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Antuña Ramos A, Mayordomo-Colunga J, Blanco Lago R, Álvarez Vega MA. Decompressive craniectomy in the acute fulminant cerebral edema. NEUROCIRUGIA (ENGLISH EDITION) 2024:S2529-8496(24)00047-9. [PMID: 39074658 DOI: 10.1016/j.neucie.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/28/2024] [Accepted: 07/06/2024] [Indexed: 07/31/2024]
Abstract
Acute fulminant cerebral edema is a type of rapidly progressive encephalitis that occurs in children and is associated with significant morbidity and mortality. We present a clinical case with seizures, rapid neurological deterioration and the early appearance of cerebral herniation signs. Although the radiological tests were initially normal and there are no established parameters that predict the evolution of encephalitis to a rapidly progressive subtype, the clinical evolution forced to consider the decompressive craniectomy due to the lack of response to the medical management of the cerebral edema. It may be necessary take a brain biopsy to confirm the etiology of the encephalitis origin of acute fulminant cerebral edema. The objective of surgery should be not only to increase survival, but also to reduce subsequent neurological sequelae.
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Affiliation(s)
- Aida Antuña Ramos
- Departamento de Neurocirugía, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Juan Mayordomo-Colunga
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Raquel Blanco Lago
- AGC Pediatría, Neuropediatria, Hospital Universitario Central de Asturias, Asturias, Spain
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Kizaki T, Kanazawa M, Ishiguro T, Natsumeda M, Tada M, Shimizu H, Okamoto K, Oishi M, Kakita A, Fujii Y, Onodera O. Indications for a brain biopsy in neurological diseases of unknown etiology: The role of magnetic resonance imaging findings and liquid biopsy in yielding definitive pathological diagnoses. J Neurol Sci 2024; 463:123150. [PMID: 39067261 DOI: 10.1016/j.jns.2024.123150] [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: 05/24/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
Brain biopsies are often considered for patients who cannot be diagnosed with various laboratory test results. However, physicians tend to be hesitant regarding their application in possibly non-neoplastic brain diseases, due to the invasiveness and risks. The aim was to determine the indications for brain biopsies in cases of neurological diseases of unknown etiology. We retrospectively evaluated diagnostic accuracy, laboratory findings (including a liquid biopsy for malignant lymphoma), magnetic resonance imaging (MRI) characteristics and the post-treatment outcomes of patients undergoing brain biopsies for neurological diseases of unknown etiology. The data of patients who had undergone a brain biopsy during their admission to Niigata University Hospital, between 2011 and 2024, were reviewed. Moreover, the laboratory data and MRI findings between patients with definitive and nonspecific biopsy diagnoses were compared. Twenty-six patients underwent a brain biopsy, and a definitive diagnosis was obtained in 14 patients (53.8%). Even in cases where a nonspecific diagnosis was made, biopsy findings helped rule out malignancy and guide clinical diagnosis and treatment decisions. The liquid biopsy for malignant lymphoma was performed in eight patients, with one yielding a positive result, consistent with primary central nervous system lymphoma. The sensitivity and specificity of liquid biopsy were 0.5 and 1, respectively. Diffusely contrasted cortical lesions and the presence of mass effects on MRI, were significantly associated with a definitive diagnosis, compared to a nonspecific diagnosis. In conclusion, brain MRI and liquid biopsies can assist in determining the appropriate indications for brain biopsies in neurological diseases of unknown etiology.
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Affiliation(s)
- Toshiya Kizaki
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan.
| | - Takanobu Ishiguro
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Kouichirou Okamoto
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Niigata 951-8585, Japan
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Laskowski M, Paździora P, Błaszczyk B, Gola M, Ciekalski M, Koperczak A, Marcin S, Zimny M, Zioła-Paździora A, Wojtacha M, Rudnik A. Comparison of Navigated and Frame-Based Stereotactic Biopsy-A Single-Center Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:949. [PMID: 38929566 PMCID: PMC11205312 DOI: 10.3390/medicina60060949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: As brain lesions present complex diagnostic challenges, accurate tissue sampling via biopsy is critical for effective treatment planning. Traditional frame-based stereotactic biopsy has been complemented by navigated biopsy techniques, leveraging advancements in imaging and navigation technology. This study aims to compare the navigated and frame-based stereotactic biopsy methods in a clinical setting, evaluating their efficacy, safety, and diagnostic outcomes to determine the optimal approach for precise brain lesion targeting. Materials and Methods: retrospective analysis was conducted on patients who underwent brain biopsies between January 2017 and August 2023 at an academic medical center. Data on patient demographics, clinical characteristics, biopsy technique (navigated vs. frame-based), and outcomes including accuracy, complications, and hospital stay duration were analyzed. Results: The cohort comprised 112 patients, with no significant age or gender differences between groups. Symptoms leading to biopsy were predominantly diminished muscle strength (42.0%), cognitive issues (28.6%), and aphasia (24.1%). Tumors were most common in the deep hemisphere (24.1%). The median hospital stay was 5 days, with a rehospitalization rate of 27.7%. Complications occurred in 4.47% of patients, showing no significant difference between biopsy methods. However, navigated biopsies resulted in fewer samples (p < 0.001) but with comparable diagnostic accuracy as frame-based biopsies. Conclusions: Navigated and frame-based stereotactic biopsies are both effective and safe, with comparable accuracy and complication rates. The choice of technique should consider lesion specifics, surgeon preference, and technological availability. The findings highlight the importance of advanced neurosurgical techniques in enhancing patient care and outcomes.
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Affiliation(s)
- Maciej Laskowski
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (M.C.); (A.K.)
| | - Piotr Paździora
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
| | - Bartłomiej Błaszczyk
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
| | - Małgorzata Gola
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (M.C.); (A.K.)
| | - Marcin Ciekalski
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (M.C.); (A.K.)
| | - Agnieszka Koperczak
- Student Scientific Society, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (M.C.); (A.K.)
| | - Setlak Marcin
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
| | - Mikołaj Zimny
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
| | - Anna Zioła-Paździora
- Department of Pediatric Surgery, Upersiliesian Children’s Health Center in Katowice, 40-752 Katowice, Poland;
| | - Maciej Wojtacha
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
| | - Adam Rudnik
- Department of Neurosurgery, University Clinical Center, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (P.P.); (B.B.); (S.M.); (M.Z.); (M.W.); (A.R.)
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MacRae CB, Grieco KC, Solomon IH. Diagnostic yield of postmortem brain examination following premortem brain biopsy for neoplastic and nonneoplastic disease. J Neuropathol Exp Neurol 2024; 83:331-337. [PMID: 38501995 PMCID: PMC11029448 DOI: 10.1093/jnen/nlae025] [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] [Indexed: 03/20/2024] Open
Abstract
Medical autopsies have decreased in frequency due in part to advances in radiological techniques and increased availability of molecular and other ancillary testing. However, premortem diagnosis of CNS disease remains challenging; while ∼90% of brain tumor biopsies are diagnostic, only 20%-70% of biopsies for presumed nonneoplastic disease result in a specific diagnosis. The added benefits of performing an autopsy following surgical brain biopsy are not well defined. A retrospective analysis was performed of patients who underwent brain biopsy and autopsy at Brigham and Women's Hospital from 2003 to 2022. A total of 135 cases were identified, including 95 (70%) patients with primary CNS neoplasms, 16 (12%) with metastatic tumors, and 24 (18%) with nonneoplastic neurological disease. Diagnostic concordance between biopsy and autopsy diagnosis was excellent both for primary CNS neoplasms (98%) and metastatic tumors (94%). Conversely, patients with nonneoplastic disease received definitive premortem diagnoses in 7/24 (29%) cases. Five (21%) additional patients received conclusive diagnoses following autopsy; 8 (33%) received a more specific differential diagnosis compared to the biopsy. Overall, autopsy confirmed premortem diagnoses or provided new diagnostic information in 131/135 (97%) cases, highlighting the value in performing postmortem brain examination in patients with both neoplastic and nonneoplastic diseases.
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Affiliation(s)
- Cassie B MacRae
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristina C Grieco
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac H Solomon
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Bex A, Mathon B. Advances, technological innovations, and future prospects in stereotactic brain biopsies. Neurosurg Rev 2022; 46:5. [PMID: 36471144 PMCID: PMC9734929 DOI: 10.1007/s10143-022-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients' management algorithms based on early discharge after biopsy optimize the patient's personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients' postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.
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Affiliation(s)
- Alix Bex
- Department of Neurosurgery, CHR Citadelle, Liege, Belgium
| | - Bertrand Mathon
- Department of Neurosurgery, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 47-83, Boulevard de L'Hôpital, 75651 Cedex 13, Paris, France.
- ICM, INSERM U 1127, CNRS UMR 7225, UMRS, Paris Brain Institute, Sorbonne University, 1127, Paris, France.
- GRC 23, Brain Machine Interface, APHP, Sorbonne University, Paris, France.
- GRC 33, Robotics and Surgical Innovation, APHP, Sorbonne University, Paris, France.
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Malaizé H, Laigle-Donadey F, Riche M, Marijon P, Mokhtari K, Bielle F, Tran S, Nichelli L, Beccaria K, Idbaih A, Hoang-Xuan K, Touat M, Carpentier A, Mathon B. Roles and outcomes of stereotactic biopsy for adult patients with brainstem lesion. J Neurooncol 2022; 160:159-170. [PMID: 36083426 DOI: 10.1007/s11060-022-04129-x] [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: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to assess the benefit-risk ratio by determining diagnostic yield and safety of brainstem biopsies in adult patients. The secondary objectives were (i) to compare brainstem biopsy safety and postbiopsy patients' outcomes and survival with those of patients biopsied for a brain or cerebellar lesion, and (ii) to assess the impact of brainstem biopsy on final diagnosis and further therapeutic management. METHODS Among 1784 stereotactic biopsies performed in adult patients at a tertiary center between April 2009 and October 2020, we retrospectively examined 50 consecutive brainstem biopsies. We compared variables regarding diagnostic yield, safety and post-biopsy outcomes between brainstem biopsy patients and brain/cerebellum biopsy patients. RESULTS Brainstem biopsy led to a diagnosis in 86% of patients (94.6% in patients with suspected tumor). Lesion contrast enhancement on imaging was the sole predictor of obtaining a diagnosis. Rates of symptomatic complications and mortality were significantly higher in brainstem biopsy patients compared to brain/cerebellum biopsy patients (20% vs 0%; p < 0.001 and 6% vs 0%; p = 0.01, respectively). Transfrontal trajectory and prebiopsy swallowing disorders were predictors of brainstem biopsy-related symptomatic complications. Brainstem biopsy findings led to diagnostic change in 22% of patients. CONCLUSIONS Stereotactic biopsy in adult patients with brainstem lesion has a high diagnostic yield. Although stereotactic brainstem biopsy is associated with more functional and fatal complications than biopsies targeting the brain/cerebellum, its safety profile appears acceptable. Thus, the benefit-risk ratio of stereotactic biopsy in patients with brainstem lesion is favorable but should nevertheless be carefully weighted on a case-by-case basis.
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Affiliation(s)
- Henri Malaizé
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Florence Laigle-Donadey
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Maximilien Riche
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Pauline Marijon
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Karima Mokhtari
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Suzanne Tran
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Lucia Nichelli
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, University of Paris Cité, APHP, Necker - Enfants Malades Hospital, 75015, Paris, France
| | - Ahmed Idbaih
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Mehdi Touat
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Bertrand Mathon
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France. .,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France.
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