Stereotactic Brain Biopsies Using Varioguide System – 101 Cases Experience


Authors: O. Bradáč ;  A. Štekláčová ;  F. Kramář ;  V. Beneš
Authors‘ workplace: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN – VFN Praha
Published in: Cesk Slov Neurol N 2016; 79/112(5): 579-584
Category: Short Communication
doi: 10.14735/amcsnn2016579

Overview

Introduction:
Stereotactic brain biopsy is a routine procedure used to evaluate brain pathologies. Knowledge of histological diagnosis is crucial for further management in the majority of cases. In this paper we present our 5-year experience with Varioguide frameless stereotactic system.

Material and methods:
Between 2010 and 2014, we treated 97 patients, 54 males and 43 females. Mean age was 61 ± 14 years. Stereobiopsies were performed using trajectories planned on IPlan application based on MRI navigation sequences. Primary outcome was diagnostic yield and rate of severe haemorrhagic complications.

Results:
We performed two procedures in four patients, thus we performed 101 procedures together. Median volume of lesion was 18.8 cm3, IQR (interquartile range) 4.6–32 cm3. Lesion volume below 1 cm3 was found in 10 cases. The biopsy was non-diagnostic in eight patients. Out of the 10 less than 1 cm3 lesions, biopsy was non-diagnostic in three cases, significantly more frequently than in larger lesions (p = 0.031). A haemorrhagic complication was encountered in eight cases, bleeding was symptomatic in four. Severe morbidity and mortality was thus 4%. On the day of surgery, a therapeutic dose of LMWH was administered in 10 cases, three of these suffered from post-op haemorrhage (p = 0.031).

Conclusions:
Frameless stereobiopsy using Varioguide system is a safe and effective system for brain biopsies. Diagnostic yield was 92%. The only identified predictor of diagnostic yield was lesion volume above 1 cm3. A therapeutic dose of LMWH on the day of surgery seems to be linked to higher incidence of haemorrhagic complications.

Key words:
frameless stereotaxy – brain biopsy – MRI navigation – diagnostic yield

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Lobao CA, Nogueira J, Souto AA, et al. Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center. Arq Neuropsiquiatr 2009; 67 (3B): 876–81.

2. Amin DV, Lozanne K, Parry PV, et al. Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation. J Neurosurg 2011; 114 (5): 1414–20. doi: 10.3171/2010.7.JNS091493.

3. Bekelis K, Radwan TA, Desai A, et al. Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety. J Neurosurg 2012; 116 (5): 1002–6. doi: 10.3171/2012.1.JNS111746.

4. Sutherland GR, Wolfsberger S, Lama S, et al. The evolution of neuroArm. Neurosurgery 2013; 72 (Suppl 1): 27–32. doi: 10.1227/NEU.0b013e318270da19.

5. Patil AA. A modified stereotactic frame as an instrument holder for frameless stereotaxis: technical note. Surg Neurol Int 2010; 1: 62. doi: 10.4103/2152-7806.70957.

6. Fukaya C, Sumi K, Otaka T, et al. Nexframe frameless stereotaxy with multitract microrecording: accuracy evaluated by frame-based stereotactic X-ray. Stereotact Funct Neurosurg 2010; 88 (3): 163–8. doi: 10.1159/000313868.

7. Ringel F, Ingerl D, Ott S, et al. VarioGuide: a new frameless image-guided stereotactic system – accuracy study and clinical assessment. Neurosurgery 2009; 64 (5 Suppl 2): 365–71. doi: 10.1227/01.NEU.0000341532.15867.1C.

8. Khatab S, Spliet W, Woerdeman PA. Frameless image-guided stereotactic brain biopsies: emphasis on diagnostic yield. Acta Neurochir (Wien) 2014; 156 (8): 1441–50. doi: 10.1007/s00701-014-2145-2.

9. Grossman R, Sadetzki S, Spiegelmann R, et al. Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biop- sies. Acta Neurochir (Wien) 2005; 147 (6): 627–31.

10. Woodworth GF, McGirt MJ, Samdani A, et al. Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 2006; 104 (2): 233–7.

11. Barnett GH, Miller DW, Weisenberger J. Frameless stereotaxy with scalp-applied fiducial markers for brain biop- sy procedures: experience in 218 cases. J Neurosurg 1999; 91 (4): 569–76.

12. Waters JD, Gonda DD, Reddy H, et al. Diagnostic yield of stereotactic needle-biopsies of sub-cubic centimeter intracranial lesions. Surg Neurol Int 2013; 4 (Suppl 3): S176–81. doi: 10.4103/2152-7806.110677.

13. Chrastina J, Novák Z, Jančálek R, et al. Úloha stereotaktické biopsie v diagnostice tumoru mozku. Onkologie 2011; 5 (1): 49–52.

14. Dammers R, Haitsma IK, Schouten JW, et al. Safety and efficacy of frameless and frame-based intracranial biop- sy techniques. Acta Neurochir (Wien) 2008; 150 (1): 23–9. doi: 10.1007/s00701-007-1473-x.

15. Zoeller GK, Benveniste RJ, Landy H, et al. Outcomes and management strategies after nondiagnostic stereotactic biopsies of brain lesions. Stereotact Funct Neurosurg 2009; 87 (3): 174–81. doi: 10.1159/000222661.

16. Frati A, Pichierri A, Bastianello S, et al. Frameless stereotactic cerebral biopsy: our experience in 296 cases. Stereotact Funct Neurosurg 2011; 89 (4): 234–45. doi: 10.1159/000325704.

17. Shooman D, Belli A, Grundy PL. Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. J Neurosurg 2010; 113 (2): 170–8. doi: 10.3171/2009.12.JNS09573.

18. Schulder M, Spiro D. Intraoperative MRI for stereotactic biopsy. Acta Neurochir Suppl 2011; 109: 81–7. doi: 10.1007/978-3-211-99651-5_13.

19. Tanaka S, Puffer RC, Hoover JM, et al. Increased frameless stereotactic accuracy with high-field intraoperative magnetic resonance imaging. Neurosurgery 2012; 71 (2 Suppl): ons321–7. doi: 10.1227/NEU.0b013e31 826a88a9.

20. Bradac O, Vrana J, Jiru F, et al. Recognition of anaplastic foci within low-grade gliomas using MR spectroscopy. Br J Neurosurg 2014; 28 (5): 631–6. doi: 10.3109/02688697. 2013.872229.

21. Gempt J, Buchmann N, Ryang YM, et al. Frameless image-guided stereotaxy with real-time visual feedback for brain biopsy. Acta Neurochir (Wien) 2012; 154 (9): 1663–7. doi: 10.1007/s00701-012-1425-y.

22. Widhalm G, Minchev G, Woehrer A, et al. Strong 5-aminolevulinic acid-induced fluorescence is a novel intraoperative marker for representative tissue samples in stereotactic brain tumor biopsies. Neurosurg Rev 2012; 35 (3): 381–91. doi: 10.1007/s10143-012- 0374-5.

23. Grimm F, Naros G, Gutenberg A, et al. Blurring the boundaries between frame-based and frameless stereotaxy: feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 2015; 123 (3): 737–42. doi: 10.3171/2014.12.JNS141 781.

24. Li G, Su H, Cole GA, et al. Robotic system for MRI-guided stereotactic neurosurgery. IEEE Trans Biomed Eng 2015; 62 (4): 1077–88.

25. Dorward NL, Paleologos TS, Alberti O, et al. The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 2002; 16 (2): 110–8.

26. Gralla J, Nimsky C, Buchfelder M, et al. Frameless stereotactic brain biopsy procedures using the Stealth Station: indications, accuracy and results. Zentralbl Neurochir 2003; 64 (4): 166–70.

27. Ali Z, Prabhakar H, Bithal PK, et al. A review of perioperative complications during frameless stereotactic surgery: our institutional experience. J Anesth 2009; 23 (3): 358–62. doi: 10.1007/s00540-009- 0759-y.

28. Niemi T, Armstrong E. Thromboprophylactic management in the neurosurgical patient with high risk for both thrombosis and intracranial bleeding. Curr Opin Anaesthesiol 2010; 23 (5): 558–63. doi: 10.1097/ACO. 0b013e32833e1589.

29. Niemi T, Silvasti-Lundell M, Armstrong E, et al. The Janus face of thromboprophylaxis in patients with high risk for both thrombosis and bleeding during intracranial surgery: report of five exemplary cases. Acta Neurochir (Wien) 2009; 151 (10): 1289–94. doi: 10.1007/s00701-009-0419-x.

30. Salmaggi A, Simonetti G, Trevisan E, et al. Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: a systematic review. J Neurooncol 2013; 113 (2): 293–303. doi: 10.1007/s11060-013-1115-5.

Labels
Paediatric neurology Neurosurgery Neurology

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