Stereotactic Biopsy Of Intracranial Lesions Research Articles

Indicators of correct targeting in stereotactic biopsy of intracranial lesions.

Background: Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.Methods: Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.Results: Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.Conclusion: This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.

A Bulk Retrospective Study of Robot-Assisted Stereotactic Biopsies of Intracranial Lesions Guided by Videometric Tracker

Background: Biopsies play an important role in the diagnosis of intracranial lesions, and robot-assisted procedures are increasingly common in neurosurgery centers. This research investigates the diagnoses, complications, and technology yield of 700 robotic frameless intracranial stereotactic biopsies conducted with the Remebot system.Method: This research considered 700 robotic biopsies performed between 2016 and 2020 by surgeons from the Department of Functional Neurosurgery in Beijing's Tiantan Hospital. The data collected included histological diagnoses, postoperative complications, operation times, and the accuracy of robotic manipulation.Results: Among the 700 surgeries, the positive rate of the biopsies was 98.2%. The most common histological diagnoses were gliomas, which accounted for 62.7% of cases (439/700), followed by lymphoma and germinoma, which accounted for 18.7% (131/700) and 7.6% (53/700). Bleeding was found in 14 patients (2%) by post-operation computed tomography scans. A total of 29 (4.14%) patients had clinical impairments after the operation, and 9 (1.29%) experienced epilepsy during the operation. The post-biopsy mortality rate was 0.43%. Operation time—from marking the cranial point to suturing the skin—was 16.78 ± 3.31 min (range 12–26 min). The target error was 1.13 ± 0.30 mm, and the entry point error was 0.99 ± 0.24 mm.Conclusion: A robot-assisted frameless intracranial stereotactic biopsy guided by a videometric tracker is an efficient, safe, and accurate method for biopsies.

Endoscopic versus stereotactic biopsies of intracranial lesions involving the ventricles

Stereotactic biopsies of ventricular lesions may be less safe and less accurate than biopsies of superficial lesions. Accordingly, endoscopic biopsies have been increasingly used for these lesions. Except for pineal tumors, the literature lacks clear, reliable comparisons of these two methods. All 1581 adults undergoing brain tumor biopsy from 2007 to 2018 were retrospectively assessed. We selected 119 patients with intraventricular or paraventricular lesions considered suitable for both stereotactic and endoscopic biopsies. A total of 85 stereotactic and 38 endoscopic biopsies were performed. Extra procedures, including endoscopic third ventriculostomy and tumor cyst aspiration, were performed simultaneously in 5 stereotactic and 35 endoscopic cases. In 9 cases (5 stereotactic, 4 endoscopic), the biopsies were nondiagnostic (samples were nondiagnostic or the results differed from those obtained from the resected lesions). Three people died: 2 (1 stereotactic, 1 endoscopic) from delayed intraventricular bleeding and 1 (stereotactic) from brain edema. No permanent morbidity occurred. In 6 cases (all stereotactic), additional surgery was required for hydrocephalus within the first month postbiopsy. Rates of nondiagnostic biopsies, serious complications, and additional operations were not significantly different between groups. Mortality was higher after biopsy of lesions involving the ventricles, compared with intracranial lesions in any location (2.4% vs 0.3%, p = 0.016). Rates of nondiagnostic biopsies and complications were similar after endoscopic or stereotactic biopsies. Ventricular area biopsies were associated with higher mortality than biopsies in any brain area.

Evaluation of intraoperative MRI-assisted stereotactic brain tissue biopsy: a single-center experience in China

BackgroundThis study aimed to investigate the value of high field-strength intraoperative magnetic resonance imaging (iMRI)-guided stereotactic biopsy in the surgery of intracranial space-occupying lesions.MethodsA total of 87 patients who underwent stereotactic biopsy of intracranial lesions in the Peking University International Hospital from March 2016 to August 2018 were retrospectively surveyed; among these, 50 patients underwent MRI-guided stereotactic biopsy using the Leksell frame (iMRI group) and 37 cases received traditional stereotactic biopsy using the Leksell frame (control group). The accuracy rates and complications of the two groups were compared.ResultsA 100% positive diagnosis was observed in all cases (n = 50) in the iMRI group. In 4 cases, the biopsy site was clearly found to have deviated from the target point, and the biopsy was performed again. The control group had 33 cases (86.5%) with positive diagnosis. No severe complications like neural functional deficit were observed in the iMRI group, while two patients developed bleeding at the puncture site (1 case receiving surgery to remove the hematoma) in the control group. There were no deaths in either group.ConclusioniMRI-assisted stereotactic biopsy can confirm the target position and adjust the puncture path in real time. Compared to the traditional stereotactic biopsy technique, the iMRI method has a higher positive diagnostic rate, though surgical trauma and complications have no significant difference.

Clinical application of multimodal image fusion in stereotactic biopsy of intracranial lesions

Objective To explore the clinical application of multimodal image fusion in stereotactic biopsy of intracranial lesions. Methods A total of 34 patients underwent multimodal image-guided stereotactic biopsy and were enrolled into this study from January to December 2016 at Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University. Images including PET/CT, 1H-MRS, BOLD-fMRI, DTI were fused with structural MRI for target confirmation and trajectory design. Framed stereotactic biopsy was performed in 14 patients and frameless stereotactic biopsy was performed in the other 20 patients. The diagnostic yield and complications of biopsy were assessed. Results Stereotactic biopsy was successfully performed in all cases including 32 with supratentorial lesions and 2 with infratentoria lesions. Post-biopsy pathology revealed glioma in 14 patients, lymphoma in 12, metastatic tumors in 6 and inflammatory demyelinating diseases in 2. The diagnostic yield was 100%. Post-biopsy CT confirmed the accuracy of biopsy targets. A small hematoma (< 5 ml) in target area was found in 1(2.9%, 1/34) patient without severe complications and no further operation was performed. There was no bleeding in any trajectory or newly-occurred neurological deficits. Conclusion Multimodal image fusion could provide anatomical, metabolic and functional information for stereotactic biopsy, increase diagnostic yield and reduce complications. Key words: Brain diseases; Biopsy; Stereotactic technology; Multimodal image fusion technique

Preoperative assessment of haemostasis in patients undergoing stereotactic brain biopsy

Parenchymal hemorrhage is considered a major risk factor for perioperative morbidity in patients undergoing stereotactic brain biopsy. Studies on patients undergoing surgical procedures have suggested that evaluation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) is of limited value with regard to prevention of haemorrhagic complications. However, this issue has not yet been addressed in patients undergoing stereotactic biopsy of intracranial lesions. We retrospectively analysed the medical records of 159 consecutive patients undergoing stereotactic biopsy of supratentorial intracranial lesions during a three-year period. Laboratory values (PT, aPTT, platelet count) were reviewed as well as clinical characteristics, modalities of surgical treatment, histopathological results and the postoperative course of patients. The overall diagnostic yield was 93.7%. Histopathological examination revealed glioma (WHO°I: 5, WHO°II: 25, WHO°III: 23, WHO°IV: 65), lymphoma (n = 14), inflammation (n = 8) and other entities (n = 6). Surgery-associated neurological deficits occurred in 7 patients (4.4%) and completely resolved in 6 of these patients. CT-confirmed intracranial hemorrhage occurred in 2 patients (1.3%) and in both cases, histopathological examination revealed glioblastoma. Results of hemostatic parameters (PT: 99 ± 13%, aPTT: 24 ± 3s, platelet count: 274 ± 87 103/μL) were within normal range values in all patients and did not correlate with postsurgical morbidity. Standard assessment of haemostasis seems to be of limited value in patients with intracranial lesions undergoing stereotactic biopsy. Further studies regarding the intratumoural vasculature’s impact on the risk of biopsy-related bleeding are necessary.

The Safety and Efficacy of Frame-Based Stereotactic Biopsy of Brain Lesion

Background Radiological imaging techniques provide early detection of neurological diseases, but they do not always provide an adequate diagnosis. With the help of stereotactic biopsy techniques, it is possible to access deep-brain lesions safely and with high precision, being crucial in the elaboration of therapeutic strategies and prevents unnecessary neurosurgical interventions. Aim To evaluate the safety, diagnostic yields, and associated mortality and morbidity of computed tomography-guided stereotactic biopsy for intracranial lesions. Materials and Methods A retrospective study of all pathologically diagnosed intracranial biopsies, between 2010 and 2016 in Baghdad Neurosurgical Teaching Hospital, was conducted. Stereotactic biopsies were performed by using the Leksell stereotactic frame in 116 patients. Medical charts, radiological studies, and postoperative complications were reviewed, and then the information was analyzed. Results A total of 116 patients underwent stereotactic surgery procedures. Patients consisted of 66 females and 50 males, ages ranging from 7 to 74 years (mean 44.4 ± 19.35 years). General anesthesia was used in 88 patients. The rest were performed under local anesthesia. The overall diagnostic yield was 98.3%. Complications were observed in 8.6% of the cases, with morbidity 5.1% of the cases, and the overall mortality rate was 3.4%. These results are comparable to other reports. Other clinical, radiological, or histological variables were not associated with an increased risk of complications. Conclusion Our findings support that frame-based stereotactic biopsy is a relatively safe and valuable technique that allows the neurosurgeon to obtain tissue samples for histopathological diagnosis of most of the intracranial mass lesions.

Implementation of multimodal navigation combined with intraoperative magnetic resonance imaging in the frameless stereotactic biopsy of intracranial lesions

Objective: To investigate the impact and value of multimodal navigation and intraoperative magnetic resonance imaging (iMRI) on the biopsy of intracranial lesions. Methods: From February, 2009 to December, 2016, this study enrolled 156 patients, who underwent multimodal navigation and iMRI-guided brain biopsy in the Neurosurgery Department of PLA General Hospital. Metabolic information was used for biopsy target selection. Intraoperative guidance helped biopsy trajectory avoid the eloquent structures. iMRI was performed to prove the biopsy accuracy and to revise the incorrect biopsy. Diagnostic rate, perioperative neurological status, surgical parameter, and surgical outcome were recorded. Results: The first iMRI helped to revise 7 (4.5%) incorrect biopsy sites, and final iMRI confirmed biopsy accuracy in all cases. Postoperative diagnostic rate was 96.8% (151/156). No statistical difference was found between postoperative and preoperative neurological statuses, despite 86 (55.1%) lesions were adjacent to eloquent areas. Additionally, iMRI detected 6 (3.8%) intraoperative hematomas that were treated immediately. Conclusions: Brian biopsy with iMRI and multimodal navigation is a safe, accurate and efficient biopsy modality. This technique may help increase the biopsy accuracy with low morbidity and mortality.

Computerized Tomography-Guided Stereotactic Biopsy of Intracranial Lesions: Report of 500 Consecutive Cases.

Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients. Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67). Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures. CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.

Automated proton magnetic resonance spectroscopy imaging guided frameless stereotactic biopsy of intracranial lesions

To evaluate the feasibility, reliability and accuracy of the automated magnetic resonance spectroscopy ((1)H-MRS) guided frameless brain biopsy with intraoperative magnetic resonance imaging (iMRI). Between July 2011 and July 2013, a consecutive series of 93 patients were prospectively enrolled. All the patients had intracranial lesions which need biopsy to confirm the diagnosis. Among them, 48 patients were male, 45 patients were female. Their age range from 7 years to 76 years, the median age was 47 years. All patients underwent MRS examination. With MRS automatic fusion technique, the metabolic images were integrated into a standard navigation system (Vario Guide) to guide frameless biopsy. High-field iMRI (1.5 T) was used for target inspection, brain shift correction, and intra-operative exclusion of intra-cerebral hemorrhage and other complications. For all the 93 patients, (1)H-MRS based metabolic images could be automatically integrated into a standard navigation system and average fusion procedure could be taken 5 minutes 6 seconds. For (1)H-MRS guided stereotactic biopsy of intracranial lesions, the diagnosis yield rate was 94.6% (88/93). Four cases did not get a clear pathological diagnosis, while 1 case did not match the pathological diagnosis result which obtained by following craniotomy. Technical related complication rate was 2.2% (2 cases, intra-cerebral hemorrhage), which were intra-operatively depicted with iMRI, and managed properly. Among them, 1 case with small volume (5 ml) intracerebral hematoma fully recovered 10 days after surgery without second surgical intervention. One case with large volume intracerebral hematoma (32 ml) was depicted with iMRI, followed by craniotomy and hematoma evacuation in the same session. This case had no new or worsened neurologic deficit post-operatively. (1)H-MRS based metabolic imaging can be automatically integrated into a standard navigation system and used for frameless brain biopsy. The target can be selected according to the metabolic status of the lesion. Hence, the target can be more accurate. And the pathological diagnosis yield rate is higher. With iMRI, the method is safe, and has high clinical efficacy.

Computed tomography-guided stereotactic biopsy of intracranial lesions in pediatric patients

The primary objective of this study was to report the results of author's 18-year experience of diagnostic stereotactic biopsy procedures in children with intracranial lesions. A retrospective analysis was conducted on stereotactic procedures performed on children with brain tumor between 1989 and 2007. Stereotactic biopsy of intracranial tumors was performed in 172 children (69 girls, and 103 boys) with the mean age of 9.17 ± 3.66years at the time of diagnosis. The most frequent anatomical location of lesions was brainstem (45.9%). Glioma was the most common diagnosis, represented in 90.7% of patients (156 patients). Other diagnosed tumors (4.7%) were classified as metastatic (1.7%), lymphomas (1.2%), oligodendroglioma (0.6%), craniopharyngioma (0.6%), and pineocytoma (0.6%). Nonneoplastic lesions were revealed in 4.7% of patients. The most frequent brain pathology of children is glioma, but the incidence of brain lesions other than gliomas and the frequency of brain lesions in the inoperable areas are compelling reasons to establish tissue diagnosis.

Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre

BackgroundPreviously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain lesions. The yield then (1996–2006) was 89.4%. In the present study, we review and evaluate our experience with intraoperative frozen-section histopathologic diagnosis on-demand in order to improve the diagnostic yield.MethodsOne hundred sixty-four consecutive frameless biopsy procedures in 160 patients (group 1, 2006–2010) were compared with the historic control group (group 2, n = 164 frameless biopsy procedures). Diagnostic yield, as well as demographics, morbidity and mortality, was compared. Statistical analysis was performed by Student's t, Mann–Whitney U, Chi-square test and backward logistic regression when appropriate.ResultsDemographics were comparable. In group 1, a non-diagnostic tissue specimen was obtained in 1.8%, compared to 11.0% in group 2 (p = 0.001). Also, both the operating time and the number of biopsies needed were decreased significantly. Procedure-related mortality decreased from 3.7% to 0.6% (p = 0.121). Multivariate analysis only proved operating time (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.000–1.025; p = 0.043), a right-sided lesion (OR, 3.183; 95% CI, 1.217–8.322; p = 0.018) and on-demand intraoperative histology (OR, 0.175; 95% CI, 0.050–0.618; p = 0.007) important factors predicting non-diagnostic biopsies.ConclusionsThe importance of a reliable pathological diagnosis as obtained by biopsy must not be underestimated. We believe that when performing stereotactic biopsy for intracranial lesions, next to minimising morbidity, one should strive for as high a positive yield as possible. In the present single centre retrospective series, we have shown that using a standardised procedure and careful on-demand intraoperative frozen-section analysis can improve the diagnostic yield of stereotactic brain biopsy procedures as compared to a historical series.

Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients

Image guided stereotactic biopsy (SB) provides cerebral tissue samples for histological analysis from minimal lesions or those that are located in deep regions, being crucial in the elaboration of therapeutic strategies, as well as the prevention of unnecessary neurosurgical interventions. Sixty patients with central nervous lesions underwent SB from November 1999 to March 2008. They were followed up to 65 months. Preoperative diagnosis was based on clinical presentation and neuro-radiological features, pathologic diagnosis, clinical outcome. The compatibility of these findings with the pathologic diagnosis was analyzed. Considering diagnosis confirmation when inflammatory hypothesis were made, our accuracy was of 76%, with 94% of those cases having clinic-pathological correspondence after an average of 65.2 months of follow up. Considering diagnosis confirmation with the preoperative hypothesis of neoplasm, our accuracy was of 69% with 90% of these cases having clinic-pathological correspondence after an average of 47.3 months of follow-up. Morbidity rate was of 5% and mortality was zero. The diagnosis rate was 95%. Stereotactic biopsy represents a safe and precise method for diagnosis. Anatomic and histopathological analyses have high compatibility with long-term clinical outcome.

Early Experience with the Gill Thomas Locator for Computed Tomography-Directed Stereotactic Biopsy of Intracranial Lesions

Early Experience with the Gill Thomas Locator for Computed Tomography-Directed Stereotactic Biopsy of Intracranial Lesions

Early experience with the Gill Thomas Locator for computed tomography-directed stereotactic biopsy of intracranial lesions.

The Gill Thomas Locator is a stereotactic adaptor for the Brown-Roberts-Wells and Cosman-Roberts-Wells systems. It is a noninvasive device that relies on temporary fixation to the maxillary teeth. A series of 20 patients have had stereotactic biopsies with this system. A diagnostic biopsy was obtained in 19 cases. The frame was well tolerated, accurately relocatable, and allowed computed tomographic scanning and surgery to be conducted at different times.

Computer-assisted stereotactic biopsy of intracranial lesions in pediatric patients.

A computer-assisted stereotactic biopsy technique has been used in 30 patient (ages 5 months to 16 years) with intracranial lesions (supratentorial in 23 and infratentorial in 7). The computer program integrates stereotactically gathered imaging data and permits preoperative planning of a biopsy trajectory. Diagnostic tissue was obtained in 27 cases. In 2 cases, therapeutic interventions--third ventriculostomy and cyst aspiration--were accomplished at the time of the biopsy. There were no major complications related to the procedure; however, 2 patients had transient neurologic deficits. Computer-assisted stereotactic biopsy is a valuable diagnostic procedure in the pediatric patient with an intracranial lesion.

Computer-assisted stereotactic biopsy of intracranial lesions.

The use of a computer program that allows the integration of stereotactically gathered CT, MRI and digital angiographic data in the planning of a biopsy trajectory is described. This system has been used to perform 447 stereotactic biopsies in 439 patients. Intracranial hemorrhages occurred in three patients; combined morbidity and mortality was less than 1%. Incorporation of angiographic data and visualization of the surgical trajectory enhances the safety and accuracy of stereotactic biopsy of intracranial lesions.

Stereotactic CT scanning for the biopsy of intracranial lesions and functional neurosurgery.

This report describes a system for incorporation of stereotactic CT scanning data, stereotactic arteriographic data and a computer-generated stereotactic atlas into a three-dimensional matrix utilizing an operating room computer. 86 patients have undergone computer-assisted stereotactic biopsies of intracranial lesions without mortality or neurologic morbidity. Neuroablative and neuroaugmentative procedures have been performed on 5 patients using the CT stereotactic atlas with good correlation with target points determined by ventriculography and microelectrode recording.