A contralateral, transfrontal, extraventricular approach to stereotactic brainstem biopsy procedures

2005 ◽  
Vol 102 (3) ◽  
pp. 565-570 ◽  
Author(s):  
Eric W. Amundson ◽  
Matthew J. McGirt ◽  
Alessandro Olivi
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Intravenous Sedation ◽  
Safe Alternative ◽  
Middle Cerebellar Peduncle ◽  
Operative Morbidity ◽  
Content Type ◽  
Cerebellar Lesions ◽  
Cerebellar Peduncle ◽  
Brainstem Biopsy

✓ The authors report on the technique and results of stereotactic biopsy for intrinsic lateral pontine and medial cerebellar lesions via a contralateral, transfrontal, extraventricular approach. Multiplanar stereotactic magnetic resonance imaging was used to plan an intraparenchymal approach, thus limiting the number of crossed pial surfaces to one and eliminating the need to cross ependymal surfaces. After the administration of a local anesthetic agent with light intravenous sedation, six patients harboring intrinsic lateral pontine lesions underwent biopsies via this intraparenchymal approach with 100% diagnostic yield and no operative morbidity. In comparison to the ipsilateral transfrontal approach, the contralateral approach laterally expands the infratentorial area accessible during biopsy to include the lateral pons and middle cerebellar peduncle. The contralateral, transfrontal, extraventricular approach is a useful, straight-forward and safe alternative to the suboccipital transcerebellar and ipsilateral, transfrontal, transtentorial routes for reaching lesions of the lateral pons and middle cerebellar peduncle.

scholarly journals Stereotactic Brainstem Biopsy: Technical Aspects with Emphasis on Role of Awake Craniotomy

2020 ◽  
Vol 9 (02) ◽  
pp. 080-084
Author(s):  
Reddy Kanala Ramnadh ◽  
Krishna Yerramneni Vamsi ◽  
Thirumal Yerragunta ◽  
Kumar Vupuloori Arvind ◽  
Varshesh Shah
Keyword(s):  
Stereotactic Biopsy ◽  
Tissue Sample ◽  
Low Grade ◽  
Middle Cerebellar Peduncle ◽  
Brainstem Lesions ◽  
Pediatric Age Group ◽  
Technical Modifications ◽  
Cerebellar Peduncle ◽  
Brainstem Biopsy

Abstract Introduction The role of frame-based stereotactic biopsy in brainstem lesions has been well established in literature. Transfrontal, transtentorial, and transcerebellar routes are used to access various targets within the brainstem. While the transfrontal approach is preferable in midbrain lesions, a transcerebellar approach via the middle cerebellar peduncle forms the shortest possible trajectory for pontine and medullary lesions. Objective Authors to describe the technical nuances of frame-based stereotactic biopsy of lower brainstem lesions to increase the procedural safety and efficacy. Materials and Methods Technical modifications in frame fixation were done to acheive the desired trajectory to the target. In adult cases biopsy was performed with patient awake during the procedure. Results Total of five patients underwent biopsy with the technical modifications. Three patients were adults and two were in pediatric age group. Their age ranged from 12 to 50 years. No complications were encountered. Two of the biopsies showed demyelination and the other three turned out to be low-grade glioma, pilocytic astrocytoma, and lymphoma, respectively. Conclusion Despite obvious inherent risks, the transcerebellar biopsy in semi-sitting position is a well-tolerated and effective method of obtaining a diagnostic tissue sample in brainstem lesions. We have noted that adoption of the technical modifications described in this article has aided in improving the safety and ease of the procedure.

Combined MRI and PET imaging in brain stem mass lesions: diagnostic yield in a series of 30 stereotactically biopsied patients

2000 ◽  
Vol 93 (6) ◽  
pp. 951-957 ◽  
Author(s):  
Nicolas Massager ◽  
Philippe David ◽  
Serge Goldman ◽  
Benoît Pirotte ◽  
David Wikler ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Emission Tomography ◽  
Histological Findings ◽  
Content Type ◽  
Positron Emission ◽  
Pet Scanning ◽  
Mass Lesions ◽  
Fine Print

Object. In the management of brainstem lesions, the place of stereotactic biopsy sampling remains debatable. The authors compared the results of magnetic resonance (MR) imaging, positron emission tomography (PET) scanning, and histological studies obtained in 30 patients who underwent MR imaging— and PET-guided stereotactic biopsy procedures for a brainstem mass lesion.Methods. Between July 1991 and December 1998, 30 patients harboring brainstem mass lesions underwent a stereotactic procedure in which combined MR imaging and PET scanning guidance were used. Positron emission tomography scanning was performed using [18F]fluorodeoxyglucose in 16 patients, methionine in two patients, and both tracers in 12 patients. Definite diagnosis was established on histological examination of the biopsy samples. Interpretation of MR imaging findings only or PET findings only was in agreement with the histological diagnosis in 63% and 73% of cases, respectively. Magnetic resonance imaging and PET findings were concordant in 19 of the 30 cases; in those cases, imaging data correlated with histological findings in 79%. Treatment based on information derived from MR imaging was concordant with therapy based on histological findings in only 17 patients (57%). Combining MR imaging and PET scanning data, the concordance between the neuroimaging-based treatment and treatments based on histological findings increased to 19 patients (63%). In seven patients who underwent biopsy procedures with one PET-defined and one MR imaging—defined trajectory, at histological examination the PET-guided samples were more representative of the tumor's nature and grade than the MR imaging—guided samples in four cases (57%). In 18 patients PET scanning was used to define a biopsy target and provided a diagnostic yield in 100% of the cases.Conclusions. Although the use of combined PET and MR imaging improves radiological interpretation of a mass lesion in the brainstem, it does not accurately replace histological diagnosis that is provided by a stereotactically obtained biopsy sample. Combining information provided by MR imaging and PET scanning in stereotactic conditions improves the accuracy of targeting and the diagnostic yield of the biopsy sample; an MR imaging— and PET-guided stereotactic biopsy procedure is a safe and efficient modality for the management of mass lesions of the brainstem.

Diagnostic yield in CT-guided stereotactic biopsy of gliomas

1989 ◽  
Vol 71 (4) ◽  
pp. 494-497 ◽  
Author(s):  
George M. Greene ◽  
Patrick W. Hitchon ◽  
Robert L. Schelper ◽  
William Yuh ◽  
Gregg N. Dyste
Keyword(s):  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Magnetic Resonance Images ◽  
Biopsy Material ◽  
Ct Guided ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Malignant Astrocytomas ◽  
Tumor Group ◽  
Tumor Distribution

✓ Twenty-seven patients underwent 29 computerized tomography (CT)-guided stereotactic biopsy procedures for untreated or recurrent malignant astrocytomas. Biopsies were obtained from the hypodense center, enhancing margin, and hypodense periphery as seen on contrast-enhanced CT scans, with diagnostic yields of (number of biopsies yielding tumor/number of biopsies obtained): 34/61 (56%), 68/101 (67%), and 8/22 (36%) from these three zones, respectively. Although tumor was identified in all three zones, diagnostic yield was significantly higher in the hypodense center and enhancing margin. Comparison of patients with untreated tumors to those with recurrent tumors demonstrated no statistical difference in tumor distribution, although there was a trend toward a higher yield from the hypodense periphery in the recurrent tumor group. Tumor was found up to 15 mm beyond the CT-enhancing margin, in addition to extending beyond the area of abnormality on T2-weighted magnetic resonance images. These findings suggest that serial stereotactic biopsies should be targeted to the hypodense center and enhancing margin for improved diagnostic yield. Biopsy material obtained from the hypodense periphery that demonstrates tumor also indicates that a tumor volume beyond the confines of the CT-enhancing margin should be considered when calculating dosimetry for interstitial radiation.

Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F]fluorodeoxyglucose

1995 ◽  
Vol 82 (3) ◽  
pp. 445-452 ◽  
Author(s):  
Marc Levivier ◽  
Serge Goldman ◽  
Benoît Pirotte ◽  
Jean-Marie Brucher ◽  
Danielle Balériaux ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Brain Biopsy ◽  
Emission Tomography ◽  
Stereotactic Brain Biopsy ◽  
Ct Guided ◽  
Content Type ◽  
Positron Emission

✓ The aim of the present study was to determine whether routine integration of positron emission tomography (PET) with 18F-labeled fluorodeoxyglucose (FDG) in the planning of stereotactic brain biopsy increases the technique's diagnostic yield. Forty-three patients underwent combined FDG-PET— and computerized tomography (CT)-guided stereotactic biopsy of intracranial lesions according to a previously described technique. In 36 patients, an area of abnormal FDG uptake was used to guide at least one stereotactic biopsy trajectory. A total of 90 stereotactic trajectories were performed; among them, 55 were based on FDG-PET—defined targets and 35 were based on CT-defined targets. Histological diagnosis was obtained in all patients, but six of the 90 trajectories were nondiagnostic; all six were based on targets defined by CT only. Differences between the diagnostic yield of trajectories based on FDG-PET—defined targets and those based on CT-defined targets were statistically significant in patients with contrast-enhanced lesions, but not in patients with nonenhancing lesions. These results support the view the FDG-PET may contribute to the successful management of brain tumor patients requiring stereotactic biopsy. Because no significant increase in discomfort or morbidity related to the technique was found, it is suggested that the development of similar techniques integrating PET data in the planning of stereotactic biopsy should be considered by centers performing stereotactic surgery and having access to PET technology.

scholarly journals Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

2021 ◽  
Author(s):  
Forrest A. Hamrick ◽  
Michael Karsy ◽  
Carol S. Bruggers ◽  
Angelica R. Putnam ◽  
Gary L. Hedlund ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patient ◽  
Cerebellopontine Angle ◽  
Resonance Imaging ◽  
Middle Cerebellar Peduncle ◽  
Cerebellar Tissue ◽  
Cerebellar Peduncle ◽  
Histopathologic Analysis ◽  
The Right ◽  
Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

scholarly journals DIPG-35. BIOLOGICAL MEDICINE FOR DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG) ERADICATION: RESULTS OF THE THREE ARM BIOMARKER-DRIVEN RANDOMIZED BIOMEDE 1.0 TRIAL

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii293-iii294
Author(s):  
Jacques Grill ◽  
Gwenael Le Teuff ◽  
Karsten Nysom ◽  
Klas Blomgren ◽  
Darren Hargrave ◽  
...  
Keyword(s):  
Disease Progression ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Steering Committee ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Open Label ◽  
Pten Loss ◽  
Multi Stage ◽  
Open Label Phase ◽  
Biological Medicine

Abstract Despite 50 years of clinical trials, no improvement of survival has been observed in DIPG and most children die within 2 years of diagnosis. Only radiotherapy transiently controls disease progression. The study was conceived as a randomized multi-arm multi-stage program. It started with an open-label phase-II trial comparing three drugs (everolimus, dasatinib, erlotinib) combined with irradiation, allocated according to the presence of their specific targets (PTEN-loss, EGFR-overexpression) defined with a stereotactic biopsy after central confirmation of the diagnosis (presence of histone H3K27M mutation or loss of K27 trimethylation). Targeted therapies were started concomitantly with radiotherapy and were continued until disease progression. No biopsy-related death was reported and diagnostic yield was excellent, with only 5 non-informative biopsies. Biopsy excluded the diagnosisof DIPG in 8% of the cases. At the 3rd interim analysis, based on 193 randomized patients, the IDMC concluded that the study was unlikely to show a difference of OS between the 3 drugs even if 250 patients would be randomized. The median OS from the time of diagnosis was 11.9, 10.5 and 10 months for everolimus, dasatinib and erlotinib. Treatment was discontinued due to toxicity in 2%, 13%, and 15%, respectively. BIOMEDE shows the feasibility of biologically-driven treatment in DIPG on a large international scale. Based on the better toxicity profile and the slightly better efficacy, although not statistically significant, the steering committee proposed that everolimus should be used as the control arm for the next BIOMEDE 2.0 trial.

scholarly journals Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy

2021 ◽  
pp. 155698452110345
Author(s):  
Vanessa Menezes ◽  
Juan Carlos Molina ◽  
Clare Pollock ◽  
Philippe Romeo ◽  
Julie Morisset ◽  
...  
Keyword(s):  
Operating Room ◽  
Lung Diseases ◽  
Diagnostic Yield ◽  
Interstitial Lung Diseases ◽  
Minor Bleeding ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Biopsy ◽  
Histologic Diagnosis ◽  
Safe Alternative ◽  
Diffuse Parenchymal Lung Diseases

Objective Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). Methods Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. Results A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe ( P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% ( P = 0.027) with Kappa-concordance of 0.60 ( P < 0.001). Conclusions Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD.

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.

Sign in / Sign up

Export Citation Format

Share Document