Correlation between magnetic resonance imaging findings and histological diagnosis of intrinsic brainstem lesions in adults

Dellaretti, Marcos; Touzet, Gustavo; Reyns, Nicolas; Dubois, François; Gusmão, Sebastião; Pereira, Jorge Luís Gavina; Blond, S.

doi:10.1093/neuonc/nor215

Cited by 31 publications

(44 citation statements)

References 18 publications

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“…27,31 This preference may be based on the slight but significant difference in terms of accuracy between the two techniques that, in our opinion, could explain the lower diagnostic yield of frameless biopsy for very small and posterior fossa lesions. 2 Although frame-based stereotaxy is reliable, accurate, and safe even for the deepest and smallest lesions, 8,9,23,24,[29][30][31] it clearly complicates the surgical workflow. Dedicated imaging must be performed on the day of surgery with the frame in place, which is time consuming.…”

Section: Discussionmentioning

confidence: 99%

“…The robotic device was used for 8 brainstem biopsies and histological diagnoses were established in every case, with only 1 case of transient clinical worsening, a result at least comparable to that obtained in frame-based biopsy series in terms of accuracy and morbidity. 9,24,30 Finally, the robot is easily combined with intraoperative CT, which can be used as reference imaging. With intraoperative FPCT, the needle in position can be coregistered with preoperative planning images, which allows the surgeon to confirm that the needle is accurately placed.…”

Section: Discussionmentioning

confidence: 99%

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Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Lefranc¹,

Capel²,

Pruvot-Occéan³

et al. 2015

JNS

105

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OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Lefranc¹,

Capel²,

Pruvot-Occéan³

et al. 2015

JNS

105

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“…MK-1775 combined with radiation is being tested in pontine gliomas (ClinicalTrials.gov Identifier: NCT01922076); these childhood tumors have a grave prognosis and over half do not have significant contrast enhancement on MR imaging (34–36). This latter finding suggests that many of these tumors have a relatively intact BBB, which, in conjunction with our observation that MK-1775 has limited penetration into normal brain, might suggest only a subset of patients with a more open BBB may benefit from therapy.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of the Wee1 Inhibitor MK-1775 Combined with Temozolomide Is Limited by Heterogeneous Distribution across the Blood–Brain Barrier in Glioblastoma

Pokorny

Calligaris

Gupta

et al. 2015

Clinical Cancer Research

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Purpose Wee1 regulates key DNA damage checkpoints, and in this study, the efficacy of the Wee1 inhibitor MK-1775 was evaluated in GBM xenograft models alone and in combination with radiation and/or temozolomide (TMZ). Experimental design In vitro MK-1775 efficacy alone and in combination with TMZ, and the impact on DNA damage was analyzed by western blotting and γH2AX foci formation. In vivo efficacy was evaluated in orthotopic and heterotopic xenografts. Drug distribution was assessed by conventional mass spectrometry (MS) and matrix-assisted laser desorption/ionization (MALDI) -MS imaging. Results GBM22 (IC50 = 68 nM) was significantly more sensitive to MK-1775 compared to 5 other GBM xenograft lines including GBM6 (IC50 >300 nM), and this was associated with a significant difference in pan-nuclear γH2AX staining between treated GBM22 (81% cells positive) and GBM6 (20% cells positive) cells. However, there was no sensitizing effect of MK-1775 when combined with TMZ in vitro. In an orthotopic GBM22 model, MK-1775 was ineffective when combined with TMZ, while in a flank model of GBM22, MK-1775 exhibited both single agent and combinatorial activity with TMZ. Consistent with limited drug delivery into orthotopic tumors, the normal brain to whole blood ratio following a single MK-1775 dose was 5%, and MALDI-MS imaging demonstrated heterogeneous and markedly lower MK-1775 distribution in orthotopic as compared to heterotopic GBM22 tumors. Conclusions Limited distribution to brain tumors may limit the efficacy of MK-1775 in GBM.

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“…█ REFERENCES fact that diffuse BSG rarely stain with contrast (8,9,28). The short time interval between the occurrence of symptoms and the diagnosis, the presence of intra-tumoral necrosis and histologic verification of high grade BSG are predictors of shorter survival period (15,25,28,30).…”

Section: Follow-up In Months Follow-up In Monthsmentioning

confidence: 99%

“…They characteristically present with multiple cranial nerve deficits, ataxia and long tract dysfunction (5,6,10). The simplest classification of BSG is into two groups as focal and diffuse (4,8). More complex grading system defined subtypes of tumors of the brainstem, according to localization, the presence of hydrocephalus and hemorrhage and growth model (5,7,11,13).…”

mentioning

confidence: 99%

Adult brainstem gliomas - retrospective analysis of 51 patients

Tasić¹,

Repac²,

Nikolić³

et al. 2016

Turkish Neurosurgery

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ABSTRACTthe specific pathology all BSG must be considered malignant because their localization itself is inoperable (23). These tumors are most often localized in pons, often with infiltration in other regions of the brainstem (16). They characteristically present with multiple cranial nerve deficits, ataxia and long tract dysfunction (5,6,10). The simplest classification of BSG is into two groups as focal and diffuse (4,8). More complex grading system defined subtypes of tumors of the brainstem, according to localization, the presence of hydrocephalus and hemorrhage and growth model (5,7,11,13).umors of the central nervous system are present in about 2% compared to all malignant tumors of the human population. They represent the leading cause of death from malignant tumors in children population and fourth in the adult population (21). In the period before computed tomography (CT) and magnetic resonance imaging (MRI), all brainstem gliomas (BSG) were considered a pathological entity with a poor prognosis. Matson emphasized that regardless of RESUlTS:Of the 51 patients, 62.7% were male and 37.3% were female. The mean age was 30.6±19.3 years. High grade glioma (Astrocytoma grade III and IV) was most common at the age of 38.2±17.9 years (t=.481, p=0.017) while low grade glioma (Astrocytoma grade I and II) was common in younger age as 25.4±17.4 years (X 2 =4.013; p=0.045), with localization in the pons (X 2 =5.299; p=0.021) and exophytic presentation (X 2 =3.862; p=0.049). Ataxia, as initial symptom, was a predictor of poor outcome (HR:5.546, p=0.012).CONClUSION: Due to its specific localization, BSG present a major challenge for neurosurgery, because of the necessity of safe approach for radical resection. Histological verification of BSG determines the need for additional therapeutic procedures such as radiotherapy and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment.

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Correlation between magnetic resonance imaging findings and histological diagnosis of intrinsic brainstem lesions in adults

Cited by 31 publications

References 18 publications

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

The Efficacy of the Wee1 Inhibitor MK-1775 Combined with Temozolomide Is Limited by Heterogeneous Distribution across the Blood–Brain Barrier in Glioblastoma

Adult brainstem gliomas - retrospective analysis of 51 patients

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