Abstract
Stereotactic biopsies are procedures performed to obtain tumor tissue for diagnostic examinations. Cerebral lesions of unknown entities can safely be accessed and tissue can be examined, resulting in correct diagnosis and according treatment. Stereotactic procedures of lesions in highly eloquent regions such as the brainstem have been performed for more than two decades in our department. In this retrospective study we focus on results, approaches, modalities of anesthesia, and complications. We performed a retrospective analysis of our prospective database, including 26 patients who underwent stereotactic biopsy of the brainstem between April 1994 and June 2015. All of the patients underwent preoperative MRI. Riechert–Mundinger-frame was used before 2000, thereafter the Leksell stereotactic frame was used. After 2000 entry and target points were calculated by using BrainLab stereotactic system. We evaluated histopathological results as well as further treatment; additionally we compared complications of local versus general anesthesia and complications of a frontal versus a trans-cerebellar approach. Median age of all patients was 33 years, and median number of tissue samples taken was 12. In all patients a final histopathological diagnosis could be established. 5 patients underwent the procedure under local anesthesia, 21 patients in general anesthesia. In 19 patients a frontal approach was performed, while in 7 patients a trans-cerebellar approach was used. Complications occurred in five patients. Thereby no significant difference was found with regard to approach (frontal versus trans-cerebellar) or anesthesia (local versus general). Stereotactic biopsies even of lesions in the brainstem are a save way to obtain tumor tissue for final diagnosis, resulting in adequate treatment. Approach can be trans-cerebellar or frontal and procedure can be performed either under local or general anesthesia without significant differences concerning complication rate.
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References
Abdelaziz O, Eshra M, Belal A, Elshafei M (2016) Diagnostic value of magnetic resonance spectroscopy compared with stereotactic biopsy of intra-axial brain lesions. J Neurol Surg A Cent Eur Neurosurg 77(4):283–290 (Epub ahead of print)
Albright AL, Packer RJ, Zimmerman R et al (1993) Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children’s Cancer Group. Neurosurgery 33:1026–1029
Blasel S, Jurcoane A, Franz K, Morawe G, Pellikan S, Hattingen E (2010) Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas. Acta Neurochir (Wien) 152(11):1893–1899
Cartmill M, Punt J (1999) Diffuse brain stem glioma. A review of stereotactic biopsies. Childs Nerv Syst 15:235–237 (discussion 238)
Dellaretti M, Reyns N, Touzet G, Dubois F, Gusmao S, Pereira JL, Blond S (2012) Stereotactic biopsy for brainstem tumors: comparison of transcerebellar with transfrontal approach. Stereotact Funct Neurosurg 90:79–83
Frank F, Fabrizi AP, Frank-Ricci R, Gaist G, Sedan R, Peragut JC (1988) Stereotactic biopsy and treatment of brain stem lesions: combined study of 33 cases (Bologna-Marseille). Acta Neurochir Suppl (Wien) 42:177–181
Giunta F, Grasso G, Marini G, Zorzi F (1989) Brain stem expanding lesions: stereotactic diagnosis and therapeutical approach. Acta Neurochir Suppl (Wien) 46:86–89
Goncalves-Ferreira AJ, Herculano-Carvalho M, Pimentel J (2003) Stereotactic biopsies of focal brainstem lesions. Surg Neurol 60:311–320 (discussion 320)
Hattingen E, Jurcoane A, Nelles M, Müller A, Nöth U, Mädler B, Mürtz P, Deichmann R, Schild HH (2015) Quantitative MR imaging of brain tissue and brain pathologies. Clin Neuroradiol 25 (Suppl 2):219–24
Kickingereder P, Willeit P, Simon T, Ruge MI (2013) Diagnostic value and safety of stereotactic biopsy for brainstem tumors: a systematic review and meta-analysis of 1480 cases. Neurosurgery 72:873–881 (discussion 882; quiz 882)
Landolfi JC, Thaler HT, DeAngelis LM (1998) Adult brainstem gliomas. Neurology 51(4):1136–1139
Lescher S, Whora K, Schwabe D, Kieslich M, Porto L (2016) Analysis of T2 signal intensity helps in the differentiation between high and low-grade brain tumours in paediatric patients. Eur J Paediatr Neurol 20(1):108–113
Lunsford LD, Niranjan A, Khan AA, Kondziolka D (2008) Establishing a benchmark for complications using frame-based stereotactic surgery. Stereotact Funct Neurosurg 86:278–287
Lu Y, Yeung C, Radmanesh A, Wiemann R, Black PM, Golby AJ (2015) Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques. World Neurosurg 83(3):261–268. doi:10.1016/j.wneu.2014.07.043 (Epub 2014 Aug 1)
Massager N (2002) Usefulness of PET scan guidance in stereotaxic radioneurosurgery using a gamma knife. Bull Mem Acad R Med Belg 157:355–362 (discussion 363–359)
Mathisen JR, Giunta F, Marini G, Backlund EO (1987) Transcerebellar biopsy in the posterior fossa: 12 years experience. Surg Neurol 28:100–104
Nöth U, Hattingen E, Bähr O, Tichy J, Deichmann R (2015) Improved visibility of brain tumors in synthetic MP-RAGE anatomies with pure T1 weighting. NMR Biomed 28(7):818–830
Pell MF, Thomas DG, Krateminos GP (1993) Stereotactic management of intrinsic brain stem lesions. Ann Acad Med Singapore 22:447–451
Preuss M, Werner P, Barthel H, Nestler U, Christiansen H, Hirsch FW, Fritzsch D, Hoffmann KT, Bernhard MK, Sabri O (2014) Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors. Childs Nerv Syst 30(8):1399–403. doi:10.1007/s00381-014-2412-9 (Epub 2014 Apr 8)
Quick-Weller J, Duetzmann S, Behmanesh B, Seifert V, Weise LM, Marquardt G. (2015) Oblique positioning of the stereotactic frame for biopsies of cerebellar and brainstem lesions. World Neurosurg 86:466-469
Raabe A, Krishnan R, Zimmermann M, Seifert V (2003) Frame-less and frame-based stereotaxy? How to choose the appropriate procedure. Zentralbl Neurochir 64(1):1–5
Rajshekhar V, Moorthy RK (2010) Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients. Stereotact Funct Neurosurg 88(6):360–366
Samadani U, Stein S, Moonis G, Sonnad SS, Bonura P, Judy KD (2006) Stereotactic biopsy of brain stem masses: Decision analysis and literature review. Surg Neurol 66:484–490 (discussion 491)
Schmalfuss IM, Camp M (2008) Skull base: pseudolesion or true lesion? Eur Radiol 18(6):1232–1243
Spiegelmann R, Friedman WA (1991) Rapid determination of thalamic CT-stereotactic coordinates: a method. Acta Neurochir (Wien) 110:77–81
Tanaka N, Abe T, Kojima K, Nishimura H, Hayabuchi N (2000) Applicability and advantages of flow artifact-insensitive fluid-attenuated inversion-recovery MR sequences for imaging the posterior fossa. Am J Neuroradiol 21(6):1095–1098
Weise LM, Bruder M, Eibach S, Seifert V, Byhahn C, Marquardt G, Setzer M (2013) Efficacy and safety of local versus general anesthesia in stereotactic biopsies: a matched-pairs cohort study. J Neurosurg Anesthesiol 25:148–153
Weise LM, Harter PN, Eibach S, Braczynski AK, Dunst M, Rieger J, Bahr O, Hattingen E, Steinbach JP, Plate KH, Seifert V, Mittelbronn M (2014) Confounding factors in diagnostics of MGMT promoter methylation status in glioblastomas in stereotactic biopsies. Stereotact Funct Neurosurg 92:129–139
White HH (1963) Brain stem tumors occurring in adults. Neurology 13:292–300
Wagner M, Nafe R, Jurcoane A, Pilatus U, Franz K, Rieger J, Steinbach JP, Hattingen E (2011) Heterogeneity in malignant gliomas: a magnetic resonance analysis of spatial distribution of metabolite changes and regional blood volume. J Neurooncol 103(3):663–672
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All authors declare not to have any conflict of interest concerning this study. This retrospective study was approved by the local ethics committee.
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Quick-Weller, J., Lescher, S., Bruder, M. et al. Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center. J Neurooncol 129, 243–250 (2016). https://doi.org/10.1007/s11060-016-2166-1
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DOI: https://doi.org/10.1007/s11060-016-2166-1