scholarly journals Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy

2019 ◽  
Vol 10 (01) ◽  
pp. 78-84 ◽  
Author(s):  
Chin Taweesomboonyat ◽  
Thara Tunthanathip ◽  
Sakchai Sae-Heng ◽  
Thakul Oearsakul
Keyword(s):  
Diagnostic Yield ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
High Grade Glioma ◽  
Intracerebral Hematoma ◽  
Low Grade ◽  
Essential Factor ◽  
Stereotactic Brain Biopsy ◽  
Intraoperative Bleeding ◽  
Positive Biopsy

Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications. Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P = 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01). Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication.

scholarly journals Diagnosis of primary central nervous system lymphoma: a systematic review of the utility of CSF screening and the role of early brain biopsy

2019 ◽  
Vol 6 (6) ◽  
pp. 415-423 ◽  
Author(s):  
Alexis A Morell ◽  
Ashish H Shah ◽  
Claudio Cavallo ◽  
Daniel G Eichberg ◽  
Christopher A Sarkiss ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Yield ◽  
Diagnostic Delay ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Suspected Case ◽  
Stereotactic Brain Biopsy

Abstract Background Because less-invasive techniques can obviate the need for brain biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL), it is common practice to wait for a thorough initial work-up, which may delay treatment. We conducted a systematic review and reviewed our own series of patients to define the role of LP and early brain biopsy in the diagnosis of PCNSL. Methods Our study was divided into 2 main sections: 1) systematic review assessing the sensitivity of cerebrospinal fluid (CSF) analysis on the diagnosis of PCNSL, and 2) a retrospective, single-center patient series assessing the diagnostic accuracy and safety of early biopsy in immunocompetent PCNSL patients treated at our institution from 2012 to 2018. Results Our systematic review identified 1481 patients with PCNSL. A preoperative LP obviated surgery in 7.4% of cases. Brain biopsy was the preferred method of diagnosis in 95% of patients followed by CSF (3.1%). In our institutional series, brain biopsy was diagnostic in 92.3% of cases (24/26) with 2 cases that required a second procedure for diagnosis. Perioperative morbidity was noted in 7.6% of cases (n = 2) due to hemorrhages after stereotactic brain biopsy that improved at follow-up. Conclusions The diagnostic yield of CSF analyses for PCNSL in immunocompetent patients remains exceedingly low. Our institutional series demonstrates that early biopsy for PCNSL is safe and accurate, and may avert protracted work-ups. We conclude that performing an early brain biopsy in a suspected case of PCNSL is a valid, safe option to minimize diagnostic delay.

scholarly journals The Influence of Corticosteroids on Diagnostic Accuracy of Biopsy for Primary Central Nervous System Lymphoma

2016 ◽  
Vol 43 (5) ◽  
pp. 721-725 ◽  
Author(s):  
Mashary Binnahil ◽  
Karolyn Au ◽  
Jian-Qiang Lu ◽  
Blaise Matthew Wheatley ◽  
Tejas Sankar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Yield ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Lymphoproliferative Disease ◽  
Stereotactic Brain Biopsy ◽  
Corticosteroid Administration ◽  
Initial Biopsy ◽  
Polymerase Chain

AbstractClassical neurosurgical teaching suggests that corticosteroid administration reduces the diagnostic yield of stereotactic brain biopsy for primary central nervous system lymphoma (PCNSL). In a single-center series spanning 6 years, we reviewed 155 consecutive biopsy patients, 135 treated with prebiopsy corticosteroids. PCNSL was correctly diagnosed on initial biopsy in 15 of 16 steroid-treated patients; in the single nondiagnostic specimen, polymerase chain reaction reanalysis by an outside institution showed evidence of lymphoproliferative disease consistent with PCNSL. Our data challenge the notion that it is necessary to withhold corticosteroid therapy for cerebral edema in patients awaiting stereotactic biopsy for suspected PCNSL.

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.

P3 Outcomes following diagnostic brain biopsy: a 1 year case review

2019 ◽  
Vol 90 (3) ◽  
pp. e27.3-e27
Author(s):  
R Ingleton ◽  
B Gorgun ◽  
N Gorgun ◽  
M Hayder ◽  
RR Vindlacheruvu
Keyword(s):  
Brain Biopsy ◽  
Low Grade ◽  
Case Review ◽  
Electronic Patient Records ◽  
Stereotactic Brain Biopsy ◽  
Neurosurgical Procedure ◽  
Tissue Diagnosis ◽  
Radiology Reports ◽  
Crucial Component ◽  
Management Plans

ObjectivesStereotactic brain biopsy is an established neurosurgical procedure utilised in times of diagnostic or therapeutic uncertainty. Achieving a definitive tissue diagnosis allows tailored surgical, medical or oncological management. We present a 1 year case review of brain biopsies and compare suspected pre-operative diagnosis with final tissue outcome.DesignRetrospective analysis of all brain biopsies performed in 2017 in an adult-only neurosurgical unit.SubjectsAll patients undergoing brain biopsy.MethodsTheatre records were retrospectively analysed to identify patients undergoing brain biopsy in 2017. Further information was obtained using electronic patient records and radiology reports.Results41 patients underwent brain biopsy in 2017. Only 1 proved inconclusive and required repeat procedure. 26 patients had a suspected diagnosis documented pre-operatively based on radiological/clinical evidence. The most commonly suspected pathologies were low grade and high grade gliomas (9 and 15 patients). Of 25 patients with both a pre-operative differential and subsequent conclusive tissue diagnosis, 10 (40%) were ultimately given diagnoses which did not match the suspected pathology. Significantly, 1 biopsy diagnosed cerebral lymphoma.ConclusionsBrain biopsy is a relatively safe and simple neurosurgical procedure which can reliably provide a definitive tissue diagnosis. We have demonstrated how it remains a crucial component in formally establishing diagnosis prior to determining optimum management plans.

scholarly journals P.157 Frame-based stereotactic brain biopsy: A retrospective review of diagnostic yield and complications at a Canadian Center

2021 ◽  
Vol 48 (s3) ◽  
pp. S65-S65
Author(s):  
PJ Gariscsak ◽  
C Gui ◽  
JC Lau ◽  
JF Megyesi
Keyword(s):  
Diagnostic Accuracy ◽  
Chart Review ◽  
Diagnostic Yield ◽  
Retrospective Chart Review ◽  
Brain Biopsy ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Stereotactic Brain Biopsy ◽  
Final Pathology ◽  
Diagnostic Biopsy

Background: Historically, frame-based stereotactic brain biopsy (SBB) has played an important role in the diagnosis of intracranial lesions. We performed a single centre analysis of the outcomes and efficacy of SBB at the London Health Sciences Centre (LHSC). Methods: We performed a retrospective chart review of frame-based SBB from 2006 to 2017 at the LHSC. Intra-operative and final pathology reports were analyzed for biopsy diagnosis and the diagnosis was compared with pre-operative neuroimaging reports for correlation. SBB-associated morbidity and mortality were investigated using chart review and post-operative neuroimaging. Results: 173 consecutive patients were identified. The overall morbidity rate was 8.7% (15 cases) and mortality rate was 0.6% (1 case). Final biopsy diagnostic accuracy was 96%, intra-operative diagnostic accuracy was 94% and pre-operative imaging diagnostic accuracy was 65%. Elevated partial thromboplastin time and the presence of hemorrhage on post-operative CT were associated with neurological morbidity and mortality. The need to obtain three or greater samples the time of biopsy was associated with non-diagnostic biopsy. Conclusions: At the LHSC, SBB is a relatively safe and effective surgical procedure with high diagnostic yield and relatively low risk of complications. Intra-operative pathology has a high efficacy in determining diagnosis when compared to final pathology.

Correlation of diagnostic yield of stereotactic brain biopsy with number of biopsy bits and site of the lesion

2006 ◽  
Vol 23 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Deepali Jain ◽  
Mehar Chand Sharma ◽  
Chitra Sarkar ◽  
Prabal Deb ◽  
Deepak Gupta ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Brain Biopsy ◽  
Stereotactic Brain Biopsy

IMPACT OF BRAIN BIOPSY ON THE MANAGEMENT OF PATIENTS WITH NONNEOPLASTIC UNDIAGNOSED NEUROLOGICAL DISORDERS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 833-838 ◽  
Author(s):  
Heinke Pulhorn ◽  
D. Gavin Quigley ◽  
Jark J.D. Bosma ◽  
Ramez Kirollos ◽  
Daniel G. du Plessis ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Diagnostic Category ◽  
Brain Biopsy ◽  
Clinical Impact ◽  
Complication Rates ◽  
Open Biopsy ◽  
Retrospective Case ◽  
Stereotactic Brain Biopsy

Abstract OBJECTIVE We sought to assess the diagnostic yield, complication rates, and therapeutic impact of open brain biopsy and serial stereotactic brain biopsy in the management of patients with nonneoplastic neurological conditions in which conventional investigations did not yield a definitive diagnosis. METHODS A retrospective case note analysis was undertaken in consecutive patients undergoing brain biopsy at The Walton Centre for Neurology and Neurosurgery during a 15-year period. The diagnostic yield, prebiopsy diagnostic category, biopsy technique (open versus stereotactic), complication rates, and impact on clinical management were assessed. Biopsies were grouped into one of five categories: diagnostic, suggestive, nonspecific, normal, or nondiagnostic. RESULTS Thirty-nine patients underwent biopsy. The diagnostic yield (combined diagnostic and suggestive) of targeted serial stereotactic biopsy was 64% (seven of 11 patients); in the open brain biopsy group, the diagnostic yield was 46% (13 of 28 patients). The prebiopsy diagnosis was confirmed in 100% (three of three patients) stereotactic biopsy patients and 75% (nine of 12 patients) of open biopsy patients. Two patients (7%) in the open biopsy group had short-term complications. The clinical impact was similar in both groups: nine of 28 (32%) open biopsy patients and four of 11 (36%) stereotactic biopsy patients. CONCLUSION Despite the low clinical impact, diagnostic brain biopsy should be considered in patients with nonneoplastic undiagnosed neurological disorders. Patients with neuroimaging abnormalities should preferentially undergo targeted biopsy.

scholarly journals Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
José Piquer ◽  
Jose L. Llácer ◽  
Vicente Rovira ◽  
Pedro Riesgo ◽  
Ruben Rodriguez ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Brain Biopsy ◽  
High Grade Glioma ◽  
Radical Resection ◽  
Histopathological Diagnosis ◽  
High Grade ◽  
Tumor Surgery ◽  
High Definition ◽  
Stereotactic Brain Biopsy ◽  
High Grade Astrocytoma

Background. The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors.Methods. Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy.Results. Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients. Total resection was achieved in 23 cases and subtotal in 7. No relevant complications related to the administration of 5-ALA were detected.Conclusions. The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.

scholarly journals Increasing the diagnostic yield of stereotactic brain biopsy using intraoperative histological smear

2019 ◽  
Vol 186 ◽  
pp. 105544 ◽  
Author(s):  
Bertrand Mathon ◽  
Aymeric Amelot ◽  
Karima Mokhtari ◽  
Franck Bielle
Keyword(s):  
Diagnostic Yield ◽  
Brain Biopsy ◽  
Stereotactic Brain Biopsy

Stereotactic Brain Biopsy With a Low-Field Intraoperative Magnetic Resonance Imager

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons217-ons224 ◽  
Author(s):  
John Quinn ◽  
David Spiro ◽  
Michael Schulder
Keyword(s):  
Magnetic Resonance ◽  
Diagnostic Yield ◽  
Target Identification ◽  
Frozen Section ◽  
Intraoperative Complications ◽  
Brain Biopsy ◽  
Frozen Sections ◽  
Stereotactic Brain Biopsy ◽  
Low Field ◽  
Cannula Placement

Abstract BACKGROUND: Techniques for stereotactic brain biopsy have evolved in parallel with the imaging modalities used to visualize the brain. OBJECTIVE: To describe our technique for performing stereotactic brain biopsy using a compact, low-field, intraoperative magnetic resonance imager (iMRI). METHODS: Thirty-three patients underwent stereotactic brain biopsies with the PoleStar N-20 iMRI system (Medtronic Navigation, Louisville, Colorado). Preoperative iMRI scans were obtained for biopsy target identification and trajectory planning. A skull-mounted device (Navigus, Medtronic Navigation) was used to guide an MRI-compatible cannula to the target. An intraoperative image was acquired to confirm accurate cannula placement within the lesion. Serial images were obtained to track cannula movement and to rule out hemorrhage. Frozen sections were obtained in all but 1 patient with a brain abscess. RESULTS: Diagnostic tissue was obtained in 32 of 33 patients. In all cases, imaging demonstrated cannula placement within the lesion. Histological diagnoses included 22 primary brain tumors and 10 nonneoplastic lesions. In 61% of the cases, initial trajectory was corrected on the basis of the intraoperative scans. In 1 patient, biopsy was nondiagnostic despite accurate cannula placement. No patient suffered a clinically or radiographically significant hemorrhage during or after surgery. There were no intraoperative complications. CONCLUSION: Stereotactic biopsy with a low-field iMRI is an accurate way to obtain specimens with a high diagnostic yield. This accuracy, combined with the acceptable additional procedural time, may obviate the need for frozen section. The ability to correct biopsy cannula placement during surgery eliminates the chance of misdiagnosis because of faulty targeting, as well as the risks associated with inconclusive frozen sections and “blind” replacement of the cannula.

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