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Okamoto D, Ushijima Y, Fujita N, Ishimatsu K, Murayama R, Itoyama M, Ishigami K. Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion. MINIM INVASIV THER 2024; 33:171-175. [PMID: 38315057 DOI: 10.1080/13645706.2024.2311720] [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: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion. MATERIAL AND METHODS Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0. RESULTS The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies. CONCLUSION CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.
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Affiliation(s)
- Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Murayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Itoyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Papalexis N, Ponti F, Masi PD, Peta G, Savarese LG, Miceli M, Facchini G, Spinnato P. Transpedicular Contrast-enhanced CT-guided biopsy of the body and dens of the axis avoiding the trans-oral approach: Technical report and literature review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:118-122. [PMID: 38644913 PMCID: PMC11029103 DOI: 10.4103/jcvjs.jcvjs_183_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 04/23/2024] Open
Abstract
This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paola Di Masi
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Leonor Garbin Savarese
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Harada K, Shinojima N, Yamamoto H, Itoyama M, Uchida D, Dekita Y, Miyamaru S, Uetani H, Orita Y, Mikami Y, Nosaka K, Hirai T, Mukasa A. A Rare Case of Adult Poorly Differentiated Chordoma of the Skull Base With Rapid Progression and Systemic Metastasis: A Review of the Literature. Cureus 2024; 16:e51605. [PMID: 38173946 PMCID: PMC10764176 DOI: 10.7759/cureus.51605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Chordoma is a rare tumor that arises from chordal tissue during fetal life. Recently, the concept of poorly differentiated chordoma, a subtype of chordoma characterized by loss of SMARCB1/INI1 with a poorer prognosis than conventional chordomas, was established. It predominantly occurs in children and is rare in adults. Here, we report a rare adult case of poorly differentiated chordoma of the skull base with a unique course that rapidly systemically metastasized and had the shortest survival time of any adult chordoma reported to date. The patient was a 32-year-old male with a chief complaint of diplopia. MRI showed a widespread neoplastic lesion with the clivus as the main locus. Endoscopic extended transsphenoidal tumor resection was performed. Pathological findings showed that the tumor was malignant, and immunohistochemistry revealed a Ki-67 labeling index of 80%, diffusely positive brachyury, and loss of INI1 expression. The final diagnosis was poorly differentiated chordoma. Postoperatively, the residual tumor in the right cavernous sinus showed rapid growth. The patient was promptly treated with gamma knife three fractions. The residual tumor regressed, but the tumor developed systemic metastasis in a short period, and the patient died seven months after diagnosis. This report of a rapidly progressing and fatal adult poorly differentiated chordoma shows the highest Ki-67 labeling index reported to date. Prompt multidisciplinary treatment should be considered when the Ki-67 labeling index is high.
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Affiliation(s)
- Keisuke Harada
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Haruaki Yamamoto
- Department of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto, JPN
| | - Mai Itoyama
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Daichi Uchida
- Department of Radiosurgery, Kumamoto Radiosurgery Clinic, Kumamoto, JPN
| | - Yuji Dekita
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, JPN
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Hospital, Kumamoto, JPN
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, JPN
| | - Kisato Nosaka
- Department of Cancer Treatment Center, Kumamoto University Hospital, Kumamoto, JPN
- Department of Hematology, Rheumatology, and Infectious Diseases, Kumamoto University Hospital, Kumamoto, JPN
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, JPN
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
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Chernov IV, Shkarubo AN, Konyashin DA, Andreev DN. [Transoral approach in surgery for chordomas extending into craniovertebral junction: a systematic review of the literature]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:111-119. [PMID: 38881024 DOI: 10.17116/neiro202488031111] [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: 06/18/2024]
Abstract
To date, treatment of chordomas involves maximal tumor resection followed by proton therapy. Various approaches are used depending on location of tumor (transcranial and through natural anatomical openings (nose, mouth), as well as their combinations). Although transoral approach has been introduced into neurosurgical practice for a long time, it is routinely used in patients with chordoma only in certain hospitals in the world. OBJECTIVE To analyze postoperative outcomes in patients with chordomas of skull base and craniovertebral joint after transoral surgery. MATERIAL AND METHODS We analyzed literature data devoted to patients with chordomas of skull base and craniovertebral joint after transoral surgery or another approach combined with transoral access. Among 111 primary articles, we selected 38 manuscripts including description of 109 patients with skull base chordoma who underwent transoral surgery or combination of approaches including transoral one. RESULTS Gross total resection was achieved in 45.9% (n=50) of cases including 1 patient after en bloc resection. Subtotal resection was carried out in 28.4% of cases, partial - in 24.8%, biopsy - in 0.9% of cases. The complication rate in this group was 30%. The most common events were swelling of the tongue (10%) and diastasis of posterior pharyngeal wall sutures (8.2%) that required redo surgery. CSF leakage and meningitis were rare (1.8% and 3.6%, respectively). CONCLUSION Transoral access allows for gross total resection of midline tumors with low incidence of severe complications. Combination of transoral and transcranial approaches is advisable to increase extent of resection.
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Affiliation(s)
- I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - D A Konyashin
- Burdenko Voronezh State Medical University, Voronezh, Russia
| | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
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Spinnato P, Colangeli M, Rinaldi R, Ponti F. Percutaneous CT-Guided Bone Biopsies: Indications, Feasibility and Diagnostic Yield in the Different Skeletal Sites-From the Skull to the Toe. Diagnostics (Basel) 2023; 13:2350. [PMID: 37510093 PMCID: PMC10378450 DOI: 10.3390/diagnostics13142350] [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: 02/20/2023] [Revised: 06/13/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
CT-guided bone biopsies are currently the diagnostic tool of choice for histopathological (and microbiological) diagnoses of skeletal lesions. Several research works have well-demonstrated their safety and feasibility in almost all skeletal regions. This comprehensive review article aims at summarizing the general concepts in regard to bone biopsy procedures, current clinical indications, the feasibility and the diagnostic yield in different skeletal sites, particularly in the most delicate and difficult-to-reach ones. The choice of the correct imaging guidance and factors affecting the diagnostic rate, as well as possible complications, will also be discussed. Since the diagnostic yield, technical difficulties, and complications risk of a CT-guided bone biopsy significantly vary depending on the different skeletal sites, subdivided analyses of different anatomical sites are provided. The information included in the current review article may be useful for clinicians assisting patients with possible bone neoplasms, as well as radiologists involved in the imaging diagnoses of skeletal lesions and/or in performing bone biopsies.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Raffaella Rinaldi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Fiani B, Jarrah R, Shields J, Durrani S, Panico N, Mualem W, Nathani KR, Pasko K. A Comprehensive Overview of Pediatric Neoplasms at the Craniocervical Junction: Meningiomas, Schwannomas, and Chordomas. Cureus 2022; 14:e31083. [DOI: 10.7759/cureus.31083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
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Davoudzadeh E, Chen K, Mashriqi F, Caplin DM. Transoral Biopsy of the Clivus in a Pediatric Patient for Suspected Osteomyelitis. Cureus 2022; 14:e29548. [DOI: 10.7759/cureus.29548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
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Spinnato P, Rimondi E, Facchini G. Percutaneous CT-Guided Biopsy of the Craniovertebral Junction: Safety, Diagnostic Yield, and Technical Notes. Diagnostics (Basel) 2022; 12:diagnostics12010168. [PMID: 35054335 PMCID: PMC8774633 DOI: 10.3390/diagnostics12010168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
The craniovertebral junction defined as the occiput, the atlas, and the axis is a complex bony region that contains vital neural and vascular structures. We report the experience of a single academic institution regarding CT-guided biopsy of this skeletal region. We reviewed all of the CT-guided biopsies performed in our department, completed in the craniovertebral junction. We collected data in regard to biopsy procedures, patients’ vital statistics, and histopathological diagnosis. In total, 16 patients (8M and 8F; mean age 52; range 16–86 years old) were included in this series. In eight patients, the lesions were located in the atlas vertebra (8/16—50%), in six patients in the axis (37.5%), and in two patients in the occiput (12.5%). No complications were observed during or after the procedures. All of the procedures were technically successful. The biopsy was diagnostic in 13/16 patients (81.3%): four metastatic lesions (25%—three breast and one prostate cancers), four multiple myeloma bone lesions (25%), three aneurismal bone cysts (18.8%), one aggressive hemangioma (6.3%), and one pseudogout (6.3%). Moreover, in two-thirds (66.6%) of non-diagnostic histological reports, malignancies were excluded. CT-guided percutaneous biopsy is a safe tool and allows obtaining a histological diagnosis, in most cases, even in the most delicate site of the human skeleton—the craniovertebral junction.
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