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Betting T, Benson JC, Madhavan A, Shlapak D, Morris P, Morris J, Diehn F, Verdoorn J, Liebo G, Carr C. Safety and histopathologic yield of percutaneous CT-guided biopsies of the skull base, orbit, and calvarium. Neuroradiology 2024; 66:417-425. [PMID: 38197949 DOI: 10.1007/s00234-023-03266-y] [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: 12/22/2022] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Although CT-guided biopsies of the calvarium, skull base, and orbit are commonly performed, the best approaches, efficacy, and safety of such procedures remain scantly described in the literature. This retrospective review of percutaneous biopsies illustrates several approaches to challenging biopsy targets and provides a review of procedural planning considerations and histopathologic yield. METHODS A retrospective review of CT-guided biopsies of the skull base, calvarium, and orbit between 1/1/2010 and 10/30/2020 was conducted. Patient demographics and procedural factors were recorded, including lesion size and location, biopsy approach, and needle gauge. Outcomes were also noted, including CT dose length product, complications, and histopathologic yield. RESULTS Sixty-one CT-guided biopsies were included in the final analysis: 34 skull base, 23 calvarial, and 4 orbital lesions. The initial diagnostic yield was 32/34 (94%) for skull base lesions, with one false-negative and one non-diagnostic sample. Twenty-one of twenty-three (91%) biopsies in the calvarium were initially diagnostic, with one false-negative and one non-diagnostic sample. In the orbit, 4/4 biopsies were diagnostic. The total complication rate for the cohort was 4/61 (6.6%). Three complications were reported in skull base procedures (2 immediate and 1 delayed). A single complication was reported in a calvarial biopsy, and no complications were reported in orbital biopsies. CONCLUSION Percutaneous CT-guided core needle biopsies can be performed safely and with a high diagnostic yield for lesions in the skull base, calvarium, and orbit.
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Affiliation(s)
- Theodore Betting
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - John C Benson
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Ajay Madhavan
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Darya Shlapak
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Padraig Morris
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jonathan Morris
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Felix Diehn
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jared Verdoorn
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Greta Liebo
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Carrie Carr
- Mayo Clinic, Rochester, 200 1st St. SW, Rochester, MN, 55905, USA
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Neuhaus MT, Zeller AN, Jehn P, Lethaus B, Gellrich NC, Zimmerer RM. Intraoperative real-time navigation and intraoperative three-dimensional imaging for patient-specific total temporomandibular joint replacement. Int J Oral Maxillofac Surg 2021; 50:1342-1350. [PMID: 33707038 DOI: 10.1016/j.ijom.2021.02.020] [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: 09/03/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
Customized solutions for replacement of the temporomandibular joint (TMJ) along with surgical guides enable precise and fast transfer of the virtual plan to the patient. However, these guides lack information on screw vectors and length, and well-defined borders for bony resections towards the medial skull base. This retrospective study was performed to investigate the feasibility and benefit of real-time navigation and intraoperative three-dimensional imaging during total TMJ replacement (TJR), as well as patient clinical outcomes. Between 2016 and 2020, 26 customized prostheses were implanted in 21 patients either with or without real-time navigation and instrument tracking. The clinical, surgical, radiological, and navigational data were analysed. The accuracy of navigation registration with instrument tracking, precision of screw insertion, and implant and screw positions were analysed by fusion of the virtual plan and surgical outcome. Real-time navigation aided orientation during lateral skull base dissection and resection. However, the results of real-time navigation-aided drilling were inconclusive regarding vector and length control. At a mean 15.3±3.0 months of follow-up, average mouth opening had improved from 21.69±2.80mm to 36.40±1.25mm; the average pain score decreased from 6.18±0.74 to 1.06±0.52. Thus, intraoperative real-time navigation for TJR assists lateral skull base dissection and resection.
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Affiliation(s)
- M-T Neuhaus
- Department of Oral- and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany; Department of Oral- and Maxillofacial Surgery, Leipzig University, Leipzig, Germany.
| | - A-N Zeller
- Department of Oral- and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - P Jehn
- Department of Oral- and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - B Lethaus
- Department of Oral- and Maxillofacial Surgery, Leipzig University, Leipzig, Germany
| | - N-C Gellrich
- Department of Oral- and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - R M Zimmerer
- Department of Oral- and Maxillofacial Surgery, Leipzig University, Leipzig, Germany
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He H, Cai M, Li M, Wei L, Luo L, Chen Z, Yang H, Guo Y, Li W. Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions. J Neurol Surg B Skull Base 2019; 81:686-693. [PMID: 33381374 DOI: 10.1055/s-0039-1696684] [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: 03/08/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA ( p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group ( p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.
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Affiliation(s)
- Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Meiqin Cai
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lei Wei
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510060, People's Republic of China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuopeng Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huasheng Yang
- Department of Eye Tumor and Orbital Disease, Zhongshan Ophthalmic Center (ZOC) of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wensheng Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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