Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases

McGirt, Matthew J.; Woodworth, Graeme F.; Coon, Alexander L.; Frazier, James M.; Amundson, Eric; Garonzik, Ira M.; Olivi, Alessandro; Weingart, Jon

doi:10.3171/jns.2005.102.5.0897

Cited by 200 publications

(174 citation statements)

References 25 publications

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“…Our morbidity rate of 4% (temporary or permanent neurologic deficit) corroborates the results of these other large series and also demonstrates that an aggressive sampling technique can be employed without compromising patient safety. This is consistent with the study of Mcgirt et al [23], which found that increasing the number of biopsy samples did not independently impact morbidity if the samples were collected along a single needle trajectory.…”

Section: Safety Considerations In Stereotactic Biopsysupporting

confidence: 92%

“…Brainstem and pineal locations accounted for three of four complications, and this is consistent with the findings of previous authors who correlated morbidity with pineal [18] and deep-seated lesions [23]. In general, relatively small numbers of pineal locations in this and other series make generalization to an accurate risk profile for these lesions difficult.…”

Section: Safety Considerations In Stereotactic Biopsysupporting

confidence: 90%

“…It is our opinion that a step-down level facility or well trained neurosurgical floor capable of providing neurologic assessments every 2 h is sufficient for the initial 12 postoperative hours in uncomplicated cases. In other publications, poor glycemic control in diabetics [23] and platelet counts \150,000 [18] have also been identified as statistically significant independent risk factors for poor outcome after stereotactic biopsy and should be considered in postbiopsy management decisions. .…”

Section: Safety Considerations In Stereotactic Biopsymentioning

confidence: 93%

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Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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Introduction In the modern era of frameless stereotaxis (FL), the role of frame-based (FB) stereotactic needle biopsy is evolving. Methods Retrospective review of prospective database of 106 lesions in 91 consecutive patients undergoing FB stereotactic needle biopsy with a systematic ''geologic core'' technique by a single surgeon. Diagnostic accuracy was calculated comparing biopsy diagnosis with final pathology in 11 patients who underwent subsequent surgical resection. All instances of intra-operative bleeding through the needle were prospectively noted and compared with post-biopsy CT scan. Lesions were classified as risky for FL technique if they were (1) infratentorial or pineal, (2) within 10 mm of the circle of Willis or root of the Sylvian fissure, or (3) within 10 mm of deep cerebral veins. Results Diagnostic yield was 94%. Diagnostic accuracy was 91%. Of 18 lesions involving the corpus callosum, 13 (72.2%) were GBM 2 were anaplastic astrocytoma, and 1 each were found to be anaplastic oligodendroglioma, primary central nervous system lymphoma (PCNSL) and tumescent MS. Of 25 multifocal lesions, malignant primary brain tumor was diagnosed in 17 (68%) (11 GBM, 3 PCNSL, 2 anaplastic ologodendroglioma, and 1 anaplastic astrocytoma). Mortality was 0%. Three patients developed temporary neurologic deficits and one had permanent deficit. Absence of persistent blood through the biopsy needle had a negative predicative value of 98.8% for subsequent neuroimaging blood [5 mm diameter. According to our criteria, 80% of patients would have been candidates for FL biopsy. Conclusions Stereotactic biopsy is an effective, safe and important technique for histologic diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions. Postbiopsy CT can be safely reserved for patients who demonstrate persistent bleeding through the biopsy needle. FB stereotaxy remains an important technique for the 20% with small or deep seated lesions or when it is advantageous to avoid an incision, a burr hole or general anesthesia.

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Section: Safety Considerations In Stereotactic Biopsysupporting

confidence: 92%

Section: Safety Considerations In Stereotactic Biopsysupporting

confidence: 90%

Section: Safety Considerations In Stereotactic Biopsymentioning

confidence: 93%

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Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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“…Recently, the literature shows advanced studies regarding the concomitant use of CT, angiography, MRI and computer software allowing the surgeon to create interactive images which will guide him precisely during biopsy, with great preservation of important anatomical and neurovascular structures. This complex system provides accurate diagnosis with low morbidity and mortality rates together with high positivity for both the frame system and the frameless needle guided biopsies 21,22 .…”

Section: Discussionmentioning

confidence: 99%

“…vides brain tissue samples for further anatomical and histopathological analysis of minimal lesions, as well as lesions located in deep or eloquent brain sites, having low complication risks given its minimal invasive characteristics 4 . The clinical indication is precise for those cases of unclear diagnosis where the precise nature is not clear.…”

Section: Intracranial Lesions Stereotactic Biopsymentioning

confidence: 99%

Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients

Silva

Vasconcellos

Lara

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: Image guided stereotactic biopsy (SB) provides cerebral tissue samples for histological analysis from minimal lesions or those that are located in deep regions, being crucial in the elaboration of therapeutic strategies, as well as the prevention of unnecessary neurosurgical interventions. Method: Sixty patients with central nervous lesions underwent SB from November 1999 to March 2008. They were followed up to 65 months. Preoperative diagnosis was based on clinical presentation and neuro-radiological features, pathologic diagnosis, clinical outcome. The compatibility of these findings with the pathologic diagnosis was analyzed. Results: Considering diagnosis confirmation when inflammatory hypothesis were made, our accuracy was of 76%, with 94% of those cases having clinic-pathological correspondence after an average of 65.2 months of follow up. Considering diagnosis confirmation with the preoperative hypothesis of neoplasm, our accuracy was of 69% with 90% of these cases having clinic-pathological correspondence after an average of 47.3 months of follow-up. Morbidity rate was of 5% and mortality was zero. The diagnosis rate was 95%. Conclusion: Stereotactic biopsy represents a safe and precise method for diagnosis. Anatomic and histopathological analyses have high compatibility with long-term clinical outcome.KEY WORDS: stereotactic biopsy, morbidity, accuracy, pathology.Biopsia estereotáctica para lesões intracranianas: compatibilidade clínico patológica em 60 casos resumo -Objetivo: A biopsia estereotáctica (BE) guiada por imagem propicia amostras de tecido cerebral para análises histológicas, sendo decisiva na estratégia terapêutica e prevenção de intervenções neurocirúrgicas desnecessárias. Método: 60 pacientes com lesões do sistema nervoso central foram submetidos à biópsia estereotáctica no período de novembro de 1999 a março de 2008. Foram analisados a acurácia do método, a capacidade de confirmar o diagnóstico clínico pré-operatório e o comportamento evolutivo com sua compatibilidade com o diagnóstico patológico. Resultados: As três lesões mais freqüentes foram: neoplasias neuroepiteliais, processos inflamatórios e infecções. Considerando a confirmação diagnóstica quando pensava-se em lesão inflamatória, nossa acurácia foi 76%, com 94% destes casos tendo compatibilidade clínico patológica após média de 65,2 meses de acompanhamento. Considerando a confirmação diagnóstica com a hipótese pré-operatória de lesão neoplásica, nossa acurácia foi 69%, com 90% destes casos tendo compatibilidade clínico-patológica após média de 47,3 meses de acompanhamento. O índice de morbidade foi 5%. A mortalidade foi nula e o índice de diagnóstico foi 95%. Conclusão: A biopsia estereotáctica é um método seguro e preciso para o diagnóstico. O exame anátomo-patológico possui alta compatibilidade com a evolução clínica dos doentes a longo prazo. PALAVRAS-CHAVE: biopsia estereotáctica, morbidade, acurácia, anatomopatológico.

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Rapid Intraoperative Molecular Characterization of Glioma

et al. 2015

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IMPORTANCE Conclusive intraoperative pathologic confirmation of diffuse infiltrative glioma guides the decision to pursue definitive neurosurgical resection. Establishing the intraoperative diagnosis by histologic analysis can be difficult in low-cellularity infiltrative gliomas. Therefore, we developed a rapid and sensitive genotyping assay to detect somatic single-nucleotide variants in the telomerase reverse transcriptase (TERT) promoter and isocitrate dehydrogenase 1 (IDH1). OBSERVATIONS This assay was applied to tissue samples from 190 patients with diffuse gliomas, including archived fixed and frozen specimens and tissue obtained intraoperatively. Results demonstrated 96% sensitivity (95% CI, 90%–99%) and 100% specificity (95% CI, 95%–100%) for World Health Organization grades II and III gliomas. In a series of live cases, glioma-defining mutations could be identified within 60 minutes, which could facilitate the diagnosis in an intraoperative timeframe. CONCLUSIONS AND RELEVANCE The genotyping method described herein can establish the diagnosis of low-cellularity tumors like glioma and could be adapted to the point-of-care diagnosis of other lesions that are similarly defined by highly recurrent somatic mutations.

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Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases

Cited by 200 publications

References 25 publications

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Stereotactic biopsy for intracranial lesions: clinical-pathological compatibility in 60 patients

Rapid Intraoperative Molecular Characterization of Glioma

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