Clinical Validation of True Frameless Stereotactic Biopsy: Analysis of the First 125 Consecutive Cases

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 830-837 ◽  
Author(s):  
Theophilos S. Paleologos ◽  
Neil L. Dorward ◽  
John P. Wadley ◽  
David G.T. Thomas
Keyword(s):  
Operative Time ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Target Selection ◽  
Guidance System ◽  
Morbidity Rate ◽  
Clinical Validation ◽  
Stereotactic Technique ◽  
The Mean ◽  
Stereotactic Biopsies

Abstract OBJECTIVE A lockable guide device, adjustable for positioning, was used to obtain samples for tissue analysis during brain biopsy procedures performed using an interactive image guidance system. Clinical validation of this technique, which was developed for true frameless stereotactic biopsies, and analyses of the histological yield, complication rate, and patient demographic characteristics for a large series of frameless stereotactic biopsies were the purposes of this study. METHODS Demographic, radiological, surgical, and clinical data were prospectively collected for a series of 125 frameless stereotactic biopsies performed using the technique described in detail previously. RESULTS Eighty-six procedures were magnetic resonance imaging-directed and 39 were computed tomography-directed. The mean diameter of the biopsied lesions was 36 mm, and the mean distance from the skin was 35.8 mm. Sixteen percent of the patients harbored multiple lesions, and 5.6% of the biopsied lesions were infratentorial. The mean operative time (including the entire anesthetic time) was 1.5 hours. The smear examination findings were corroborated by conclusive histological results in 96% of the cases, and definitive positive diagnoses were obtained in 122 cases (97.6%). Ten patients experienced surgical complications, but the sustained morbidity rate was 2.4% (including the death of a patient who was in critical clinical condition preoperatively and who died 2 mo later as a result of a chest infection; mortality rate, 0.8%). CONCLUSION This true frameless stereotactic biopsy technique was associated with low morbidity and mortality rates and an excellent diagnostic yield, with overall results at least as good as those observed for frame-based stereotaxy. The excellent accuracy results demonstrated previously and statistically significant reductions in operative time, as well as improved image presentation, target selection, and simplicity, support the use of this frameless stereotactic technique in preference to frame-based biopsy techniques.

Stereotactic Biopsy and Resection of Thalamic Astrocytomas

Neurosurgery ◽  
1989 ◽  
Vol 25 (2) ◽  
pp. 185-195 ◽  
Author(s):  
Patrick J. Kelly
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Biopsy ◽  
Mass Effect ◽  
Additional Patient ◽  
Pilocytic Astrocytomas ◽  
Neurological Morbidity ◽  
The Mean ◽  
Grade 3 ◽  
Stereotactic Biopsies ◽  
Significant Mass Effect

Abstract In this study of 72 patients who had histologically verified thalamic astrocytomas, 44 patients underwent stereotactic serial biopsy, 22 underwent stereotactic resection of the neoplasm, and an additional 6 patients underwent stereotactic biopsy followed by stereotactic resection of the tumor at a later date. Of the 50 patients who underwent stereotactic biopsy, 3 were neurologically worse after the procedure (morbidity, 6%), and 3 additional patients with Grade 4 astrocytomas who preoperatively were rapidly deteriorating neurologically, died within 30 days of the procedure. Of the 28 patients who underwent stereotactic resection, 14 were neurologically improved after the procedure, 10 were unchanged, and 4 were worse. One additional patient died 10 days postoperatively. Thirty-four patients had Grade 4 astrocytomas: 27 underwent stereotactic biopsies. The mean survival after biopsy and irradiation for patients with Grade 4 astrocytomas was 21.4 weeks. The mean survival was 62 weeks in 7 patients with Grade 4 astrocytomas who underwent stereotactic resection and radiation therapy. The mean survival time after biopsy and radiation therapy for patients who had Grade 3 and Grade 2 lesions was 54.4 weeks and 91 weeks, respectively. Twenty-three patients had pilocytic astrocytomas; 8 underwent stereotactic biopsies, and 19 underwent stereotactic resection of the tumor (4 of these underwent biopsy prior to resection). There was no neurological morbidity, but one patient died after resection. Many of those who underwent resection were deteriorating due to an enlarging tumor mass or recurring cyst, and had undergone more conservative therapies such as biopsy and radiation. Even though stereotactic biopsy is appropriate in many patients harboring thalamic astrocytomas, selected patients with significant mass effect from solid tumor or recurring cyst can benefit from stereotactic resection.

Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique

2006 ◽  
Vol 104 (2) ◽  
pp. 233-237 ◽  
Author(s):  
Graeme F. Woodworth ◽  
Matthew J. McGirt ◽  
Amer Samdani ◽  
Ira Garonzik ◽  
Alessandro Olivi ◽  
...  
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Brain Biopsy ◽  
Morbidity Rate ◽  
Frameless Stereotaxy ◽  
Cortical Lesions ◽  
Stereotactic Brain Biopsy ◽  
Biopsy Procedure ◽  
Image Guided ◽  
Permanent Morbidity

Object The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques. Methods A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling. Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity. Conclusions With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.

scholarly journals Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

2015 ◽  
Vol 122 (2) ◽  
pp. 342-352 ◽  
Author(s):  
Michel Lefranc ◽  
Cyrille Capel ◽  
Anne-Sophie Pruvot-Occean ◽  
Anthony Fichten ◽  
Christine Desenclos ◽  
...  
Keyword(s):  
Stereotactic Biopsy ◽  
Clinical Symptoms ◽  
Diagnostic Yield ◽  
Ct Scanning ◽  
Fiducial Marker ◽  
Surface Registration ◽  
Histological Diagnosis ◽  
Consecutive Series ◽  
Mortality And Morbidity ◽  
Stereotactic Biopsies

OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

scholarly journals Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

2020 ◽  
Author(s):  
Bhavin B. Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Operative Time ◽  
Univariate Analysis ◽  
Operating Time ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
The Mean ◽  
Eras Protocol

ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.

scholarly journals From Small Acorns – Developing a Laparoscopic Colorectal Surgical Service

2008 ◽  
Vol 90 (7) ◽  
pp. 606-611 ◽  
Author(s):  
JK Smith ◽  
AG Acheson ◽  
JAD Simpson ◽  
J Stewart ◽  
IJ Beckingham ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Resection Margin ◽  
Laparoscopic Colorectal Surgery ◽  
Morbidity Rate ◽  
Lymph Node Retrieval ◽  
Clear Resection Margin ◽  
The Mean ◽  
Randomised Controlled

INTRODUCTION Randomised controlled trials have shown that laparoscopic colorectal surgery is equal in terms of safety to open surgery. Benefits have been seen for length of stay, blood loss, immune suppression and analgesia requirements. The aim of this study was to assess the safety and feasibility of introducing laparoscopic colorectal surgery to our unit. PATIENTS AND METHODS Prospectively collected cases of all patients undergoing laparoscopic colorectal surgery between July 2003 and July 2007 were reviewed. RESULTS A total of 143 patients (75 males and 68 females) with amean age of 65.8 years (range, 21–95 years) underwent surgery. Laparoscopic resection for colorectal malignancy was performed in 93 patients (65%). The conversion rate for all cases was 14.7%. Mean operative time was 203 min (range, 100–400 min), with amean blood loss of 180 ml. The mean number of lymph nodes in malignant cases was 13.8 with clear resection margin in all but one case. The mean postoperative stay was 5.6 days (median, 4 days; range, 2–35 days). UKCCR standard for lymph node retrieval was achieved in 62.6% of cases. There were four postoperative deaths. The overall 30-day morbidity rate was 21.7%. The service is consultant-led with 9.8% of cases performed by senior trainees and 37% of procedures performed by two consultants. CONCLUSIONS Laparoscopic colorectal surgery is technically feasible and safe in our hands. Although operative time is longer, this is counterbalanced by shorter hospital stay. The results from this series support the findings of others and continuing development of this service.

scholarly journals Stereotactic biopsies of brainstem lesions: which approach?

2021 ◽  
Author(s):  
Amer Jaradat ◽  
Andreas Nowacki ◽  
Jens Fichtner ◽  
Janine-Ai Schlaeppi ◽  
Claudio Pollo
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Definitive Diagnosis ◽  
Accurate Diagnosis ◽  
The Body ◽  
Brainstem Lesions ◽  
High Diagnostic Yield ◽  
Permanent Morbidity ◽  
Diagnostic Importance ◽  
Stereotactic Biopsies

Abstract Background Stereotactic biopsies for brainstem lesions are frequently performed to yield an accurate diagnosis and help guide subsequent management. In this study, we summarize our experience with different stereotactic approaches to brainstem lesions of different locations and discuss possible implications for safety and diagnostic yield. Methods We retrospectively analyzed 23 adult patients who underwent a stereotactic biopsy for brainstem lesions between October 2011 and December 2019. Depending on the location supra- or infratentorial, trajectories were planned. We assessed the postoperative complications during the hospital stay as well as the diagnostic yield. Results A supratentorial transfrontal approach was used in 16 (70%) cases, predominantly for lesions in the midbrain, upper pons, and medulla oblongata. An infratentorial, transcerebellar-transpeduncular approach was used in 7 (30%) cases mainly for lesions within the lower pons. All biopsies were confirmed to represent pathological tissue and a definitive diagnosis was achieved in 21 cases (91%). Three patients (13%) had transient weakness in the contralateral part of the body in the immediate postoperative period, which improved spontaneously. There was no permanent morbidity or mortality in this series of patients. Conclusion Lesions of various locations within the brainstem can be successfully targeted via either a supratentorial transfrontal or an infratentorial transcerebellar transpeduncular approach. Our high diagnostic yield of over 90% and the low rate of complications underlines the diagnostic importance of this procedure in order to guide the medical management of these patients.

scholarly journals Total clipless cholecystectomy by means of harmonic sealing

2015 ◽  
Vol 28 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Almino Cardoso RAMOS ◽  
Manoela Galvão RAMOS ◽  
Manoel dos Passos GALVÃO-NETO ◽  
Josemberg MARINS ◽  
Eduardo Lemos de Souza BASTOS ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operative Time ◽  
Case Series ◽  
Cystic Artery ◽  
Morbidity Rate ◽  
Pressure Test ◽  
The Mean ◽  
Prospective Case Series ◽  
Laparoscopic Cholecistectomy

BACKGROUND: In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. AIM: To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver. METHODS: Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation. RESULTS: The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking. CONCLUSION: The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience

1993 ◽  
Vol 79 (6) ◽  
pp. 839-844 ◽  
Author(s):  
Alok Ranjan ◽  
Vedantam Rajshekhar ◽  
Thomas Joseph ◽  
Mathew J. Chandy ◽  
Sushil M. Chandi
Keyword(s):  
Stereotactic Biopsy ◽  
Target Selection ◽  
Consecutive Series ◽  
Ct Guided ◽  
Content Type ◽  
Negative Biopsy ◽  
Significant Difference ◽  
Stereotactic Biopsies ◽  
Biopsy Rate ◽  
Fine Print

Nondiagnostic biopsies were analyzed in a consecutive series of 407 patients undergoing computerized tomography (CT)-guided stereotactic biopsies. These were categorized as either negative biopsies, when normal tissue or nonspecific pathology was found, or inconclusive, when a definitive diagnosis could not be made although representative tissue was obtained. Nineteen biopsies (4.7%) were negative and 10 (2.4%) were inconclusive, giving an overall nondiagnostic biopsy rate of 7.1% (29 of the 407 cases). Suspected neoplastic masses (390 cases) were classified on the basis of their CT morphology into four groups: Group 1 included purely hypodense nonenhancing masses; Group 2 included isodense nonenhancing masses; Group 3 included ring-enhancing masses; and Group 4 included mixed-density enhancing masses. Although a higher proportion of hypodense nonenhancing masses (six of 56, or 10.7%) yielded a negative result, there was no statistically significant difference in the negative biopsy rates for the different CT categories (p = 0.06). The negative biopsy rates for the 6 years of the study, 1987 to 1992 (1987 being an incomplete year) were as follows: 13.3%, 6%, 3.2%, 3%, 5.8%, and 2.7%. There was no significant decrease in the negative biopsy rate as experience with this procedure increased (p = 0.20). A total of eight surgeons independently performed the biopsies. There was no significant difference (p = 0.24) in the negative biopsy rate of the surgeon with the most experience (124 biopsies, 2.4% negative biopsy rate) compared with that of the seven other surgeons combined (283 biopsies; 5.7% negative biopsy rate). These findings suggest that the yield in a stereotactic biopsy is independent of the CT appearance of the mass. Adherence to certain basic principles in patient and target selection will ensure a reasonable percentage of positive yield with stereotactic biopsy procedures even if the surgeon is relatively inexperienced. There does not appear to be a learning curve in the performance of CT-guided stereotactic biopsies. The management of patients with nondiagnostic biopsies is discussed.

LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

2018 ◽  
Vol 8 (4) ◽  
pp. 76-80
Author(s):  
Thao Nguyen Minh ◽  
Vu Pham Anh ◽  
Tri Nguyen Huu ◽  
Phu Nguyen Doan Van ◽  
Phuc Nguyen Thanh ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Bilateral Hernia ◽  
Repair Method ◽  
Tapp Repair ◽  
Post Operation ◽  
Average Operative Time ◽  
The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

The incidence of central serous chorioretinopathy in the population of Kazan: Results of a retrospective epidemiological analysis for 2009–2018

2020 ◽  
pp. 30-33
Author(s):  
D. R. Аgliullin ◽  
G. R. Khasanova ◽  
E. A. Abdulaeva ◽  
S. T. Agliullina ◽  
A. N. Amirov ◽  
...  
Keyword(s):  
Growth Rate ◽  
Central Serous Chorioretinopathy ◽  
Morbidity Rate ◽  
Seasonal Prevalence ◽  
Upward Trend ◽  
Epidemiological Analysis ◽  
Significant Upward Trend ◽  
Track Record ◽  
Minimum Age ◽  
The Mean

Objective: To assess the incidence of central serous chorioretinopathy (CSC) through the example of a large industrial Russian city.Methods: A retrospective analysis of CSC of Kazan population for 2009–2018 has been done.Results: From 2019 to 2018, 831 new cases of CSC were registered in Kazan. A statistically significant upward trend with growth rate 105.2% and accession rate 5.2% was typical for the annual track record. The mean age of patients was 50 years, the minimum age was 14 years, the maximum age was 87 years. A statistically significant upward trend was detected in track record of incidence in groups of 30–39-year-old and 40–49-year-old. Seasonal increase of the incidence was recorded in February, March, April, October, and November.Conclusions: The upward trend and seasonal prevalence are typical for longterm morbidity of CSC in Kazan. The highest morbidity rate of CSC and statistically significant upward trend of its incidence in track record were recorded in the age of 30–39. 

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