Current Trends for Improving Safety of Stereotactic Brain Biopsies: Advanced Optical Methods for Vessel Avoidance and Tumor Detection.

Serik K Akshulakov,Dara S Farhadi,Talgat T Kerimbayev,Michael Y Biryuchkov,Vadim A Byvaltsev,Yermek A Urunbayev

doi:10.3389/fonc.2019.00947

Serik K Akshulakov, Dara S Farhadi + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2019.00947

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Abstract

Stereotactic brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh the potential outcome benefits. The main goal of such procedures is not to improve the resection extent but to safely acquire viable tissue representative of the lesion for further comprehensive histological, immunohistochemical, and molecular analyses. Herein, we review advanced optical techniques for improvement of safety and efficacy of stereotactic needle biopsy procedures. These technologies are aimed at three main areas of improvement: (1) avoidance of vessel injury, (2) guidance for biopsy acquisition of the viable diagnostic tissue, and (3) methods for rapid intraoperative assessment of stereotactic biopsy specimens. The recent technological developments in stereotactic biopsy probe design include the incorporation of fluorescence imaging, spectroscopy, and label-free imaging techniques. The future advancements of stereotactic biopsy procedures in neuro-oncology include the incorporation of optical probes for real-time vessel detection along and around the biopsy needle trajectory and in vivo confirmation of the diagnostic tumor tissue prior to sample acquisition.

Highlights

Brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh the potential outcome benefits
Current developments for increasing the safety and efficacy of stereotactic brain biopsy procedures are centered around the two main areas: avoidance of the vessels and detection of the viable diagnostic tissue, which could be achieved in vivo or ex vivo (Figure 1D)
Because vessel avoidance is a major component for the safety of any stereotactic needle-based procedure including needle brain biopsy, deep brain stimulation [77], or interstitial laser thermal therapy [78, 79], advancements in the surgical tools that allow for timely vessel detection is of utmost importance

Summary

Introduction

Brain needle biopsies are indicated for deep-seated or multiple brain lesions and for patients with poor prognosis in whom the risks of resection outweigh the potential outcome benefits. A recent systematic review and evidence-based clinical practice guideline investigating the role of stereotactic brain biopsy for low-grade gliomas provided level III evidence in support of brain biopsies and recommended that surgeons consider using advanced imaging techniques to improve diagnostic accuracy [1]. In suspected low-grade tumors that are not considered for resection, biopsy location should be planned based on molecular guidance techniques, such as positron emission tomography, magnetic resonance (MR) spectroscopy, or others in order to provide a reliable molecular diagnosis [2]. The current standard-of-care method for stereotactic brain needle biopsy involves a 1.6- to 2-mm-diameter needle cannula insertion through a cranial burr-hole aligned to a predetermined trajectory. When the desired position is reached, these windows are aligned, and brain tissue is lodged into cannula using suction and cut by sliding the inner cannula

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