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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 -
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 -
Surgical Neurology International 2020Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the...
BACKGROUND
Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the emergence of postbiopsy symptomatic intracranial hemorrhage. Based on our findings, we suggest recommendations to improve its usual clinical practice.
METHODS
We made a retrospective study of 429 cases with stereotactic biopsies performed in the past 37 years. The surgical procedure-was adapted in terms of the stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs available in the hospital. Fifty-three variables were analyzed for each patient (SPSS.23).
RESULTS
The diagnostic yield was 90.7%. Forty-one patients (9.5%) suffered a symptomatic postbiopsy hemorrhage; only 17 (3.9%) had permanent morbidity. The mortality was 0.93% ( = 4). A postsurgical CT scan was requested only in 99 patients (23%) of our series. Lesion mass effect, cystic component, contrast enhancement, histological nature, or number of targets were not associated with a greater risk of symptomatic postbiopsy hemorrhage ( > 0.05). On the other hand, the biopsies made by nonexpert neurosurgeons ( = 0.01) or under general anesthesia ( = 0.02) resulted in a greater risk of symptomatic postbiopsy hemorrhage. Anesthetic type was the clearest predictive factor of bleeding with this technique (OR: 0.24).
CONCLUSION
Stereotactic biopsy is a very valuable tool. To optimize its safety and minimize the risk of intracranial bleeding, it requires both a knowledge of stereotactic techniques and very careful surgical planning. While the patient's stay in intensive vigilance units after the procedure is a useful strategy, the request for control CT scans should be conditioned by the clinical evolution of each patient.
PubMed: 32874721
DOI: 10.25259/SNI_102_2020 -
Stereotactic biopsy for lesions in brainstem and deep brain: a single-center experience of 72 cases.Brazilian Journal of Medical and... 2021Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in...
Stereotactic biopsies for lesions in the brainstem and deep brain are rare. This study aimed to summarize our 6-year experience in the accurate diagnosis of lesions in the brain stem and deep brain and to discuss the technical note and strategies. From December 2011 to January 2018, 72 cases of intracranial lesions in the brainstem or deep in the lobes undergoing stereotactic biopsy were retrospectively reviewed. An individualized puncture path was designed based on the lesion's location and the image characteristics. The most common biopsy targets were deep in the lobes (43 cases, 59.7%), including frontal lobe (33 cases, 45.8%), temporal lobe (4 cases, 5.6%), parietal lobe (3 cases, 4.2%), and occipital lobe (3 cases, 4.2 %). There were 12 cases (16.7%) of the brainstem, including 8 cases (11.1%) of midbrain, and 4 cases (5.6%) of pons or brachium pontis. Other targets included internal capsule (2 cases, 2.8%), thalamus (3 cases, 4.2%), and basal ganglion (12 cases, 16.7%). As for complications, one patient developed acute intracerebral hemorrhage in the biopsy area at 2 h post-operation, and one patient had delayed intracerebral hemorrhage at 7 days post-operation. The remaining patients recovered well after surgery. There was no surgery-related death. The CT-MRI-guided stereotactic biopsy of lesions in the brainstem or deep in the brain has the advantages of high safety, accurate diagnosis, and low incidence of complications. It plays a crucial role in the diagnosis of atypical, microscopic, diffuse, multiple, and refractory lesions.
Topics: Biopsy; Brain; Brain Stem; Humans; Image-Guided Biopsy; Retrospective Studies; Stereotaxic Techniques
PubMed: 34320122
DOI: 10.1590/1414-431X2021e11335 -
Child's Nervous System : ChNS :... Jul 2018Stereotactic brain biopsy represents one of the earliest applications of surgical robotics. The aim of the present systematic review and bibliometric analysis was to...
INTRODUCTION
Stereotactic brain biopsy represents one of the earliest applications of surgical robotics. The aim of the present systematic review and bibliometric analysis was to evaluate the literature supporting robot-assisted brain biopsy and the extent to which the scientific community has accepted the technique.
METHODS
The Cochrane and PubMed databases were searched over a 30-year period between 1st of January 1988 and 31st of December 2017. Titles and abstracts were screened to identify publications that met the following criteria: (1) featured patients with brain pathology, (2) undergoing stereotactic brain biopsy, (3) reporting robot-assisted surgery, and (4) outcome data were provided. The reference lists of selected studies were also sought, and expert opinion sought to identify further eligible publications. Selected manuscripts were then reviewed, and data extracted on effectiveness and safety. The status of scientific community acceptance was determined using a progressive scholarly acceptance analysis.
RESULTS
All identified studies were non-randomised, including 1 retrospective cohort study and 14 case series or reports. The diagnostic biopsy rate varied from 75 to 100%, and the average target accuracy varied from 0.9 to 4.5 mm. Use of the robot was aborted in two operations owing to geometric inaccessibility and an error in image registration but no associated adverse events were reported. A compounding progressive scholarly acceptance analysis suggested a trend towards acceptance of the technique by the scientific community.
CONCLUSIONS
In conclusion, robot-assisted stereotactic brain biopsy is an increasingly mainstream tool in the neurosurgical armamentarium. Further evaluation should proceed along the IDEAL framework with research databases and comparative trials.
Topics: Biopsy; Brain; Humans; Robotic Surgical Procedures; Stereotaxic Techniques
PubMed: 29744625
DOI: 10.1007/s00381-018-3821-y -
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 -
Neurologia Medico-chirurgica Apr 2022Frameless stereotactic brain biopsy (FSB) with navigation system has been widely used. We reported preliminary experience of FSB with intraoperative computed tomography...
Frameless stereotactic brain biopsy (FSB) with navigation system has been widely used. We reported preliminary experience of FSB with intraoperative computed tomography (iCT) and examined the usefulness of this novel adjuvant technique and real target registration error (rTRE) of FSB. The FSB with 5-aminolevulinic acid (5-ALA) and iCT was performed on 10 patients. The gadolinium-enhanced lesions on magnetic resonance image were defined as the biopsy target. In the procedure, iCTs were scanned twice, for autoregistration of the navigation system and for confirmation of the position of the actual inserted biopsy needle. The red fluorescence of the samples was observed under excitation with violet-blue light through a low-cut filter of neurosurgical microscope. The distance between the planned target and the tip of the biopsy needle in the image of iCT was calculated in a workstation for the assessment of rTRE. The median volume of the target was 12.13 mL (0.06-39.15 mL). We performed the surgical procedure in a prone position in four patients. None to faint 5-ALA-induced fluorescence was observed in six samples. There existed no sampling errors. The mean target distance between the planned and real targets of the mean rTRE of FSB was 2.7 ± 0.56 mm. The real TRE of FSB was first reported and was larger than the reported rTRE exactly calculated from the fiducial registration error. iCT guarantees accurate tumor sampling with autoregistration regardless of the surgical position and prevents inaccurate biopsy to occur even with ALA fluorescence assistance.
Topics: Aminolevulinic Acid; Biopsy; Brain Neoplasms; Humans; Magnetic Resonance Imaging; Neuronavigation; Stereotaxic Techniques; Tomography, X-Ray Computed
PubMed: 35197401
DOI: 10.2176/jns-nmc.2021-0343 -
Acta Neurochirurgica May 2019Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical...
BACKGROUND
Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach. The present study reports our experience with frameless stereotactic brain biopsy in this molecular era.
METHODS
One hundred forty consecutive patients treated from January 2013 to September 2018 were analyzed. Biopsies were performed using the Brainlab Varioguide® frameless stereotactic system. Patients' clinical and demographic data, the time of occupation of the operating room, the surgical time, the morbidity, and the diagnostic yield in providing a histological and molecular diagnosis were recorded and evaluated.
RESULTS
The overall diagnostic yield was 93.6% with nine procedures resulting non-diagnostic. Among 110 patients with glioma, the IDH-1 mutational status was characterized in 108 cases (98.2%), resulting wild-type in all subjects but 3; MGMT methylation was characterized in 96 cases (87.3%), resulting present in 60 patients, and 1p/19q codeletion was founded in 6 of the 20 cases of grade II-III gliomas analyzed. All the specimens were apt for molecular analysis when performed. Bleeding requiring surgical drainage occurred in 2.1% of the cases; 8 (5.7%) asymptomatic hemorrhages requiring no treatment were observed. No biopsy-related mortality was recorded. Median length of hospital stay was 5 days (IQR 4-8) with mean surgical time of 60.77 min (± 23.12) and 137.44 ± 24.1 min of total occupation time of the operative room.
CONCLUSIONS
Stereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
Topics: Adult; Aged; Brain Neoplasms; Female; Glioma; Humans; Male; Middle Aged; Neuronavigation; Postoperative Complications
PubMed: 30895395
DOI: 10.1007/s00701-019-03873-w