had also undergone LITT at the time of initial biopsy. TRs were treated with resection, reirradiation, or observation/systemic therapy. CONCLUSIONS In this study the authors identified a nontrivial, higher than previously described rate of BrM-biopsy tract recurrence, which often required additional surgery or radiation and justified close radiographic surveillance. As BrMs are commonly treated with SRS limited to enhancing tumor margins, consideration should be made, in cases lacking CNS-active systemic treatments, to include biopsy tracts in adjuvant radiation plans where feasible.
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Affiliation(s)
- Joseph A Carnevale
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | | | - Graham M Winston
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | - Jacob L Goldberg
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center.,2Department of Neurological Surgery, NewYork-Presbyterian Hospital, Weill Cornell Medical Center; and
| | - Ase Ballangrud
- 4Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cameron W Brennan
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
| | | | - Viviane Tabar
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
| | - Nelson S Moss
- 1Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center
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9
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Richter J, Haj-Hosseini N, Milos P, Hallbeck M, Wårdell K. Optical Brain Biopsy with a Fluorescence and Vessel Tracing Probe. Oper Neurosurg (Hagerstown) 2021; 21:217-224. [PMID: 34192763 PMCID: PMC8440062 DOI: 10.1093/ons/opab216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate stereotactic biopsies of brain tumors are imperative for diagnosis and tailoring of the therapy. Repetitive needle insertions enhance risks of brain lesioning, hemorrhage, and complications due to prolonged procedure. OBJECTIVE To investigate clinical benefits of a combined 5-aminolaevulinic acid (5-ALA) fluorescence and laser Doppler flowmetry system for the detection of malignant brain tumor and blood vessels in stereotactic biopsies. METHODS Planning of targets and trajectories was followed by optical measurements in 20 patients, using the Leksell Stereotactic System and a manual insertion device. Fluorescence spectra, microvascular blood flow, and tissue grayness were recorded each millimeter along the paths. Biopsies were taken at preplanned positions. The diagnoses were compared with the fluorescence signals. The recordings were plotted against measurement positions and compared. Sites indicating a risk of hemorrhage were counted as well as the time for the procedures. RESULTS Signals were recorded along 28 trajectories, and 78 biopsies were collected. The final diagnosis showed 17 glioblastomas, 2 lymphomas, and 1 astrocytoma grade III. Fluorescence was seen along 23 of the paths with 4 having the peak of 5-ALA fluorescence 3 mm or more from the precalculated target. There was increased microcirculation in 40 of 905 measured positions. The measurement time for each trajectory was 5 to 10 min. CONCLUSION The probe provided direct feedback of increased blood flow along the trajectory and of malignant tissue in the vicinity of the target. The method can increase the precision and the safety of the biopsy procedure and reduce time.
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Affiliation(s)
- Johan Richter
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.,Department of Neurosurgery, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Peter Milos
- Department of Neurosurgery, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Hallbeck
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Pathology, Linköping University, Linköping, Sweden
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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10
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Fujii Y, Ogiwara T, Goto T, Kanaya K, Hara Y, Hanaoka Y, Hardian RF, Hongo K, Horiuchi T. Microscopic Navigation-Guided Fence Post Technique for Maximal Tumor Resection During Glioma Surgery. World Neurosurg 2021; 151:e355-e362. [PMID: 33887499 DOI: 10.1016/j.wneu.2021.04.044] [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: 03/14/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The fence post technique, which involves insertion of catheters as fence posts around a tumor, has been widely used to demarcate the tumor border for maximal resection of intraparenchymal tumors, such as gliomas. However, a standard procedure for fence post insertion has not been established, and there are some limitations. To overcome this problem, a simple microscopic navigation-guided fence post technique was developed. The feasibility and efficacy of this novel technique during glioma surgery were assessed. METHODS The microscopic navigation-guided fence post technique was used in 46 glioma surgeries performed in 42 patients. Intraoperatively, the preplanned trajectory was overlaid on the microscopic surgical field, and the microscope angle was changed until the entry and target points of the trajectory overlapped. A fence post catheter was inserted as planned under microscopic view, and the tumor was resected with fence post guidance. Preoperative tumor characteristics and surgical outcomes were evaluated. RESULTS Mean age of patients was 50 years (range, 16-78 years), and 19 (45%) of 42 patients were women. Maximal safe resection was successfully achieved in 45 surgeries (97.8%), which was planned preoperatively with identification of the tumor border with fence posts without adverse effects of brain shift. No surgical complications attributable to fence post insertion occurred. CONCLUSIONS Clinical experience indicated that the microscopic navigation-guided fence post technique, in which fence posts can be placed without requiring the surgeon to take their eyes off the microscope, is safe and useful in glioma surgery.
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Affiliation(s)
- Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Saint Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Saß B, Pojskic M, Bopp M, Nimsky C, Carl B. Comparing Fiducial-Based and Intraoperative Computed Tomography-Based Registration for Frameless Stereotactic Brain Biopsy. Stereotact Funct Neurosurg 2020; 99:79-89. [PMID: 32992321 DOI: 10.1159/000510007] [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: 04/05/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to compare fiducial-based and intraoperative computed tomography (iCT)-based registration for frameless stereotactic brain biopsy. METHODS Of 50 frameless stereotactic biopsies with the VarioGuide, 30 cases were registered as iCT based and 20 as fiducial based. Statistical analysis of the target registration error (TRE), dose length product, effective radiation dose (ED), operation time, and diagnostic yield was performed. RESULTS The mean TRE was significantly lower using iCT-based registration (mean ± SD: 0.70 ± 0.32 vs. 2.43 ± 0.73 mm, p < 0.0001). The ED was significantly lower when using iCT-based registration compared to standard navigational CT (mean ± SD: 0.10 ± 0.13 vs. 2.23 ± 0.34 mSv, p < 0.0001). Post-biopsy iCT was associated with a significant lower (p < 0.0001) ED compared to standard CT (mean ± SD: 1.04 ± 0.18 vs. 1.65 ± 0.26 mSv). The mean surgical time was shorter using iCT-based registration, although the mean total operating room (OR) time did not differ significantly. The diagnostic yield was 96.7% (iCT group) versus 95% (fiducial group). Post-biopsy imaging revealed severe bleeding in 3.3% (iCT group) versus 5% (fiducial group). CONCLUSION iCT-based registration for frameless stereotactic biopsies increases the accuracy significantly without negative effects on the surgical time or the overall time in the OR. Appropriate scan protocols in iCT registration contribute to a significant reduction of the radiation exposure. The high accuracy of the iCT makes it the more favorable registration strategy when taking biopsies of small tumors or lesions near eloquent brain areas.
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Affiliation(s)
- Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany,
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
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Pasternak KA, Schwake M, Warneke N, Masthoff M, Zawy Alsofy S, Suero Molina E, Stummer W, Schipmann S. Evaluation of 311 contemporary cases of stereotactic biopsies in patients with neoplastic and non-neoplastic lesions-diagnostic yield and management of non-diagnostic cases. Neurosurg Rev 2020; 44:2597-2609. [PMID: 32951126 PMCID: PMC8490258 DOI: 10.1007/s10143-020-01394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022]
Abstract
Stereotactic biopsies are an established tool for obtaining diagnosis of unclear brain lesions. However, non-diagnostic biopsies still occur. We aimed to analyze the contemporary diagnostic yield of stereotactic biopsies, predictors for non-diagnostic biopsies, outcome, and follow-up strategy after non-diagnostic biopsy. We conducted a single-center retrospective study of 311 adult patients undergoing stereotactic biopsies due to a newly diagnosed lesion at our department between 2012 and 2018. Patient data regarding comorbidities, presenting symptoms, imaging features, and non-invasive diagnostic procedures were obtained. The overall diagnostic yield was 86.2% and differed significantly between the various suspected diagnosis groups and was the highest when suspecting primary brain tumor compared with non-neoplastic lesions (91.2% vs. 73.3%, p > 0.001). Predicators for non-diagnostic biopsies were small lesion size, lack of contrast-enhancement, presence of sepsis, or underlying hemato-oncological disease. In case of non-diagnostic biopsy, a re-biopsy was performed in 12 cases, revealing a final diagnosis in 75%. In 16 cases, empiric therapy was started based on the suspected underlying disease. Close follow-up was performed in the remaining 15 cases. We showed that stereotactic biopsy is a safe procedure with reasonable diagnostic yield even for non-neoplastic lesions, when non-invasive diagnostic was inconclusive. In addition, we developed treatment recommendations for cases of non-diagnostic biopsies.
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Affiliation(s)
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Nils Warneke
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Max Masthoff
- Institute of Clinical Radiology, University Hospital Muenster, Münster, Germany
| | - Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westphalian Wilhelms-University Münster, Hamm, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
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13
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Cooper ME, Zhong J, Kim S, Hoch MJ, Weinberg BD. Malignant seeding of the biopsy needle tract outside of the radiation therapy field in a patient with Glioblastoma. BJR Case Rep 2020; 6:20190070. [PMID: 33029363 PMCID: PMC7527002 DOI: 10.1259/bjrcr.20190070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022] Open
Abstract
A 44-year-old male initially presented with a right thalamic brain tumor that was confirmed with stereotactic biopsy to be glioblastoma (GBM). The patient was treated with radiotherapy and temozolomide for 6 weeks. At 1 month after completing chemoradiation therapy, the patient underwent follow-up imaging that revealed the primary lesion had mildly responded to chemoradiation, but a secondary lesion had developed along the biopsy needle tract. This secondary lesion was outside of the field of radiation therapy for the primary tumor and concluded to be intracranial spread of GBM along the biopsy tract. The patient’s final imaging 4 months after initial diagnosis revealed the primary and secondary lesions had enlarged. Subsequently, the patient clinically deteriorated and died 7 months after initial diagnosis.
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Affiliation(s)
- Maxwell E. Cooper
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jim Zhong
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Sera Kim
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Michael J. Hoch
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Brent D. Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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14
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Taweesomboonyat C, Tunthanathip T, Sae-Heng S, Oearsakul T. Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy. J Neurosci Rural Pract 2019; 10:78-84. [PMID: 30765975 PMCID: PMC6337997 DOI: 10.4103/jnrp.jnrp_166_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications. Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P = 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01). Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication.
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Affiliation(s)
- Chin Taweesomboonyat
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Thara Tunthanathip
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Sakchai Sae-Heng
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Thakul Oearsakul
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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15
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Frameless stereotactic neuronavigated biopsy: A retrospective study of morbidity, diagnostic yield, and the potential of fluorescence. Clin Neurol Neurosurg 2019; 181:28-32. [DOI: 10.1016/j.clineuro.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022]
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16
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Xie Q, Wu J, Du Z, Di N, Yan R, Pang H, Jin T, Zhang H, Wu Y, Zhang Y, Yao Z, Feng X. DCE-MRI in Human Gliomas: A Surrogate for Assessment of Invasive Hypoxia Marker HIF-1Α Based on MRI-Neuronavigation Stereotactic Biopsies. Acad Radiol 2019; 26:179-187. [PMID: 29754996 DOI: 10.1016/j.acra.2018.04.015] [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: 02/04/2018] [Revised: 03/31/2018] [Accepted: 04/12/2018] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to correlate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters with data from a specific marker of hypoxia, hypoxia-inducible factor 1α (HIF-1α), in human gliomas on a point-to-point basis by using coregistered magnetic resonance imaging and frameless stereotactic biopsies. MATERIALS AND METHODS Thirty-four patients with treatment-naive gliomas underwent DCE, axial T1-weighted, T2-weighted, T2-weighted fluid acquisition of inversion recovery, and three-dimensional T1-weighted brain volume with gadolinium contrast enhancement sequences on a 3.0-T magnetic resonance scanner before stereotactic surgery. Quantitative perfusion indices such as endothelial transfer constant, fractional extravascular extracellular space volume, fractional plasma volume, and reflux rate were measured at corresponding stereotactic biopsy sites. Each sample was considered an independent measurement, and its histology grade was diagnosed. HIF-1α expression was quantified from the point-to-point biopsy tissues. Analyses of receiver operating characteristic curves were done for HIF-1α to discriminate different grades of glioma. To look for correlations between immunohistochemical parameters and DCE indices, Spearman's correlation coefficient was used. RESULTS Seventy biopsy samples from 34 subjects were included in the analysis. Mean immunoreactivity scores of HIF-1α were 2.75 ± 1.11 for grade II (n = 24), 6.20 ± 2.33 for grade III (n = 20), and 10.46 ± 2.42 for grade IV (n = 26). HIF-1α showed very good-to-excellent accuracy in discriminating grade II from III, III from IV, and II from IV (area under the curve = 0.838, 0.862, and 0.994, respectively). Endothelial transfer constant and fractional extravascular extracellular space volume showed a significantly positive correlation with HIF-1α expression (r = 0.686, P < .001; r = 0.549, P < .001, respectively). CONCLUSION Our study demonstrated HIF-1α to be a significant predictor of different grades of gliomas with high sensitivity and specificity. DCE-MRI is a useful, noninvasive imaging tool for quantitative evaluation of HIF-1α, and its parameters may be used as a surrogate for HIF-1α expression.
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17
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The role of frameless stereotactic biopsy in contemporary neuro-oncology: molecular specifications and diagnostic yield in biopsied glioma patients. J Neurooncol 2018; 141:183-194. [DOI: 10.1007/s11060-018-03024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022]
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18
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Giannakou M, Yiallouras C, Menikou G, Ioannides C, Damianou C. MRI-guided frameless biopsy robotic system with the inclusion of unfocused ultrasound transducer for brain cancer ablation. Int J Med Robot 2018; 15:e1951. [PMID: 30157310 DOI: 10.1002/rcs.1951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A magnetic resonance image (MRI) guided robotic system dedicated for brain biopsy was developed. The robotic system carries a biopsy needle and a small rectangular unfocused, single element, planar ultrasonic transducer which can be potentially utilized to ablate small and localized brain cancer. MATERIALS AND METHODS The robotic device includes six computer-controlled axes. An agar-based phantom was developed which included an olive that mimics brain target. A rectangular ultrasonic transducer operated at 4 MHz was used. RESULTS The functionality of the robotic system was assessed by means of ultrasound imaging, MRI imaging, and MR thermometry, demonstrating effective targeting. The heating capabilities of the ultrasonic transducer were also evaluated. CONCLUSIONS A functional MRI-guided robotic system was produced which can perform frameless brain biopsy. In the future, if a tumour is proven malignant, the needle can be pulled-out and a small ultrasonic transducer can be inserted to ablate the tumour.
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Affiliation(s)
- Marinos Giannakou
- Electrical Engineering Department, Cyprus University of Technology, Cyprus
| | | | - Georgios Menikou
- Department of Bioengineering, City University, London, UK.,R&D, MEDSONIC LTD, Limassol, Cyprus
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19
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He X, Liu M, Liu C, Fang J, Xu Y, Wang L, Xiang J, Sequeiros RB, Li C. Real-time MR-guided brain biopsy using 1.0-T open MRI scanner. Eur Radiol 2018; 29:85-92. [PMID: 29948073 DOI: 10.1007/s00330-018-5531-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/24/2018] [Accepted: 05/07/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To evaluate the safety, feasibility and diagnostic performance of real-time MR-guided brain biopsy using a 1.0-T open MRI scanner. METHODS Medical records of 86 consecutive participants who underwent brain biopsy under the guidance of a 1.0-T open MRI scanner with real-time and MR fluoroscopy techniques were evaluated retrospectively. All procedures were performed under local anaesthesia and intravenous conscious sedation. Diagnostic yield, diagnostic accuracy, complication rate and procedure duration were assessed. The lesions were divided into two groups according to maximum diameters: ≤ 1.5 cm (n = 16) and > 1.5 cm (n = 70). The two groups were compared using Fisher's exact test. RESULTS Diagnostic yield and diagnostic accuracy were 95.3% and 94.2%, respectively. The diagnostic yield of lesions ≤ 1.5 cm and > 1.5 cm were 93.8% and 95.7%, respectively. There was no significant difference in diagnostic yield between the two groups (p > 0.05). Mean procedure duration was 41 ± 5 min (range 33-49 min). All biopsy needles were placed with one pass. Complication rate was 3.5% (3/86). Minor complications included three cases of a small amount of haemorrhage. No serious complications were observed. CONCLUSIONS Real-time MR-guided brain biopsy using a 1.0-T open MRI scanner is a safe, feasible and accurate diagnostic technique for pathological diagnosis of brain lesions. The procedure duration is shortened and biopsy work flow is simplified. It could be considered as an alternative for brain biopsy. KEY POINTS • Real-time MRI-guided brain biopsy using a 1.0-T open MRI scanner is safe, feasible and accurate. • No serious complications occurred in real-time MRI-guided brain biopsy. • Procedure duration is shortened and biopsy work flow is simplified.
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Affiliation(s)
- Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Chao Liu
- Department of Minimally Invasive Tumor, Tai'an Central Hospital, Tai'an, Shandong, People's Republic of China
| | - Jing Fang
- Department of Hemodialysis, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China
| | - Ligang Wang
- Department of Medical Imaging and Interventional Radiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
| | - Jianfeng Xiang
- Department of Intervention, Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, People's Republic of China
| | | | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong, People's Republic of China.
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20
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Accuracy of intraoperative pathological diagnosis using frozen sections of spinal cord lesions. Clin Neurol Neurosurg 2018; 167:117-121. [DOI: 10.1016/j.clineuro.2018.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/23/2018] [Accepted: 02/15/2018] [Indexed: 11/20/2022]
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21
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Foster MT, Harishchandra LS, Mallucci C. Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects. Front Pediatr 2018; 6:309. [PMID: 30443540 PMCID: PMC6223202 DOI: 10.3389/fped.2018.00309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/01/2018] [Indexed: 01/23/2023] Open
Abstract
Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery.
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Affiliation(s)
- Mitchell T Foster
- Department of Neurosurgery, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Conor Mallucci
- Department of Neurosurgery, Alder Hey NHS Foundation Trust, Liverpool, United Kingdom
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Preibisch C, Shi K, Kluge A, Lukas M, Wiestler B, Göttler J, Gempt J, Ringel F, Al Jaberi M, Schlegel J, Meyer B, Zimmer C, Pyka T, Förster S. Characterizing hypoxia in human glioma: A simultaneous multimodal MRI and PET study. NMR IN BIOMEDICINE 2017; 30:e3775. [PMID: 28805936 DOI: 10.1002/nbm.3775] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Hypoxia plays an important role for the prognosis and therapy response of cancer. Thus, hypoxia imaging would be a valuable tool for pre-therapeutic assessment of tumor malignancy. However, there is no standard validated technique for clinical application available yet. Therefore, we performed a study in 12 patients with high-grade glioma, where we directly compared the two currently most promising techniques, namely the MR-based relative oxygen extraction fraction (MR-rOEF) and the PET hypoxia marker H-1-(3-[18 F]-fluoro-2-hydroxypropyl)-2-nitroimidazole ([18 F]-FMISO). MR-rOEF was determined from separate measurements of T2 , T2 * and relative cerebral blood volume (rCBV) employing a multi-parametric approach for quantification of the blood-oxygenation-level-dependent (BOLD) effect. With respect to [18 F]-FMISO-PET, besides the commonly used late uptake between 120 and 130 min ([18 F]-FMISO120-130 min ), we also analyzed the hypoxia specific uptake rate [18 F]-FMISO-k3 , as obtained by pharmacokinetic modeling of dynamic uptake data. Since pharmacokinetic modeling of partially acquired dynamic [18 F]-FMISO data was sensitive to a low signal-to-noise-ratio, analysis was restricted to high-uptake tumor regions. Individual spatial analyses of deoxygenation and hypoxia-related parameter maps revealed that high MR-rOEF values clustered in (edematous) peritumoral tissue, while areas with high [18 F]-FMISO120-130 min concentrated in and around active tumor with disrupted blood-brain barrier, i.e. contrast enhancement in T1 -weighted MRI. Volume-of-interest-based correlations between MR-rOEF and [18 F]-FMISO120-130 min as well as [18 F]-FMISO-k3 , and voxel-wise analyses in individual patients, yielded limited correlations, supporting the notion that [18 F]-FMISO uptake, even after 2 h, might still be influenced by perfusion while [18 F]-FMISO-k3 was severely hampered by noise. According to these results, vascular deoxygenation, as measured by MR-rOEF, and severe tissue hypoxia, as measured by [18 F]-FMISO, show a poor spatial correspondence. Overall, the two methods appear to rather provide complementary than redundant information about high-grade glioma biology.
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Affiliation(s)
- Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
- Clinic for Neurology, Technische Universität München, Munich, Germany
| | - Kuangyu Shi
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Anne Kluge
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Mathias Lukas
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Mohamed Al Jaberi
- Department of Neuropathology, Technische Universität München, Munich, Germany
| | - Jürgen Schlegel
- Department of Neuropathology, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Thomas Pyka
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Stefan Förster
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
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Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V. Accuracy of VarioGuide Frameless Stereotactic System Against Frame-Based Stereotaxy: Prospective, Randomized, Single-Center Study. World Neurosurg 2017; 104:831-840. [PMID: 28454992 DOI: 10.1016/j.wneu.2017.04.104] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
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Affiliation(s)
- Ondrej Bradac
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic.
| | - Anna Steklacova
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Katerina Nebrenska
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Jiri Vrana
- Department of Neuroradiology, Military University Hospital, Prague, The Czech Republic
| | - Patricia de Lacy
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
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Pinggera D, Kvitsaridtze I, Stockhammer G, Eisner W, Thomé C, Freyschlag CF, Moser P, Kerschbaumer J. Serious tumor seeding after brainstem biopsy and its treatment-a case report and review of the literature. Acta Neurochir (Wien) 2017; 159:751-754. [PMID: 28154933 DOI: 10.1007/s00701-017-3102-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
Abstract
Stereotactic brain biopsies for histopathological diagnosis are a common technique in case of intracranial lesions, particularly in those not amenable for resection. Tumor seeding alongside the surgical trajectory after fine-needle aspiration is a known problem in several visceral tumors. Whereas in these cases a complete resection of the biopsy trajectory may later be performed, this strategy is not feasible in stereotactic brain biopsy. We report a case of tumor seeding along the entire biopsy tract after stereotactic biopsy of a brainstem metastasis. A 68-year-old male patient with a concomitantly diagnosed kidney lesion presented with a singular lesion in the brainstem. After confirmation of metastasis by stereotactic biopsy, stereotactic radiosurgery (SRS) was applied. The primary tumor was treated by laparoscopic nephrectomy. Three months after SRS, the patient presented with a secondary clinical deterioration for only a few weeks. The MRI scan showed tumor seeding along the entire biopsy tract. Salvage treatment including hypofractionated stereotactical irradiation and seven cycles of bevacizumab was administered to obtain symptom control. Massive seeding of tumor after stereotactic biopsy accordingly rare, taking into account that stereotactic biopsy is a very common neurosurgical intervention. Nonetheless, we think that the potential risk has to be kept in mind, as it might be neglected.
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Affiliation(s)
- D Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - I Kvitsaridtze
- Department of Radiotherapy and Radiooncology, Medical University of Innsbruck, Innsbruck, Austria
| | - G Stockhammer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - W Eisner
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - P Moser
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Avecillas-Chasin JM, Budke M, Villarejo F. Neuroendoscopic Intraventricular Biopsy in Children with Small Ventricles Using Frameless VarioGuide System. World Neurosurg 2016; 87:136-42. [PMID: 26723291 DOI: 10.1016/j.wneu.2015.12.022] [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: 09/21/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/15/2022]
Abstract
Endoscopic biopsy for intraventricular tumors in pediatric patients with small ventricles is a challenging procedure because of the risk of morbidity during the intraventricular approach. We describe the use of the VarioGuide system for intraventricular endoscopic biopsy in 9 consecutive pediatric patients with intraventricular lesions and small ventricular size. All patients had lesions in the anterior part of the third ventricle with a median frontal and occipital horn ratio of 0.33. Patients presented with growth failure (n = 4), visual disturbances (n = 4), and seizures (n = 1). The VarioGuide system consists of an ergonomic arm with 3 joints for gross adjustment. The 3 rotational joints on the distal side of the system are adjusted according to the angles of the planned trajectory. The endoscope is adjusted to the distal side of the VarioGuide and inserted through the ring, previously set for the diameter of the endoscope and for the planned trajectory. The accuracy of the trajectory and correct ventricular cannulation are confirmed under endoscopic guidance. The biopsy is carried out according to the standard technique. In all cases, the biopsy sample provided the definitive diagnosis. Diagnoses included germinomas in 4 patients, hamartoma in 1 patient, hypothalamic astrocytoma in 2 patients, and craniopharyngioma in 2 patients. The use of the VarioGuide system for intraventricular endoscopic biopsy is highly recommended for pediatric patients with small ventricle size. This technique may help minimize the risk of unnecessary brain damage during the entrance to small ventricles.
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Affiliation(s)
| | - Marcelo Budke
- Department of Neurosurgery, Hospital Infantil Universitario Niño Jesus, Madrid, Spain.
| | - Francisco Villarejo
- Department of Neurosurgery, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
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26
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Ragel BT, Ryken TC, Kalkanis SN, Ziu M, Cahill D, Olson JJ. The role of biopsy in the management of patients with presumed diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline. J Neurooncol 2015; 125:481-501. [PMID: 26530259 DOI: 10.1007/s11060-015-1866-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/27/2015] [Indexed: 10/22/2022]
Abstract
QUESTION What is the optimal role of biopsy in the initial management of presumptive low-grade glioma in adults? TARGET POPULATION Adult patients with imaging suggestive of a low-grade glioma. RECOMMENDATIONS LEVEL III Stereotactic biopsy is recommended when definitive surgical resection is limited by lesions that are deep-seated, not resectable, and/or located within eloquent cortex, or in patients unable to undergo craniotomy due to medical co-morbidities to obtain the critical tissue diagnosis needed for targeted treatment planning for patients with low-grade gliomas. QUESTION What is the best technique for brain biopsy? TARGET POPULATION Adult patients with imaging suggestive of a low-grade glioma. RECOMMENDATIONS LEVEL III Frameless and frame-based stereotactic brain biopsy for low-grade gliomas are recommended based on clinical circumstances as they provide similar diagnostic yield, diagnostic accuracy, morbidity, and mortality. It is recommended the surgeon consider advanced imaging techniques (e.g., perfusion, spectroscopy, metabolic studies) to target specific regions of interest to potentially improve diagnostic accuracy.
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Affiliation(s)
- Brian T Ragel
- Rebound Orthopedics and Neurosurgery, 200 NE Mother Joseph Place, Suite 210, Vancouver, WA, 98664, USA.
| | - Timothy C Ryken
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Mateo Ziu
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA
| | | | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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27
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Contemporary frameless intracranial biopsy techniques: Might variation in safety and efficacy be expected? Acta Neurochir (Wien) 2015; 157:2011-6; discussion 2016. [PMID: 26315461 PMCID: PMC4604498 DOI: 10.1007/s00701-015-2543-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022]
Abstract
Background Frameless stereotactic neuronavigation has proven to be a feasible technology to acquire brain biopsies with good accuracy and little morbidity and mortality. New systems are constantly introduced into the neurosurgical armamentarium, although few studies have actually evaluated and compared the diagnostic yield, morbidity, and mortality of various manufacturer’s frameless neuronavigation systems. The present study reports our experience with brain biopsy procedures performed using both the Medtronic Stealth TreonTM Vertek® and BrainLAB® Varioguide frameless stereotactic brain biopsy systems. Patients and methods All 247 consecutive biopsies from January 2008 until May 2013 were evaluated retrospectively. One hundred two biopsies each were performed using the Medtronic (2008–2009) and BrainLAB® system (2011–2013), respectively. The year 2010 was considered a transition year, in which 43 biopsies were performed with either system. Patient demographics, perioperative characteristics, and histological diagnosis were reviewed, and a comparison was made between the two brain biopsy systems. Results The overall diagnostic yield was 94.6 %, i.e., 11 biopsies were nondiagnostic, 5 (4.9 %) with the Medtronic and 6 (5.9 %) with the BrainLAB® system. No differences besides the operating time (108 vs 120 min) were found between the two biopsy methods. On average, 6.6 tissue samples were taken with either technique. Peri- and postoperative complications were seen in 5.3 % and 12.9 %, consisting of three symptomatic hemorrhages (1.2 %). Biopsy-related mortality occurred in 0.8 % of all biopsies. Conclusions Regarding diagnostic yield, complication rate, and biopsy-related mortality, there seems to be no difference between the frameless biopsy technique from Medtronic and BrainLAB®. In contemporary time, the neurosurgeon has many tools to choose from, all with a relatively fast learning curve and ever improving feasibility. Thus, the issue of choice involves not the results, but the familiarity, end-user friendliness, and overall comfort when operating the system.
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Khatab S, Spliet W, Woerdeman PA. Frameless image-guided stereotactic brain biopsies: emphasis on diagnostic yield. Acta Neurochir (Wien) 2014; 156:1441-50. [PMID: 24898761 DOI: 10.1007/s00701-014-2145-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies regarding frameless stereotactic brain biopsy mainly report high diagnostic yield (DY) as opposed to relatively low diagnostic accuracy. This discrepancy raises the question of the certainty and precision of obtained diagnoses. This article proposes a DY definition encompassing diagnostic certainty and precision according to the World Health Organization (WHO) central nervous system (CNS) tumour classification system. Furthermore, our eight-year experience with this procedure is reviewed and evaluated. METHODS A consecutive series of 235 frameless biopsy procedures was reviewed. Criteria were set up for categorising obtained diagnoses. All cases were included in a predictive factor analysis of inconclusive biopsy and postoperative complications. RESULTS According to our predefined DY criteria, the DY was 72.8 %. The inconclusive biopsy outcome measured 21.7 %; the non-diagnostic biopsy outcome was 5.5 %. The only predictive factor found for inconclusive biopsy procedures was age under 30. Predictive factors for postoperative complications, which were found statistically significant after multivariable analysis, were glucose level and intra-operative haemorrhage. The total morbidity rate was 8.5 %, including a mortality rate of 0.9 %. CONCLUSIONS Although frameless stereotactic brain biopsy procedures are considered to be relatively safe, the true DY is significantly less than previously reported, most probably due to the lack of standardised DY criteria. Based on our DY definition and subsequent DY findings, standardisation of DY criteria and definition is paramount for biopsy diagnosis interpretation.
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Affiliation(s)
- Sodaba Khatab
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Multimodal imaging in cerebral gliomas and its neuropathological correlation. Eur J Radiol 2014; 83:829-34. [DOI: 10.1016/j.ejrad.2014.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/04/2014] [Indexed: 02/01/2023]
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30
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Gempt J, Gerhardt J, Toth V, Hüttinger S, Ryang YM, Wostrack M, Krieg SM, Meyer B, Förschler A, Ringel F. Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging. J Neurosurg 2013; 119:1395-400. [DOI: 10.3171/2013.9.jns13596] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Brain metastases occur in 10% to 40% of patients harboring cancer. In cases of neurosurgical metastasis resection, all postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage due to resection, hemorrhage, venous congestive infarcts, or arterial ischemic events leading to tissue infarction. The aim of this study was to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastasis and to determine their influence on new postoperative neurological deficits.
Methods
Patients who underwent resection of brain metastases and had preoperative and early postoperative (within 48 hours) MRI scans, including diffusion-weighted imaging sequences and apparent diffusion coefficient maps, between January 2009 and May 2012 were included in this study. Clinical and histopathological data (histopathological results, pre- and postoperative neurological status, and previous tumor-specific therapy) were recorded.
Results
One hundred twenty-two patients (56 male, 66 female) who underwent resection of brain metastases were included. The patients' mean age was 60 years (range 21–89 years). The mean time span from initial tumor diagnosis to resection of brain metastasis was 44 months (range 0–338 months). The mean preoperative Karnofsky Performance Status was 80% (exact mean 76% ± 17% [SD]), and the mean postoperative value was 80% (exact mean 78% ± 17%). Twelve (9.8%) of the 122 patients had postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit; 44 (36.1%) of the 122 patients had postoperative ischemic lesions. When comparing patients with and without previous brain irradiation, 53.8% of patients with previous brain irradiation had ischemic lesions on postoperative imaging compared with 31.3% of patients without previous brain irradiation (p = 0.033). There was a significant association between ischemia and postoperative neurological status deterioration (transient or permanent); 13 (29.5%) of 44 patients with ischemic lesions had deterioration of their neurological status compared with 7 (9%) of the 78 patients who did not have ischemic lesions (p = 0.003).
Conclusions
This study demonstrates a high prevalence of vascular incidents in patients undergoing resection for metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological deficits (transient or permanent). Patients who had previous irradiation therapy are at higher risk of developing postoperative ischemic lesions. A large number of postoperative neurological deficits are caused by ischemic incidents.
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Affiliation(s)
- Jens Gempt
- 1Neurochirurgische Klinik und Poliklinik and
| | | | - Vivien Toth
- 2Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Germany
| | | | - Yu-Mi Ryang
- 1Neurochirurgische Klinik und Poliklinik and
| | | | | | | | - Annette Förschler
- 2Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Germany
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Long S, Frey S, Freestone DR, LeChevoir M, Stypulkowski P, Giftakis J, Cook M. Placement of deep brain electrodes in the dog using the Brainsight frameless stereotactic system: a pilot feasibility study. J Vet Intern Med 2013; 28:189-97. [PMID: 24237394 PMCID: PMC4895539 DOI: 10.1111/jvim.12235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/03/2013] [Accepted: 09/19/2013] [Indexed: 12/03/2022] Open
Abstract
Background Deep brain stimulation (DBS) together with concurrent EEG recording has shown promise in the treatment of epilepsy. A novel device is capable of combining these 2 functions and may prove valuable in the treatment of epilepsy in dogs. However, stereotactic implantation of electrodes in dogs has not yet been evaluated. Objective To evaluate the feasibility and safety of implanting stimulating and recording electrodes in the brain of normal dogs using the Brainsight system and to evaluate the function of a novel DBS and recording device. Animals Four male intact Greyhounds, confirmed to be normal by clinical and neurologic examinations and hematology and biochemistry testing. Methods MRI imaging of the brain was performed after attachment of fiducial markers. MRI scans were used to calculate trajectories for electrode placement in the thalamus and hippocampus, which was performed via burr hole craniotomy. Postoperative CT scanning was performed to evaluate electrode location and accuracy of placement was calculated. Serial neurologic examinations were performed to evaluate neurologic deficits and EEG recordings obtained to evaluate the effects of stimulation. Results Electrodes were successfully placed in 3 of 4 dogs with a mean accuracy of 4.6 ± 1.5 mm. EEG recordings showed evoked potentials in response to stimulation with a circadian variation in time‐to‐maximal amplitude. No neurologic deficits were seen in any dog. Conclusions and Clinical Importance Stereotactic placement of electrodes is safe and feasible in the dog. The development of a novel device capable of providing simultaneous neurostimulation and EEG recording potentially represents a major advance in the treatment of epilepsy.
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Affiliation(s)
- S Long
- Section of Neurology and Neurosurgery, Faculty of Veterinary Science, University of Melbourne, Melbourne, Australia
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MR-based hypoxia measures in human glioma. J Neurooncol 2013; 115:197-207. [PMID: 23918147 DOI: 10.1007/s11060-013-1210-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 07/28/2013] [Indexed: 10/26/2022]
Abstract
Hypoxia plays a central role in tumor stem cell genesis and is related to a more malignant tumor phenotype, therapy resistance (e.g. in anti-angiogenic therapies) and radio-insensitivity. Reliable hypoxia imaging would provide crucial metabolic information in the diagnostic work-up of brain tumors. In this study, we applied a novel BOLD-based MRI method for the measurement of relative oxygen extraction fraction (rOEF) in glioma patients and investigated potential benefits and drawbacks. Forty-five glioma patients were examined preoperatively in a pilot study on a 3T MR scanner. rOEF was calculated from quantitative transverse relaxation rates (T2, T2*) and cerebral blood volume (CBV) using a quantitative BOLD approach. rOEF maps were assessed visually and by means of a volume of interest (VOI) analysis. In six cases, MRI-targeted biopsy samples were analyzed using HIF-1α-immunohistochemistry. rOEF maps could be obtained with a diagnostic quality. Focal spots with high rOEF values were observed in the majority of high-grade tumors but in none of the low-grade tumors. VOI analysis revealed potentially hypoxic tumor regions with high rOEF in contrast-enhancing tumor regions as well as in the non-enhancing infiltration zone. Systematic bias was found as a result of non-BOLD susceptibility effects (T2*) and contrast agent leakage affecting CBV. Histological samples demonstrated reasonable correspondence between MRI characteristics and HIF-1α-staining. The presented method of rOEF imaging is a promising tool for the metabolic characterization of human glioma. For the interpretation of rOEF maps, confounding factors must be considered, with a special focus on CBV measurements in the presence of contrast agent leakage. Further validation involving a bigger cohort and extended immuno-histochemical correlation is required.
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Burkhardt JK, Neidert MC, Woernle CM, Bozinov O, Bernays RL. Intraoperative low-field MR-guided frameless stereotactic biopsy for intracerebral lesions. Acta Neurochir (Wien) 2013; 155:721-6. [PMID: 23435865 DOI: 10.1007/s00701-013-1639-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND To present our intraoperative low-field magnetic resonance imaging (ioMRI) technique for stereotactic brain biopsy in various intracerebral lesions. METHOD Seventy-eight consecutive patients underwent stereotactic biopsies with the PoleStar N-20/N-30 ioMRI system and data were evaluated retrospectively. Biopsy technique included ioMRI before surgery, followed by insertion of the biopsy cannula in the lesion, and ioMRI before and after biopsy. Statistical analysis was performed to compare subgroups using Excel and SPSS statistic software. RESULTS In all patients, stereotactic biopsy was possible, with a mean intraoperative surgery time of 86.2 ± 28.6 min and a mean hospital stay of 11.6 ± 4.6 days. In 97.4 % (n = 76), histology was conclusive, representing 58 brain tumors and 18 other pathologies. Five patients were biopsied previously without conclusive diagnosis, and all biopsies were conclusive this time. Mean cross-sectional lesion size in MRI T1 with contrast (n = 64) was 6.9 ± 5.7 cm(2), and in lesions without T1 contrast enhancement (n = 14), T2 mean cross-sectional lesion size was 5.5 ± 3.9 cm(2). Mean distance from the cortex surface to the lesion was 3.4 ± 1.2 cm. One patient suffered from a postoperative wound dehiscence; neither clinically or radiologically significant hemorrhage after surgery, nor intraoperative complications occurred. CONCLUSIONS Low-field ioMR-guided frameless stereotactic biopsy accurately diagnosed different intracerebral lesions without major complications for the patients, and within an acceptable surgery time and hospital stay. In repeated non-conclusive biopsies in particular, low-field ioMRI offers a technique for arriving at a diagnosis.
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