Safety and Efficacy of Frameless Stereotactic Brain Biopsy Techniques

doi:10.1016/S1001-9294(13)60032-2

Chinese Medical Sciences Journal

Volume 28, Issue 2, June 2013, Pages 113-116

https://doi.org/10.1016/S1001-9294(13)60032-2 Get rights and content

Objective

To explore the safety and efficacy of frameless stereotactic brain biopsy.

Methods

Diagnostic accuracy was calculated by comparing biopsy diagnosis with de?nitive pathology in 62 patients who underwent frameless stereotactic brain biopsy between January 2008 and December 2010 in Xiamen University Southeast Hospital. Preoperative characteristics and histological diagnosis were reviewed and then information was analysed to identify factors associated with the biopsy not yielding a diagnosis and complications.

Results

Diagnostic yield was 93.5%. No differences were found between pathological diagnosis and frozen pathological diagnosis. The most common lesions were astrocytic lesions, included 16 cases of low-grade glioma and 12 cases of malignant glioma. Remote hemorrhage, metastasis, and lymphoma were following in incidence. Multiple brain lesions were found in 17 cases (27.4%). Eleven cases were frontal lesions (17.7%), 8 were frontotemporal (12.9%), 6 were frontoparietal (9.7%), and 5 each were temporal, parietal, and parietotemporal lesions (8.1%). Postoperative complications occurred in 21.0% of the patients after biopsies, including 10 haemorrhages (16.1%) and 3 temporary neurological deficits (1 epilepsy, 1 headache, and 1 partial hemiparesis). No patient required operation for hematoma evacuation.

Conclusion

Frameless stereotactic biopsy is an effective and safe technique for histologic diagnosis of brain lesions, particularly for multifocal and frontal lesions.

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Preliminary clinical application of multimodal imaging combined with frameless robotic stereotactic biopsy in the diagnosis of primary central nervous system lymphoma
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Citation Excerpt :
The four markers should not be arranged in a line array and not in the same plane, and the nearby scalp should be kept flat in case of the fixed marker shifting. Second, it would be better to choose the central area of the lesion as the puncture target instead of the areas of necrosis or calcification, and it is necessary to avoid the important structures such as the sulcal vessels, ventricles, cisterns, and functional areas when designing a biopsy puncture path strategy [29]. Third, it was vital to learn whether there was hematocele or active bleeding inside the lesion at the end of surgery by observing the puncture needle [40, 41].
To evaluate the clinical application of multimodal imaging combined with frameless robotic stereotactic biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL).
We retrospectively reviewed the clinical data of 8 patients who were considered suspected cases of PCNSL by multimodal imaging techniques. The final pathologic diagnosis were determined by the frameless robotic stereotactic biopsy. The postoperative related complications and pathological results were analyzed.
All patients underwent biopsies under general anesthesia with an average surgery time of 29.5 ± 4.5 min. The final pathological diagnostic accordant rate with the preoperative ones was 100%, and the pathologic examination of our patients showed features of diffuse large B-cell lymphoma. During the surgery, one patient suffered intratumoral hemorrhage without leading to serious cerebral edema, and conservative treatment was given. There was no death occurring during the study, and there were no significant differences in the Karnofsky Performance Scale Scores of all patients before and after surgery. Finally, they were transferred to the hematology department for standardized chemoradiotherapy according to the pathological results of PCNSL.
This study shows that it may play a vital role in the early diagnosis of PCNSL with the technique of multimodal imaging. The technique of frameless robotic stereotactic biopsy for obtaining the pathology outcomes in suspected PCNSL patients has the advantages of safety, efficiency, and minimally invasiveness.
Robot-Assisted Stereotactic Biopsies in 377 Consecutive Adult Patients with Supratentorial Diffuse Gliomas: Diagnostic Yield, Safety, and Postoperative Outcomes
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The length of hospital stay was >7 days in 13.5% of cases because of the practical difficulties with patient discharge, often requiring a transfer to inpatient physical and rehabilitation medicine departments.58 In previous studies, different brain neoplasms, use of varying surgical techniques, and previous oncologic treatments affected the complication and diagnostic yield rates.9,16,41,43,59 The present study controlled for this bias by selecting a homogeneous population.
Multiple biopsy samples are warranted for the histomolecular diagnosis of diffuse gliomas in the current molecular era, which possibly increases morbidity.
We assessed diagnostic yield, safety, and risk factors of postoperative morbidity after robot-assisted serial stereotactic biopsy sampling along 1 biopsy trajectory for diffuse gliomas.
Observational retrospective analysis of consecutive magnetic resonance imaging–based robot-assisted stereotactic biopsies performed at a single institution to assess the diagnosis of nonresectable newly diagnosed supratentorial diffuse gliomas in adults (2006–2016).
In 377 patients, 4.2 ± 1.9 biopsy samples were obtained at 2.6 ± 1.2 biopsy sites. The histopathologic diagnosis was obtained in 98.7% of cases. Preoperative neurologic deficit (P = 0.030), biopsy site hemorrhage ≥20 mm (P = 0.004), and increased mass effect on postoperative imaging (P = 0.014) were predictors of a new postoperative neurologic deficit (7.7%). Postoperative neurologic deficit (P < 0.001) and increased mass effect on postoperative imaging (P = 0.014) were predictors of a Karnofsky Performance Status decrease ≥20 points postoperatively (4.0%). Increased intracranial pressure preoperatively (P = 0.048) and volume of the contrast-enhanced area ≥13 cm³ (P = 0.048) were predictors of an increased mass effect on postoperative imaging (4.4%). Preoperative Karnofsky Performance Status <70 (P = 0.045) and increased mass effect on postoperative imaging (P < 0.001) were predictors of mortality 1 month postoperatively (2.9%). Preoperative neurologic deficit (P = 0.005), preoperative Karnofsky Performance Status <70 (P < 0.001), subventricular zone contact (P = 0.004), contrast enhancement (P = 0.018), and steroid use (P = 0.003), were predictors of the inability to discharge to home postoperatively (37.0%).
Robot-assisted stereotactic biopsy sampling results in high diagnostic accuracy with low complication rates. Multiple biopsy sites and samples do not increase postoperative complications.
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ORIGINAL ARTICLESafety and Efficacy of Frameless Stereotactic Brain Biopsy Techniques

Objective

Methods

Results

Conclusion

Supratentorial masses: stereotactic or freehand biopsy?

Br J Neurosurg

Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques

Neurosurgery

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

J Neurooncol

Safety and efficacy of frameless and frame-based intracranial biopsy techniques

Acta Neurochir (Wien)

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

J Neurosurg

ORIGINAL ARTICLE
Safety and Efficacy of Frameless Stereotactic Brain Biopsy Techniques