Brainstem stereotactic biopsy sampling in children

Pincus, David W.; Richter, Erich O.; Yachnis, Anthony T.; Bennett, Jeffrey; Bhatti, Muhammad Tariq; Smith, Amy

doi:10.3171/ped.2006.104.2.7

Cited by 28 publications

(28 citation statements)

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“…Although MRI scans may reliably categorize pediatric brainstem lesions as tumor versus nontumor, they remain inaccurate in predicting tumor grade and histological subtype, particularly in brainstem gliomas (7,8,41). For this reason, the reliance on imaging for the diagnosis of pediatric brainstem tumors has been questioned (7,30,35,40). In our series, MRI scans carried a 58% diagnostic error rate.…”

Section: Indicationsmentioning

confidence: 69%

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Transcerebellar Stereotactic Biopsy for Lesions of the Brainstem and Peduncles Under Local Anesthesia

et al. 2008

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Section: Indicationsmentioning

confidence: 69%

“…In children, some authors advocate a surgical biopsy to obtain tissue when the radiographic features are not consistent with a diffuse pontine glioma (35). Similarly, in adults, it is increasingly apparent that the heterogeneity of brainstem lesions complicates the ability to diagnose and prognosticate on the basis of imaging alone (14,22,37,39,40,44).…”

mentioning

confidence: 98%

Transcerebellar Stereotactic Biopsy for Lesions of the Brainstem and Peduncles Under Local Anesthesia

et al. 2008

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“…This finding has been previously reported in childhood brainstem tumors, leading some authors [11] to the conclusion that "apart from cystic or exophytic tumors or the placement of a shunt, surgery can only be recommended when it is considered to have a low risk of causing any neurologic sequelae and when performed by an experienced neurosurgeon". On the other hand, the need for histologic assessment by means of stereotactic biopsy is still advocated by some authors [12] in children with brainstem lesions "not exhibiting the classic MR imaging and clinical features of diffuse glioma". More in general, regarding the need of a biopsy to establish an histological diagnosis in the patients who are not candidates to a surgical resection (i. e. those with exophytic and/or cystic tumors), our approach is similar to that of Landolfi et al and Guillamo et al Patients exhibiting the "classical" picture of a diffusely infiltrating non-enhancing lesion on MRI do not require a biopsy, as MRI has a high degree of accuracy and the risk of morbidity due to tumor location is quite high.…”

Section: Discussionmentioning

confidence: 99%

Natural history and management of brainstem gliomas in adults

et al. 2008

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Brainstem gliomas in adults are rare tumors, with heterogeneous clinical course; only a few studies in the MRI era describe the features in consistent groups of patients. In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy. Of the patients 18 were male, 14 female, with a median age of 31. In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma). Contrast enhancement at MRI was present in 14 patients. In all of the 9 patients who were investigated with MR spectroscopy, the Cho/NAA ratio was elevated at diagnosis. In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide). Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease. Grade III or IV myelotoxicity was observed in 6 patients. After a follow-up ranging from 9 to 180 months, all but 2 patients have progressed and 14 have died (12 for disease progression, 2 for pulmonary embolism). Median overall survival time was of 59 months. Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival. Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.

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“…7,15 From our literature review, the mismatch of pre-operative radiological diagnosis with histological diagnosis happened in about 10e20% of cases. 11,14,15 In our series, the radiologist successfully diagnosed brainstem glioma (8 patients) according to the MRI and/or MRS, but failed in predicting the tumor grade. In Taiwan, the payment for alkylating agent (Temozolomide) from the National Health Insurance is according to definite pathology report.…”

Section: Othersmentioning

confidence: 91%

“…There were only two case reports about contralateral approach. 9,11 Concurrent neurological deficits should be taken into consideration for decision-making. In Case 2, we performed left-side approach because of the relatively mild right-limb weakness.…”

Section: Transfrontal Ipsilateral or Contralateral Approachmentioning

confidence: 99%