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Vilela-Filho O, Porfírio J, Goulart LC. Indicators of correct targeting in stereotactic biopsy of intracranial lesions. Surg Neurol Int 2022; 13:251. [PMID: 35855128 PMCID: PMC9282734 DOI: 10.25259/sni_246_2022] [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: 03/11/2022] [Accepted: 05/29/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.
Methods:
Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.
Results:
Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.
Conclusion:
This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.
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Riche M, Marijon P, Amelot A, Bielle F, Mokhtari K, Chambrun MPD, Joncour AL, Idbaih A, Touat M, Do CH, Deme M, Pasqualotto R, Jacquens A, Degos V, Shotar E, Chougar L, Carpentier A, Mathon B. Severity, timeline, and management of complications after stereotactic brain biopsy. J Neurosurg 2021; 136:867-876. [PMID: 34507289 DOI: 10.3171/2021.3.jns21134] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The literature shows discrepancies in stereotactic brain biopsy complication rates, severities, and outcomes. Little is known about the timeline of postbiopsy complications. This study aimed to analyze 1) complications following brain biopsies, using a graded severity scale, and 2) a timeline of complication occurrence. The secondary objectives were to determine factors associated with an increased risk of complications and to assess complication-related management and extra costs. METHODS The authors retrospectively examined 1500 consecutive stereotactic brain biopsies performed in adult patients at their tertiary medical center between April 2009 and April 2019. RESULTS Three hundred eighty-one biopsies (25.4%) were followed by a complication, including 88.2% of asymptomatic hemorrhages. Symptomatic complications involved 3.0% of the biopsies, and 0.8% of the biopsies were fatal. The severity grading scale had a 97.6% interobserver reproducibility. Twenty-three (51.1%) of the 45 symptomatic complications occurred within the 1st hour following the biopsy, while 75.6% occurred within the first 6 hours. Age ≥ 65 years, second biopsy procedures, gadolinium-enhanced lesions, glioblastomas, and lymphomas were predictors of biopsy-related complications. Brainstem biopsy-targeted lesions and cerebral toxoplasmosis were predictive of mortality. Asymptomatic hemorrhage was associated with delayed (> 6 hours) symptomatic complications. Symptomatic complications led to extended hospitalization in 86.7% of patients. The average extra cost for management of a patient with postbiopsy symptomatic complication was $35,702. CONCLUSIONS Symptomatic complications from brain biopsies are infrequent but associated with substantial adverse effects and cost implications for the healthcare system. The use of a severity grading scale, as the authors propose in this article, helps to classify complications according to the therapeutic consequences and the patient's outcome. Because this study indicates that most complications occur within the first few hours following the biopsy, postbiopsy monitoring can be tailored accordingly. The authors therefore recommend systematic monitoring for 2 hours in the recovery unit and a CT scan 2 hours after the end of the biopsy procedure. In addition, they propose a modern algorithm for optimal postoperative management of patients undergoing stereotactic biopsy.
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Affiliation(s)
- Maximilien Riche
- Departments of1Neurosurgery.,2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM
| | - Pauline Marijon
- Departments of1Neurosurgery.,2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM
| | | | - Franck Bielle
- 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.,3Neuropathology
| | - Karima Mokhtari
- 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.,3Neuropathology
| | - Marc Pineton de Chambrun
- 4Internal Medicine 2.,5Intensive Care Medicine.,6INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition
| | | | - Ahmed Idbaih
- 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.,8Neurology Mazarin
| | - Mehdi Touat
- 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.,8Neurology Mazarin
| | - Chung-Hi Do
- 9Anesthesia, Critical Care, and Perioperative Medicine, and
| | - Mamadou Deme
- 9Anesthesia, Critical Care, and Perioperative Medicine, and
| | | | - Alice Jacquens
- 9Anesthesia, Critical Care, and Perioperative Medicine, and
| | - Vincent Degos
- 9Anesthesia, Critical Care, and Perioperative Medicine, and.,10Clinical Research Group ARPE, Sorbonne University.,11INSERM UMR 1141, PROTECT, Paris, France
| | - Eimad Shotar
- 12Neuroradiology, APHP, Sorbonne University, La Pitié-Salpêtrière Hospital
| | - Lydia Chougar
- 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.,12Neuroradiology, APHP, Sorbonne University, La Pitié-Salpêtrière Hospital
| | - Alexandre Carpentier
- Departments of1Neurosurgery.,2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM
| | - Bertrand Mathon
- Departments of1Neurosurgery.,2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM
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Acosta MC, Kundro M, Viloria G, Peressín Paz A, Morello F, Latorre F, Seoane E, Toibaro J, Losso M. The role of brain biopsy in the clinical management of HIV-related focal brain lesions. HIV Med 2018; 19:673-678. [PMID: 30004180 DOI: 10.1111/hiv.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Up to 20% of HIV-related focal brain lesion (FBL) diagnoses cannot be determined without invasive procedures. In such cases, brain biopsy is an important step in the evaluation algorithm. The aims of this study were to describe the clinical outcomes of patients with FBL, the proportion of diagnoses confirmed by brain biopsies and their aetiologies, and to analyse the proportion of patients in whom the biopsy motivated a change in therapeutic management. METHODS A retrospective cohort study was performed. The data from clinical records of patients with HIV-related FBL admitted between January 2005 and December 2015 were reviewed. RESULTS A total of 137 patients were included in the study. The median age was 39 years [interquartile range (IQR) 33-44.5 years]. The median CD4 count was 54 cells/μL (IQR 21-124 cells/μL). Cerebral brain biopsy was performed in 21.16% of patients (29 of 137); 68.9% of these individuals (20 of 29) were diagnosed by histology, with results of central nervous system (CNS) lymphoma in 20.6% (six of 29), progressive multifocal leucoencephalopathy in 6.8% (two of 29), toxoplasmosis in 6.8% (two of 29), tuberculoma in 6.8% (two of 29), and other diagnoses in 27.6% (eight of 29). In nine patients, the histology was nonspecific. In 75.8% of patients (22 of 29), the result of the biopsy led to a change in the therapeutic management. We did not observe higher rates of mortality related to the procedure. Overall mortality at 30 and 90 days was similar in patients who were and were not biopsied. CONCLUSIONS In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients.
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Affiliation(s)
- M C Acosta
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - M Kundro
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - G Viloria
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - A Peressín Paz
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - F Morello
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - F Latorre
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - E Seoane
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - J Toibaro
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - M Losso
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
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Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets. BMC Infect Dis 2017; 17:66. [PMID: 28086758 PMCID: PMC5237164 DOI: 10.1186/s12879-016-2159-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. Case presentation A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4+ T cells and higher percentage of activated CD4+ T cells at HAART initiation. The percentage of memory CD4+ T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8+ T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. Conclusion Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2159-x) contains supplementary material, which is available to authorized users.
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Quick-Weller J, Konczalla J, Duetzmann S, Franz-Jaeger C, Strouhal U, Brawanski N, Setzer M, Lescher S, Seifert V, Marquardt G, Weise LM. General Anesthesia Versus Local Anesthesia in Stereotactic Biopsies of Brain Lesions: A Prospective Randomized Study. World Neurosurg 2017; 97:16-20. [DOI: 10.1016/j.wneu.2016.09.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Zhang J, Liu X, Fu K, Xu C, Gong R, Liu L, Guo T, Zhou H, Zhao X, Chen J, Zhang J. Diagnostic Value and Safety of Stereotactic Biopsy in Acquired Immune Deficiency Syndrome Patients with Intracranial Lesions: Systematic Review and Meta-Analysis. World Neurosurg 2016; 98:790-799.e13. [PMID: 27965075 DOI: 10.1016/j.wneu.2016.11.151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis. METHODS Relevant cohort studies were identified through a literature search in PubMed, Embase, and Ovid from 1985 to October 1, 2016. Appropriate studies were identified per search criteria. Systematic review and meta-analysis were used to assess the diagnostic success rate, changed management rate, clinical improvement rate, mortality rate, morbidity rate, hemorrhage rate, hemorrhage in morbidity rate, and final histologic diagnosis results. Study-specific outcomes were combined per a random effects model. Outcomes were compared between the pre-highly active antiretroviral therapy (HAART) and post-HAART groups. Correlations between outcomes were assessed via meta-regression analysis. RESULTS A total of 19 cohort studies with 820 patients were included in this meta-analysis. The weighted proportions per the random effects model were 92.2% (95% confidence interval [CI; 89.3%-94.5%]) for diagnostic success rate, 5.1% (95% CI [2.5%-8.3%]) for morbidity, and 0.7% (95% CI [0%-1.9%]) for mortality. The most common procedure-related morbidity was hemorrhage at 3.3% (95% CI [1.1%-6.3%]). Hemorrhage in morbidity was 78.0% (95% CI [51.4%-97.4%]). Management changed and clinical improvement were 60.4% (95% CI [49.4%-71.0%]) and 34.0% (95% CI [22.2%-46.8%]), respectively. The 4 most common diagnoses were primary central nervous system lymphoma (27.8%; 95% CI [20.2%-36.1%]), progressive multifocal leukoencephalopathy (PML) (21.0%; 95% CI [14.3%-28.4%]), toxoplasma encephalitis (TE) (20.3%; 95% CI [14.3%-27.0%]), and human immunodeficiency virus (HIV) encephalitis (4.1%; 95% CI [1.4%-7.6%]). Multiple diagnoses rate was 1.2% (95% CI [0.0%-3.6%]). HIV encephalitis rate was significantly higher in the post-HAART group than the pre-HAART group (17.9% vs. 3.2%, respectively; P = 0.0024). CONCLUSIONS Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patients with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. The 4 most common intracranial lesions in patients with AIDS are lymphoma, PML, TE, and HIV encephalitis.
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Affiliation(s)
- Jibo Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuemeng Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Fu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui Gong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tao Guo
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Zhou
- Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Zhang JB, Fu K, Gong R, Liu XM, Chen LD, Zhang YX, Yang GF, Zhang J. Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China: Report of 7 cases. Medicine (Baltimore) 2016; 95:e5526. [PMID: 27930545 PMCID: PMC5266017 DOI: 10.1097/md.0000000000005526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE The aim of the study was to evaluate stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS. PATIENT CONCERNS Seven AIDS patients with an intracranial lesion who underwent stereotactic biopsy were included in this retrospective study (4 males and 3 females, 15 to 49 years old). The patients' disease history ranged from 1 month to 1 year. The samples were examined by hematoxylin-eosin (HE) staining and immunohistochemical examination. DIAGNOSES, INTERVENTIONS AND OUTCOMES All patients were successfully sampled, and the histological results showed inflammation in 4 cases, toxoplasma gondii infection in 1 case, astrocytoma in 1 case, and abscess in 1 case. The clinical diagnosis included toxoplasma encephalitis (TE) in 2 cases, cryptococcus encephalitis in 2 cases, cytomegalovirus (CMV) encephalitis in 2 case, tubercular abscess in 1 case, astrocytoma in 1 case, and co-infection of TE with Cryptococcus infection in 1 patient. The clinical diagnosis was made according to the plasma and cerebrospinal fluid (CSF) laboratory testing, the imaging data and the histological findings. The diagnostic yield was 100%, and the post-operation morbidity was 14.3% (1/7) with an asymptomatic haemorrhage and seizure in 1 case. There was no operation-related mortality. Patients were followed up for 6 months to 6 years; 1 case fully recovered, 4 cases significantly improved in symptoms, and 2 died. LESSONS Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patient with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. Due to the broad spectrum of nervous system abnormalities in AIDS, histological findings are very valuable. However, histology is not a unique tool for making a definite diagnosis, whereas the combination of molecular pathology and stereotactic biopsy should play a more important role in the future.
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Affiliation(s)
| | - Kai Fu
- Department of Neurosurgery
| | | | | | | | | | - Gui-fang Yang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
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