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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 -
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 -
The Indian Journal of Medical Research Aug 2021Stereotactic biopsy is used for sampling of suspicious non-palpable lesions identified on mammography or digital breast tomosynthesis which are not visible on... (Review)
Review
Stereotactic biopsy is used for sampling of suspicious non-palpable lesions identified on mammography or digital breast tomosynthesis which are not visible on ultrasound. Stereotactic biopsy is preferable to surgical excision biopsy and helps avoid surgery for benign lesions. Providing tissue diagnosis in patients with early breast cancer may help in formulating a management strategy. Stereotactic biopsy can be carried out using either a dedicated prone table with the patient lying prone or an upright mammographic add-on system with the patient in a sitting or lateral decubitus position. This review focuses on the advantages and disadvantages of both these systems, the indications, contraindications and the complications inherent with this technique. The important pitfalls and their management as well as ways to ensure quality assurance have also been elaborated upon. Data regarding uptake of stereotactic biopsy in other parts of the world have been discussed using evidence from existing registries and databases and attempts made to quantify the need of the technique in the Indian set-up. In the absence of a national breast screening programme and limited resources in India, a hub and spoke model has been proposed as a viable model for healthcare providers for providing stereotactic biopsy.
Topics: Asian People; Biopsy; Breast; Breast Neoplasms; Female; Humans; Mammography
PubMed: 35142645
DOI: 10.4103/ijmr.IJMR_1815_20 -
Clinical Imaging 2019Prior to stereotactic breast biopsy, some radiologists obtain a mammogram image with an overlying alphanumeric grid to mark the skin overlying the target. Our purpose is...
OBJECTIVE
Prior to stereotactic breast biopsy, some radiologists obtain a mammogram image with an overlying alphanumeric grid to mark the skin overlying the target. Our purpose is to determine if this grid image affects stereotactic biopsy efficiency and accuracy, including total images obtained, procedure time and need for retargeting.
MATERIALS AND METHODS
IRB approved, HIPAA compliant retrospective review of prone stereotactic biopsy cases targeting calcifications 9/1/2015 to 9/1/2016 was performed. Images and reports were reviewed for number and type of images obtained, evidence of retargeting and biopsy table time. Attending radiologist, technologist and trainee involvement were recorded. Statistical analysis was performed utilizing SAS statistical software v 9.4 (SAS Institute, Cary, NC).
RESULTS
Of 463 women (avg age 58.0 years, range 30-94), 392/463 (84.7%) had grid images obtained pre-biopsy. Grid patients had more images total than non-grid (avg 9.26 versus 8.44 images/patient; p < 0.0001) but spent less time on the biopsy table (avg 15 min 2 s versus 16 min 44 s/procedure; p < 0.0001). Non-grid patients were more likely to undergo initial retargeting (45% non-grid vs 30% of grid patients; p = 0.013); however, later retargeting after needle placement was comparable (p = 0.3).
CONCLUSION
Grid imaging increases images obtained but decreases retargeting and biopsy table time at the expense of mammogram room/technologist time to obtain the grid image. The overall result is longer total procedure time (grid time plus table time) for the patient/technologist. A grid image therefore has limited usefulness and should be used judiciously in cases where prone positioning is challenging to patients.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Breast; Breast Diseases; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Imaging, Three-Dimensional; Mammography; Middle Aged; Patient Positioning; Retrospective Studies; Urogenital Surgical Procedures
PubMed: 30321753
DOI: 10.1016/j.clinimag.2018.10.007 -
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 -
CA: a Cancer Journal For Clinicians 1994The substantial majority of questionable lesions detected by mammography are benign, and there is growing interest among health care professionals and patients in... (Review)
Review
The substantial majority of questionable lesions detected by mammography are benign, and there is growing interest among health care professionals and patients in alternatives to surgical biopsy for diagnosing these lesions. Stereotactic breast biopsy is an x-ray guided method for localizing and sampling breast lesions discovered on mammography and considered to be suspicious for malignancy. Its use in sampling small, nonpalpable breast lesions has been investigated over the past 15 years, using fine-needle aspiration for cytology and, more recently, core-needle biopsy for histology. Multiple series comparing stereotactic biopsy with surgical biopsy have shown that stereotactic techniques accurately sample small lesions and have a sensitivity of 90 to 95 percent for breast cancer detection. State-of-the-art stereotactic breast biopsy is comparable in sensitivity to surgical biopsy, and the procedure is quicker, cheaper, and easier than the standard practice of preoperative, mammographically guided localization followed by surgical biopsy. In an age of miniaturization, stereotactic techniques provide miniature breast biopsies. The University of Chicago acquired the first prone stereotactic table in the United States in 1986, and we have found stereotactic breast biopsy to be a very good alternative for certain lesions that would otherwise require surgical biopsy for diagnosis. Most lesions (70 percent) sent to conventional biopsy at the University of Chicago between 1986 and 1989 were graded by observers as being in a low-suspicion category (less than 10 percent chance of malignancy based on mammographic findings), and the positive malignancy yield of this category of lesions was seven percent. These lesions were also examined with stereotactic fine-needle aspiration performed as a "piggy-back" procedure to the needle localization for surgery. The results of this study have led us to use stereotactic biopsy rather than surgical biopsy for low-suspicion lesions since then. We currently use stereotactic breast biopsy for about half the nonpalpable lesions considered for breast biopsy at our institution and find it to be reliable and readily accepted by informed patients. The introduction of automated core-biopsy guns has escalated interest in the technique, due to increased confidence in the histologic samples obtained and the ability to make specific benign diagnoses more frequently. Some centers have extended the potential use of stereotaxis to virtually all suspicious mammographic lesions, including those with a high probability of malignancy, to plan definitive surgery. Based on current estimates, there are now over 1,000 centers either investigating or using stereotactic biopsy for occult breast lesions.
Topics: Biopsy; Breast Neoplasms; Humans; Stereotaxic Techniques
PubMed: 7621069
DOI: 10.3322/canjclin.44.3.172 -
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 -
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 -
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