scholarly journals Frameless Robot-Assisted Stereotactic Biopsies for Lesions of the Brainstem – A Series of 103 Consecutive Biopsies

2021 ◽  
Author(s):  
Iulia Peciu-Florianu ◽  
Victor Legrand ◽  
Apolline Monfilliette-Djelad ◽  
Claude-Alain Maurage ◽  
Quentin Vannod-Michel ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Targeted Treatment ◽  
Histopathological Diagnosis ◽  
Diffuse Glioma ◽  
Safe Procedure ◽  
Robot Assisted ◽  
Permanent Disability ◽  
Brainstem Lesions ◽  
Common Location ◽  
Stereotactic Biopsies

Abstract PurposeTargeted treatment for brainstem lesions requires above all a precise histopathological and molecular diagnosis. In the current technological era, robot-assisted stereotactic biopsies represent an accurate and safe procedure for tissue diagnosis. We present our center’s experience in frameless robot-assisted biopsies for brainstem lesions. MethodsWe performed a retrospective analysis of all patients benefitting from a frameless robot-guided stereotactic biopsy at our University Hospital, from 2001 to 2017. Patients consented to the use of data and/or images. The NeuroMate® robot (Renishaw™, UK) was used. We report on lesion location, trajectory strategy, histopathological diagnosis and procedure safety. ResultsOur series encompasses 96 patients (103 biopsies) treated during a 17 years period. Mean age at biopsy: 34.0 years (range 1-78). Most common location: pons (62.1%). Transcerebellar approach: 61 procedures (59.2%). Most common diagnoses: diffuse glioma (67.0%), metastases (7.8%) and lymphoma (6.8%). Non conclusive diagnosis: 10 cases (9.7%). After second biopsy this decreased to 4 cases (4.1%). Overall biopsy diagnostic yield: 95.8%. Permanent disability was recorded in 3 patients (2.9%, all adults), while transient complications in 17 patients (17.7%). Four cases of intra-tumoral hematoma were recorded (one case with rapid decline and fatal issue). Adjuvant targeted treatment was performed in 72.9% of patients. Mean follow-up (in the Neurosurgery Department): 2.2 years. ConclusionFrameless robot-assisted stereotactic biopsies can provide the initial platform towards a safe and accurate management for brainstem lesions, offering a high diagnostic yield with low permanent morbidity.

scholarly journals Medical thoracoscopy in evaluation of undiagnosed pleural effusion

2019 ◽  
Vol 7 (5) ◽  
pp. 1803
Author(s):  
Khurshid Ahmad Dar ◽  
Sheikh Tariq Sultan ◽  
Ahmed Jamal Jamil ◽  
Nazia Mehfooz ◽  
Naveed Nazir Shah ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Yield ◽  
Cost Effective ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Safe Procedure ◽  
Diagnostic Modality ◽  
Medical Thoracoscopy ◽  
Multiple Variable ◽  
Age Range

Background: Medical thoracoscopy or pleuroscopy, in recent past has received lot of interest for diagnostic as well as therapeutic purposes. In the evaluation of undiagnosed pleural effusion, it has become a key diagnostic modality as it is a cost effective and safe procedure. The aim of present study was to assess the diagnostic yield of medical thoracoscopy in patients with undiagnosed exudative pleural effusion.Methods: This prospective study was conducted at government chest diseases hospital Srinagar between December 2016 to June 2018. One hundred and twenty-five (125) patients who fulfilled inclusion criteria were included in this study. Thoracoscopy was done using rigid thoracoscope under local anesthesia.  Thoracoscopic and histopathological data of enrolled patients was collected prospectively and analysed.Results: Patients enrolled in the study were in the age range of 17 to 82 years and consisted of 80 males and 45 females. Most common thoracoscopic finding was multiple variable sized nodules (53.6%) followed by sago grain infiltration (15.2%). Malignancy was the most common histopathological diagnosis (60.8%) with metastatic adenocarcinoma being the most common histopathological diagnosis (50%). The overall diagnostic yield of thoracoscopy was 90.4%.Conclusions: Medical thoracoscopy is a safe procedure with excellent diagnostic yield for evaluation of undiagnosed pleural effusion with minimal complication rates.

scholarly journals Percutaneous CT Fluoroscopy-Guided Core Needle Biopsy of Mediastinal Masses: Technical Outcome and Complications of 155 Procedures during a 10-Year Period

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 781
Author(s):  
Caroline Burgard ◽  
Robert Stahl ◽  
Giovanna Negrao de Figueiredo ◽  
Julien Dinkel ◽  
Thomas Liebig ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Diagnostic Yield ◽  
Lesion Size ◽  
Histopathological Diagnosis ◽  
Safe Procedure ◽  
Ct Fluoroscopy ◽  
Mediastinal Tumors ◽  
Core Needle ◽  
Mediastinal Masses

Purpose: To evaluate technical outcome, diagnostic yield and safety of computed tomographic fluoroscopy-guided percutaneous core needle biopsies in patients with mediastinal masses. Methods: Overall, 155 CT fluoroscopy-guided mediastinal core needle biopsies, performed from March 2010 to June 2020 were included. Size of lesion, size of needle, access path, number of success, number of biopsies per session, diagnostic yield, patient’s position, effective dose, rate of complications, tumor localization, size of tumor and histopathological diagnosis were considered. Post-interventional CT was performed, and patients observed for any complications. Complications were classified per the Society of Interventional Radiology (SIR). Results: 148 patients (age, 54.7 ± 18.2) underwent 155 CT-fluoroscopy-guided percutaneous biopsies with tumors in the anterior (114; 73.5%), middle (17; 11%) and posterior (24; 15.5%) mediastinum, of which 152 (98%) were technically successful. For placement of the biopsy needle, in 82 (52.9%) procedures a parasternal trajectory was chosen, in 36 (23.3%) a paravertebral access, in 20 (12.9%) through the lateral intercostal space and in 17 (11%) the thoracic anterior midline, respectively. A total of 136 (89.5%) of the biopsies were considered adequate for a specific histopathologic analysis. Total DLP (dose-length product) was 575.7 ± 488.8 mGy*cm. Mean lesion size was 6.0 ± 3.3 cm. Neoplastic pathology was diagnosed in 115 (75.7%) biopsies and 35 (23%) biopsy samples showed no evidence of malignancy. Minor complications were observed in 18 (11.6%) procedures and major pneumothorax requiring drainage insertion in 3 interventions (1.9%). Conclusion: CT fluoroscopy-guided percutaneous core needle biopsy of mediastinal masses is an effective and safe procedure for the initial assessment of patients with mediastinal tumors.

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 CT guided lung biopsy: Diagnostic yield and complications, using 18G coaxial semi-automatic core needle

2019 ◽  
Vol 4 (1) ◽  
pp. 20-25
Author(s):  
Ajit Thapa ◽  
Kamal Subedi ◽  
Sundar Suwal ◽  
Dinesh Chataut
Keyword(s):  
Core Biopsy ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Lung Nodule ◽  
Histopathological Diagnosis ◽  
Safe Procedure ◽  
Ct Guided ◽  
Biopsy Needle ◽  
Core Needle ◽  
Clinically Significant

Introduction: CT guided biopsy is essential for histopathological diagnosis of suspicious lung nodule, which are not amenable for either bronchoscopic or sonography guided sampling. Methods: Twenty eight patients with suspicious lung nodules not amenable for bronchoscopic or sonography guided sampling who underwent CT guided lung biopsy with 18 G coaxial semiautomatic core biopsy needle in one year were retrospectively studied for diagnostic yield and complications. Results: Out of 28 patients, who underwent CT guided lung nodule biopsy, 18 were male and 10 were female. The age ranged from 22 to 80 years. Lesion size ranged from one cm to four cm and depth of lesion from pleura ranged from zero cm to five cm. Diagnostic yield of our core needle biopsy was 26(92.3%). Clinically significant complication was low. Massive pneumothorax which needed intercostal drainage was 7.14% (2 patients). Pulmonary hemorrhage manifesting as hemoptysis was seen in 14.3 %( 2 patients). No hemothorax or air embolism was noted in any of the patient. Conclusion: CT guided lung lesion biopsy with 18 G coaxial semi-automatic core biopsy needle is a safe procedure with good diagnostic yield and relatively low incidence of clinically significant complications.

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

2021 ◽  
pp. 155698452097822
Author(s):  
Byron D. Patton ◽  
Daniel Zarif ◽  
Donna M. Bahroloomi ◽  
Iam C. Sarmiento ◽  
Paul C. Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Open Approach ◽  
Robotic Approach ◽  
Robotic Group ◽  
Robot Assisted ◽  
Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

scholarly journals Cryoprobe biopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin

2019 ◽  
Vol 21 (2) ◽  
pp. 119-123
Author(s):  
Marcos J Las Heras ◽  
Jose Dianti ◽  
Manuel Tisminetzky ◽  
Graciela Svetliza ◽  
Sergio E Giannasi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Diagnostic Yield ◽  
Specific Treatment ◽  
Case Series ◽  
Safe Procedure ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Select Group ◽  
Lung Sample ◽  
Appropriate Treatment

Rationale Acute hypoxemic respiratory failure is a condition that comprises a wide array of entities. Obtaining a histological lung sample might help reach a diagnosis and direct an appropriate treatment in a select group of patients. Objective To describe our experience in the use of cryobiopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin. Methods Retrospective analysis of case series of patients with acute hypoxemic respiratory failure who underwent lung cryobiopsy at the Intensive Care Unit of the Hospital Italiano de Buenos Aires, Argentina. Results Cryobiopsy yielded a histological diagnosis in all patients ( n = 10, 100%). This led to either a change in therapy or continuation of a specific treatment in eight of these patients. Cryobiopsy was found to be contributive in all the patients who did not meet Berlin criteria for acute respiratory distress syndrome. No major complications were associated with the procedure. Conclusions Cryobiopsy is a safe procedure with a high diagnostic yield in a selected group of patients.

Stereotactic biopsies of focal brainstem lesions

2003 ◽  
Vol 60 (4) ◽  
pp. 311-320 ◽  
Author(s):  
Patrick J Kelly ◽  
A.J Gonçalves-Ferreira ◽  
M Herculano-Carvalho ◽  
J Pimentel
Keyword(s):  
Brainstem Lesions ◽  
Stereotactic Biopsies

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.

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