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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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Zhang H, Jiang X, Ren F, Gu Q, Yao J, Wang X, Zou S, Gan Y, Gu J, Xu Y, Wang Z, Liu S, Wang X, Wei B. Development and external validation of dual online tools for prognostic assessment in elderly patients with high-grade glioma: a comprehensive study using SEER and Chinese cohorts. Front Endocrinol (Lausanne) 2023; 14:1307256. [PMID: 38075045 PMCID: PMC10702965 DOI: 10.3389/fendo.2023.1307256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Elderly individuals diagnosed with high-grade gliomas frequently experience unfavorable outcomes. We aimed to design two web-based instruments for prognosis to predict overall survival (OS) and cancer-specific survival (CSS), assisting clinical decision-making. Methods We scrutinized data from the SEER database on 5,245 elderly patients diagnosed with high-grade glioma between 2000-2020, segmenting them into training (3,672) and validation (1,573) subsets. An additional external validation cohort was obtained from our institution. Prognostic determinants were pinpointed using Cox regression analyses, which facilitated the construction of the nomogram. The nomogram's predictive precision for OS and CSS was gauged using calibration and ROC curves, the C-index, and decision curve analysis (DCA). Based on risk scores, patients were stratified into high or low-risk categories, and survival disparities were explored. Results Using multivariate Cox regression, we identified several prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in elderly patients with high-grade gliomas, including age, tumor location, size, surgical technique, and therapies. Two digital nomograms were formulated anchored on these determinants. For OS, the C-index values in the training, internal, and external validation cohorts were 0.734, 0.729, and 0.701, respectively. We also derived AUC values for 3-, 6-, and 12-month periods. For CSS, the C-index values for the training and validation groups were 0.733 and 0.727, with analogous AUC metrics. The efficacy and clinical relevance of the nomograms were corroborated via ROC curves, calibration plots, and DCA for both cohorts. Conclusion Our investigation pinpointed pivotal risk factors in elderly glioma patients, leading to the development of an instrumental prognostic nomogram for OS and CSS. This instrument offers invaluable insights to optimize treatment strategies.
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Affiliation(s)
- Hongyu Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xinzhan Jiang
- Department of Neurobiology, Harbin Medical University, Harbin, China
| | - Fubin Ren
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiang Gu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiahao Yao
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xinyu Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuhuai Zou
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yifan Gan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianheng Gu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongji Xu
- Department of Neurosurgery, Hulin People’s Hospital, Jixi, Heilongjiang, China
| | - Zhao Wang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Shuang Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuefeng Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Baojian Wei
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
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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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