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Kaes M, Beynon C, Kiening K, Neumann JO, Jakobs M. Stereotactic frame-based biopsy of infratentorial lesions via the suboccipital-transcerebellar approach with the Zamorano-Duchovny stereotactic system-a retrospective analysis of 79 consecutive cases. Acta Neurochir (Wien) 2024; 166:147. [PMID: 38520537 PMCID: PMC10960772 DOI: 10.1007/s00701-024-06036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Lesions of the posterior fossa (brainstem and cerebellum) are challenging in diagnosis and treatment due to the fact that they are often located eloquently and total resection is rarely possible. Therefore, frame-based stereotactic biopsies are commonly used to asservate tissue for neuropathological diagnosis and further treatment determination. The aim of our study was to assess the safety and diagnostic success rate of frame-based stereotactic biopsies for lesions in the posterior fossa via the suboccipital-transcerebellar approach. METHODS We performed a retrospective database analysis of all frame-based stereotactic biopsy cases at our institution since 2007. The aim was to identify all surgical cases for infratentorial lesion biopsies via the suboccipital-transcerebellar approach. We collected clinical data regarding outcomes, complications, diagnostic success, radiological appearances, and stereotactic trajectories. RESULTS A total of n = 79 cases of stereotactic biopsies for posterior fossa lesions via the suboccipital-transcerebellar approach (41 female and 38 male) utilizing the Zamorano-Duchovny stereotactic system were identified. The mean age at the time of surgery was 42.5 years (± 23.3; range, 1-87 years). All patients were operated with intraoperative stereotactic imaging (n = 62 MRI, n = 17 CT). The absolute diagnostic success rate was 87.3%. The most common diagnoses were glioma, lymphoma, and inflammatory disease. The overall complication rate was 8.7% (seven cases). All patients with complications showed new neurological deficits; of those, three were permanent. Hemorrhage was detected in five of the cases having complications. The 30-day mortality rate was 7.6%, and 1-year survival rate was 70%. CONCLUSIONS Our data suggests that frame-based stereotactic biopsies with the Zamorano-Duchovny stereotactic system via the suboccipital-transcerebellar approach are safe and reliable for infratentorial lesions bearing a high diagnostic yield and an acceptable complication rate. Further research should focus on the planning of safe trajectories and a careful case selection with the goal of minimizing complications and maximizing diagnostic success.
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Affiliation(s)
- Manuel Kaes
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Department of Neurosurgery, Division for Stereotactic Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Medical Faculty, Heidelberg University, Grabengasse 1, 69117, Heidelberg, Germany.
| | - Christopher Beynon
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Grabengasse 1, 69117, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Neurosurgery, Division for Stereotactic Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Grabengasse 1, 69117, Heidelberg, Germany
| | - Jan-Oliver Neumann
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Neurosurgery, Division for Stereotactic Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Grabengasse 1, 69117, Heidelberg, Germany
| | - Martin Jakobs
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Department of Neurosurgery, Division for Stereotactic Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Grabengasse 1, 69117, Heidelberg, Germany
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Gavryushin AV, Khukhlaeva EA, Veselkov AA, Pronin IN, Konovalov AN. [Primary tumors of the brain stem. State of the problem]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:98-104. [PMID: 38549416 DOI: 10.17116/neiro20248802198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Primary brainstem gliomas are still poorly studied in neurooncology. This concept includes tumors with different histological and genetic features, as well as variable clinical course and outcomes. Nevertheless, treatment implies radiotherapy without a clear idea of morphological substrate of disease in 80% of cases. Small number of studies and insufficient data on histological and genetic nature of brainstem tumors complicate clear diagnostic and treatment algorithms. This review provides current information regarding primary glial brainstem tumors. Appropriate problems and objectives are highlighted. The purpose of the review is to provide a comprehensive and updated understanding of the current state of brainstem glial tumors and to identify areas requiring further study for improvement of diagnosis and treatment of these diseases. Brainstem tumors are an understudied problem with small amount of data that complicates optimal treatment strategies. Further researches and histological verification are required to develop new methods of therapy, especially for diffuse forms of neoplasms.
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Affiliation(s)
- A V Gavryushin
- Burdenko Neurosurgical Center, Moscow, Russia
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia
| | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Tripathy A, John V, Wadden J, Kong S, Sharba S, Koschmann C. Liquid biopsy in pediatric brain tumors. Front Genet 2023; 13:1114762. [PMID: 36685825 PMCID: PMC9853427 DOI: 10.3389/fgene.2022.1114762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
Malignant primary brain tumors are the most common cancer in children aged 0-14 years, and are the most common cause of death among pediatric cancer patients. Compared to other cancers, pediatric brain tumors have been difficult to diagnose and study given the high risk of intracranial biopsy penetrating through vital midline structures, where the majority of pediatric brain tumors originate (Ostrom et al., 2015). Furthermore, the vast majority of these tumors recur. With limitations in the ability to monitor using clinical and radiographic methods alone, minimally invasive methods such as liquid biopsy will be crucial to our understanding and treatment. Liquid biopsy of blood, urine, and cerebrospinal fluid (CSF) can be used to sample cfDNA, ctDNA, RNA, extracellular vesicles, and tumor-associated proteins. In the past year, four seminal papers have made significant advances in the use of liquid biopsy in pediatric brain tumor patients (Liu et al., 2021; Cantor et al., 2022; Miller et al., 2022; Pagès et al., 2022). In this review, we integrate the results of these studies and others to discuss how the newest technologies in liquid biopsy are being developed for molecular diagnosis and treatment response in pediatric brain tumors.
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Affiliation(s)
- Arushi Tripathy
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, United States
| | - Vishal John
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
| | - Jack Wadden
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
| | - Seongbae Kong
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
| | - Sana Sharba
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
| | - Carl Koschmann
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, United States
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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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Hirano Y, Shinya Y, Aono T, Hasegawa H, Kawashima M, Shin M, Takami H, Takayanagi S, Umekawa M, Ikemura M, Ushiku T, Taoka K, Tanaka S, Saito N. The Role of Stereotactic Frame-Based Biopsy for Brainstem Tumors in the Era of Molecular-Based Diagnosis and Treatment Decisions. Curr Oncol 2022; 29:4558-4565. [PMID: 35877220 PMCID: PMC9318548 DOI: 10.3390/curroncol29070360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic frame-based brain tumor biopsy (SFB) is a potent diagnostic tool considering its minimal invasiveness, though its diagnostic power and safety for brainstem lesions remain to be discussed. Here, we aimed to examine the usefulness of SFB for brainstem tumors. Twenty-two patients with brainstem tumors underwent 23 SFBs at our institution during 2002–2021. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including surgery-related complications and the diagnostic value. Seven (32%) tumors were located from the midbrain to the pons, eleven (50%) in the pons only, and four (18%) from the pons to the medulla oblongata. The target lesions were in the middle cerebellar peduncles in sixteen procedures (70%), the cerebellum in four (17%), the inferior cerebellar peduncles in two (9%), and the superior cerebellar peduncles in one (4%). A definitive diagnosis was made in 21 patients (95%) at the first SFB. The diagnoses were glioma in seventeen (77%) cases, primary central nervous system lymphoma in four (18%), and a metastatic brain tumor in one (5%). The postoperative complications (cranial nerve palsy in three [13%] cases, ataxia in one [4%]) were all transient. SFB for brainstem tumors yields a high diagnostic rate with a low risk of morbidity.
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Affiliation(s)
- Yudai Hirano
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan;
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Correspondence: (Y.S.); (S.T.); Tel.: +03-5800-8853 (Y.S.)
| | - Toshiya Aono
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Masahiro Shin
- Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan;
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Shunsaku Takayanagi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
| | - Masako Ikemura
- Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (M.I.); (T.U.)
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (M.I.); (T.U.)
| | - Kazuki Taoka
- Department of Hematology and Oncology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
- Correspondence: (Y.S.); (S.T.); Tel.: +03-5800-8853 (Y.S.)
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; (Y.H.); (T.A.); (H.H.); (M.K.); (H.T.); (S.T.); (M.U.); (N.S.)
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