Frameless image-guided stereotactic brain biopsies: emphasis on diagnostic yield

Abstract

Although frameless stereotactic brain biopsy procedures are considered to be relatively safe, the true DY is significantly less than previously reported, most probably due to the lack of standardised DY criteria. Based on our DY definition and subsequent DY findings, standardisation of DY criteria and definition is paramount for biopsy diagnosis interpretation.

Evaluation of 126 consecutive cases of stereotactic procedures: brain biopsy, diagnostic yield, accuracy, non-diagnostic results, hemorrhagic complications and follow up.

“…There are few studies on the management and follow up of non-diagnostic biopsy cases in the literature (1,13,23,29,39). The institution of empirical treatments after a presumptive diagnosis using serial imaging was advised for patients with non-diagnostic biopsies (1,39).…”

“…Many predictive factors for non-diagnostic biopsy have been described, including younger age (11,23), longer operating time (10), insufficient material and sampling error (4), lesions locating at right side (10), midline and cerebellum (9,25), smaller and deeply located lesions and posterior fossa lesions (3). A misdiagnosis is an incorrect diagnosis and occurs most often with mis-staged glial tumors during stereotactic brain biopsies (36).…”

“…Jain et al (22) suggested that multiple bits were associated with a high diagnostic yield, even reaching 100 % for 5 to 6 bits; however, Zoeller et al (39) found no statistically significant correlation between the number of biopsies and non-diagnosis. The diagnosis and grading of glial tumors are special applications of the stereotactic biopsy (2,5,13,21,23,27), and one of the main problems is the representation of the whole lesion within the biopsy material (21,24). Callovini (5) concluded that, in the lesions of the corpus callosum, histological analysis seems not to be required in order to proceed to complementary therapies, presuming these lesions are high grade gliomas.…”

Real-time magnetic resonance imaging-guided frameless stereotactic brain biopsy: technical note

“…1,3,6,8,14,15,23 The primary limitations of these approaches are the inability to account for the shift of intracranial structures (reduces accuracy of the biopsy at the target), the inability to adapt to vital structures along the needle trajectory in real-time, and the lack of intraoperative imaging confirmation of the accuracy of the biopsy target. 5,7,13,22 Moreover, miscalculations or technical misalignment of hardware during biopsy can result in intraoperative morbidity.…”

“…6,10 Recent data indicate that the diagnostic accuracy of stereotaxy using conventional preoperative neuronavigation may be lower than previously reported (accuracy range 51%-91%). 3,4,8 To overcome these limitations, technology has been developed that now permits the integration of intraoperative MRI (iMRI) with frameless stereotaxy. The resolution and real-time feedback of this iMRI technology has been demonstrated in phantom experiments, 12,18 nonhuman primate studies, 16,17 drug infusion cannula placement, 2 and placement of deep brain stimulator leads.…”