Robot-Assisted Stereotactic Biopsy of Diffuse Intrinsic Pontine Glioma: A Single-Center Experience

Carai, Andrea; Mastronuzzi, Angela; Benedictis, Alessandro De; Messina, Raffaella; Cacchione, Antonella; Miele, Evelina; Randi, Franco; Esposito, Giacomo; Trezza, Andrea; Colafati, Giovanna Stefania; Savioli, A.; Locatelli, Franco; Marras, Carlo Efisio

doi:10.1016/j.wneu.2017.02.088

Cited by 56 publications

(49 citation statements)

References 23 publications

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“…24 Cumulatively, there is a body of evidence suggesting that brainstem biopsy can be safely performed with a high diagnostic yield. Furthermore, meta-analyses suggest that different surgical approaches such as transfrontal versus transcerebellar, 6,13,33 the use of frame-based versus frameless stereotactic biopsy, 14,69 or the use of robot-assisted systems 6,12 have all consistently resulted in an excellent diagnostic yield with relatively minor morbidity. Biopsy tissue has revitalized the study of DIPG, leading to new classifications, dozens of promising preclinical trials, individualized therapy targeting patientspecific mutations, and multiple clinical trials.…”

Section: Feasibility Safety and Utility Of Brainstem Biopsiesmentioning

confidence: 99%

Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care

Williams

Young

Vitanza

et al. 2020

Neurosurgical Focus

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Diffuse intrinsic pontine glioma (DIPG) is a universally fatal pediatric brainstem tumor affecting approximately 300 children in the US annually. Median survival is less than 1 year, and radiation therapy has been the mainstay of treatment for decades. Recent advances in the biological understanding of the disease have identified the H3K27M mutation in nearly 80% of DIPGs, leading to the 2016 WHO classification of diffuse midline glioma H3K27M-mutant, a grade IV brainstem tumor. Developments in epigenetic targeting of transcriptional tendencies have yielded potential molecular targets for clinical trials. Chimeric antigen receptor T cell therapy has also shown preclinical promise. Recent clinical studies, including prospective trials, have demonstrated the safety and feasibility of pediatric brainstem biopsy in the setting of DIPG and other brainstem tumors. Given developments in the ability to analyze DIPG tumor tissue to deepen biological understanding of this disease and develop new therapies for treatment, together with the increased safety of stereotactic brainstem biopsy, the authors present a case for offering biopsy to all children with suspected DIPG. They also present their standard operative techniques for image-guided, frameless stereotactic biopsy.

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Section: Feasibility Safety and Utility Of Brainstem Biopsiesmentioning

confidence: 99%

Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care

Williams

Young

Vitanza

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Due to the potential risks of the surgical procedure and poor benefit for patients, biopsy of DIPG was abandoned by the majority of neurosurgical teams in the last 20 years. However, with the development of novel molecular genetic techniques and existence of various molecular signatures which indicated for different therapeutic schemes and agents, the role of stereotactic biopsy during the treatment of DIPG was gradually refocused in the recent years (Puget et al, 2015; Carai et al, 2017). Meanwhile, studies of brainstem anatomy have revealed 12 “safe entry zones” in the brainstem, including the perioculomotor (Bricolo et al, 1991); lateral mesencephalic sulcus; suprafacial (Kyoshima et al, 1993), interfacial (Bricolo and Turazzi, 1995), and lateral (Lawton et al, 2006) sulcus limitans; periolivary; posterior median sulcus; infraclavicular and supraclavicular areas; and the peritrigeminal, infrafacial, and supratrigeminal zones (Cavalheiro et al, 2015).…”

Section: Progess In Traditional Treatments For Dipgmentioning

confidence: 99%

Potential New Therapies for Pediatric Diffuse Intrinsic Pontine Glioma

et al. 2017

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Diffuse intrinsic pontine glioma (DIPG) is an extensively invasive malignancy with infiltration into other regions of the brainstem. Although large numbers of specific targeted therapies have been tested, no significant progress has been made in treating these high-grade gliomas. Therefore, the identification of new therapeutic approaches is of great importance for the development of more effective treatments. This article reviews the conventional therapies and new potential therapeutic approaches for DIPG, including epigenetic therapy, immunotherapy, and the combination of stem cells with nanoparticle delivery systems.

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“…Robotic implantation of SEEG electrodes has many advantages over other frame-based methods of neuro-navigation including optimization of diagnostic accuracy, particularly given that stereotactic target accuracy is inversely related to trajectory length, which is significant when reaching deeper brain targets during SEEG implantation [ 5 , 6 ]. Furthermore, robotic assistance allows several trajectory options without requiring numerous frame adjustments, shortening operative duration and reducing potential complications [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

et al. 2020

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Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.

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Robot-Assisted Stereotactic Biopsy of Diffuse Intrinsic Pontine Glioma: A Single-Center Experience

Cited by 56 publications

References 23 publications

Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care

Progress in diffuse intrinsic pontine glioma: advocating for stereotactic biopsy in the standard of care

Potential New Therapies for Pediatric Diffuse Intrinsic Pontine Glioma

Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

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