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Future Oncology (London, England) Sep 2018Meningiomas are the most common primary intracranial tumor. Important advances are occurring in meningioma research. These are expected to accelerate, potentially... (Review)
Review
Meningiomas are the most common primary intracranial tumor. Important advances are occurring in meningioma research. These are expected to accelerate, potentially leading to impactful changes on the management of meningiomas in the near and medium term. This review will cover the histo- and molecular pathology of meningiomas, including recent 2016 updates to the WHO classification of CNS tumors. We will discuss clinical and radiographic presentation and therapeutic management. Surgery and radiotherapy, the two longstanding primary therapeutic modalities, will be discussed at length. In addition, data from prior and ongoing investigations of other treatment modalities, including systemic and targeted therapies, will be covered. This review will quickly update the reader on the contemporary management and future directions in meningiomas. [Formula: see text].
Topics: Animals; Biopsy; Combined Modality Therapy; Humans; Meningeal Neoplasms; Meningioma; Multimodal Imaging; Neoplasm Staging; Prognosis; Symptom Assessment; Treatment Outcome
PubMed: 30084265
DOI: 10.2217/fon-2018-0006 -
Genome Medicine Sep 2022Primary central nervous system lymphoma (PCNSL) is a rare lymphoma of the central nervous system, usually of diffuse large B cell phenotype. Stereotactic biopsy followed...
BACKGROUND
Primary central nervous system lymphoma (PCNSL) is a rare lymphoma of the central nervous system, usually of diffuse large B cell phenotype. Stereotactic biopsy followed by histopathology is the diagnostic standard. However, limited material is available from CNS biopsies, thus impeding an in-depth characterization of PCNSL.
METHODS
We performed flow cytometry, single-cell RNA sequencing, and B cell receptor sequencing of PCNSL cells released from biopsy material, blood, and cerebrospinal fluid (CSF), and spatial transcriptomics of biopsy samples.
RESULTS
PCNSL-released cells were predominantly activated CD19CD20CD38CD27 B cells. In single-cell RNA sequencing, PCNSL cells were transcriptionally heterogeneous, forming multiple malignant B cell clusters. Hyperexpanded B cell clones were shared between biopsy- and CSF- but not blood-derived cells. T cells in the tumor microenvironment upregulated immune checkpoint molecules, thereby recognizing immune evasion signals from PCNSL cells. Spatial transcriptomics revealed heterogeneous spatial organization of malignant B cell clusters, mirroring their transcriptional heterogeneity across patients, and pronounced expression of T cell exhaustion markers, co-localizing with a highly malignant B cell cluster.
CONCLUSIONS
Malignant B cells in PCNSL show transcriptional and spatial intratumor heterogeneity. T cell exhaustion is frequent in the PCNSL microenvironment, co-localizes with malignant cells, and highlights the potential of personalized treatments.
Topics: Central Nervous System Neoplasms; Humans; Immune Checkpoint Proteins; Lymphoma; Receptors, Antigen, B-Cell; T-Lymphocytes; Tumor Microenvironment
PubMed: 36153593
DOI: 10.1186/s13073-022-01110-1 -
Journal of the Korean Society of... Mar 2023Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or... (Review)
Review
Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or digital breast tomosynthesis only without detected on breast US, stereotactic biopsy and mammography-guided preoperative localization is one of the method for pathologic diagnosis. This review aims to describe the indication, contraindication, technique of stereotactic biopsy, clip placement after stereotactic biopsy, and digital breast tomosynthesis-guided stereotactic biopsy. In addition, this article reviews mammography-guided preoperative localization using a wire or non-wire device.
PubMed: 37051394
DOI: 10.3348/jksr.2022.0145 -
Neurosurgical Review Feb 2022Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of...
Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of outpatient stereotactic brain biopsies, few data from other countries with different health care systems are available. We therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. We prospectively examined all the consecutive stereotactic brain biopsies performed in an outpatient setting at our tertiary medical center, between June 2018 and September 2020. Among the 437 patients who underwent stereotactic brain biopsy during the study period, 40 (9.2%) patients were enrolled for an outpatient management. The sex ratio was 1 and the median age on biopsy day was 55 [41-66] years. The median distance from patients' home to hospital was 17 km [3-47]. 95% of patients had pre-biopsy ASA score of 1 or 2 and mRs equal to 2 or less. The rate of same-day discharge was 100%. No patient experienced post-biopsy symptomatic complication necessitating readmission within the month following the biopsy. One patient (2.5%) resorted to an unplanned consultation. Histological findings obtained from brain biopsy led to a diagnosis in all patients; the most frequently found were neoplastic lesions (77.5%). Stereotactic brain biopsies can therefore be safely achieved on an outpatient setting in carefully selected patients. This process could be more widely adopted in other neurosurgical centers, without affecting the quality of patient's health care and safety. In this article, we propose management guidelines and pre-biopsy checklist for performing ambulatory stereotactic brain biopsies.
Topics: Biopsy; Brain; Humans; Neurosurgical Procedures; Outpatients; Patient Discharge
PubMed: 34164746
DOI: 10.1007/s10143-021-01593-3 -
Brain Sciences Oct 2021Stereotactic biopsy of posterior fossa lesions is often regarded as hazardous due to the critical structures in that area. Therefore, the aim of the study was to...
Stereotactic biopsy of posterior fossa lesions is often regarded as hazardous due to the critical structures in that area. Therefore, the aim of the study was to evaluate the diagnostic accuracy and safety of infratentorial stereotactic biopsy of brainstem or cerebellar lesions and its associations with other clinical, laboratory, and radiological parameters. From January 2000 to May 2021, 190 infratentorial stereotactic biopsies of posterior fossa tumors, including 108 biopsies of brainstem lesions, were performed. Moreover, 63 supratentorial biopsies of cerebral peduncle lesions were analyzed to compare the safety and efficacy of both approaches. Additionally, the presence of antibodies against and Epstein-Barr Virus (EBV) were documented in 67 and 66 patients, respectively, and magnetic resonance imaging (MRI) scans were evaluated in 114 patients. Only 4% of patients had minor complications and 1.5% had major complications, including one patient who died from intracranial bleeding. Nine (4.7%) biopsies were non-diagnostic. Isocitrate dehydrogenase 1 () mutation, 1p/19q codeletion, and O6-methylguanine-DNA methyltransferase () promoter methylation status were assessed in 29 patients, and were non-diagnostic in only 3 (10.3%) cases. Patients with high-grade gliomas (HGG) were more frequently seropositive for than individuals with low-grade gliomas (LGG; < 0.001). A total of 27% of HGG and 41% of LGG were non-enhancing on MRI. The infratentorial approach is generally safe and reliable for biopsy of brainstem and cerebellar lesions. In our study, the safety and efficacy of supratentorial biopsy of the cerebral peduncle and infratentorial biopsy of lesions below the cerebral peduncle were comparably high. Moreover, patients with HGG were more frequently seropositive for than patients with LGG, and the relationship between toxoplasmosis and gliomagenesis requires further investigation.
PubMed: 34827431
DOI: 10.3390/brainsci11111432 -
Neurosurgery Clinics of North America Oct 2020Brain metastases (BrM) affect up to 20% of patients with cancer and represent an increasing portion of patients with surgical brain tumors owing to improving prognoses... (Review)
Review
Brain metastases (BrM) affect up to 20% of patients with cancer and represent an increasing portion of patients with surgical brain tumors owing to improving prognoses of cancer patients in general and in many cases even of those with brain metastases. With advances in molecular biology and targeted therapy, the indications for neurosurgical sampling and specifically stereotactic biopsy are likely to change in the future. In this review the authors address some of the scientific advances in BrM biology, the clinical rationale and range of techniques currently used to perform stereotactic biopsy, and how the advent of molecular interrogation may potentially alter the way patients with BrM are managed in the future.
Topics: Aged; Aged, 80 and over; Brain Neoplasms; Female; Humans; Image-Guided Biopsy; Male; Middle Aged; Stereotaxic Techniques
PubMed: 32921348
DOI: 10.1016/j.nec.2020.06.002 -
Neurosurgical Review Dec 2022Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and... (Review)
Review
Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients' management algorithms based on early discharge after biopsy optimize the patient's personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients' postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.
Topics: Humans; Brain Neoplasms; Inventions; Stereotaxic Techniques; Biopsy; Brain
PubMed: 36471144
DOI: 10.1007/s10143-022-01918-w -
Frontiers in Neurology 2022Frame-based stereotactic biopsy is well-established to play an essential role in neurosurgery. In recent years, different robotic devices have been introduced in...
INTRODUCTION
Frame-based stereotactic biopsy is well-established to play an essential role in neurosurgery. In recent years, different robotic devices have been introduced in neurosurgery centers. This study aimed to compare the SINO surgical robot-assisted frameless brain biopsy with standard frame-based stereotactic biopsy in terms of efficacy, accuracy and complications.
METHODS
A retrospective analysis was performed on 151 consecutive patients who underwent stereotactic biopsy at Chongqing Sanbo Jiangling Hospital between August 2017 and December 2021. All patients were divided into the frame-based group ( = 47) and the SINO surgical robot-assisted group ( = 104). The data collected included clinical characteristics, diagnostic yield, operation times, accuracy, and postoperative complications.
RESULTS
There was no significant difference in diagnostic yield between the frame-based group and the SINO surgical robot-assisted group (95.74 vs. 98.08%, > 0.05). The mean operation time in the SINO surgical robot-assisted group was significantly shorter than in the frame-based group (29.36 ± 13.64 vs. 50.57 ± 41.08 min). The entry point error in the frame-based group was significantly higher than in the robot-assisted group [1.33 ± 0.40 mm (0.47-2.30) vs. 0.92 ± 0.27 mm (0.35-1.65), < 0.001]. The target point error in the frame-based group was also significantly higher than in the robot-assisted group [1.63 ± 0.41 mm (0.74-2.65) vs. 1.10 ± 0.30 mm (0.69-2.03), < 0.001]. Finally, there was no significant difference in postoperative complications between the two groups.
CONCLUSION
Robot-assisted brain biopsy becomes an increasingly mainstream tool in the neurosurgical procedure. The SINO surgical robot-assisted platform is as efficient, accurate and safe as standard frame-based stereotactic biopsy and provides a reasonable alternative to stereotactic biopsy in neurosurgery.
PubMed: 35923834
DOI: 10.3389/fneur.2022.928070 -
Asian Journal of Neurosurgery 2018This study describes a technique using gravity for guidance in stereotactic brain biopsy. This will be especially useful in hospitals where the stereotactic equipment is...
INTRODUCTION
This study describes a technique using gravity for guidance in stereotactic brain biopsy. This will be especially useful in hospitals where the stereotactic equipment is unavailable.
OBJECTIVES
The aim of this study is to describe the technique, develop a formula to define its limits of accuracy, and report on its clinical application.
METHODS
Using the positioning laser grid lines on the computed tomography scanner, a small metallic marker is placed on the scalp at the intended biopsy site. The distance between the tumor and the inner table of the bone is measured. In the operating theater, the patient is positioned such that the tip and the bridge of the nose are aligned in a horizontal position. The patient's two eyebrows or the orbital canthi are aligned in a vertical line. Simultaneously, the posterior borders of the two pinnae are aligned vertically. Gravity is used to guide the biopsy needle through the marked burr hole into the target. Seven patients had biopsies. One was for targeting the craniopharyngioma cyst to place an Ommaya catheter. The fraction of error or error fraction (EF), was developed for verification of its limits of accuracy.
RESULTS
All the biopsies were diagnostic and the Ommaya catheter was correctly sited. The EFs at α = 5° were all predictive of the limits of accuracy of this technique.
CONCLUSION
This is the first reported gravity-guided stereotactic brain surgery. The outcome in all the eight cases showed that it was within the limits of its accuracy. EF can be calculated to ensure accuracy. This technique is helpful if a commercial stereotactic system is not available.
PubMed: 30283515
DOI: 10.4103/1793-5482.238075