Skull base: pseudolesion or true lesion?

Stereotactic biopsies are procedures performed to obtain tumor tissue for diagnostic examinations. Cerebral lesions of unknown entities can safely be accessed and tissue can be examined, resulting in correct diagnosis and according treatment. Stereotactic procedures of lesions in highly eloquent regions such as the brainstem have been performed for more than two decades in our department. In this retrospective study we focus on results, approaches, modalities of anesthesia, and complications. We performed a retrospective analysis of our prospective database, including 26 patients who underwent stereotactic biopsy of the brainstem between April 1994 and June 2015. All of the patients underwent preoperative MRI. Riechert-Mundinger-frame was used before 2000, thereafter the Leksell stereotactic frame was used. After 2000 entry and target points were calculated by using BrainLab stereotactic system. We evaluated histopathological results as well as further treatment; additionally we compared complications of local versus general anesthesia and complications of a frontal versus a trans-cerebellar approach. Median age of all patients was 33 years, and median number of tissue samples taken was 12. In all patients a final histopathological diagnosis could be established. 5 patients underwent the procedure under local anesthesia, 21 patients in general anesthesia. In 19 patients a frontal approach was performed, while in 7 patients a trans-cerebellar approach was used. Complications occurred in five patients. Thereby no significant difference was found with regard to approach (frontal versus trans-cerebellar) or anesthesia (local versus general). Stereotactic biopsies even of lesions in the brainstem are a save way to obtain tumor tissue for final diagnosis, resulting in adequate treatment. Approach can be trans-cerebellar or frontal and procedure can be performed either under local or general anesthesia without significant differences concerning complication rate.

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“…This might be true especially in case of brain stem masses due to artifacts, limiting imaging of the skull base and below [3,24,26].…”

Section: Compliance With Ethical Standardsmentioning

confidence: 99%

Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center

et al. 2016

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“…The radiological evaluation of this complex anatomical region requires a great deal of expertise and involves many potential pitfalls because the appearance of fissures, sutures and neurovascular channels closely resembles the appearance of fractures [6,7]. Depending on their location, fractures of the skull base can cause severe damage.…”

Section: Introductionmentioning

confidence: 97%

Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms

et al. 2009

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The purpose of this study was to retrospectively assess the detection rate of skull-base fractures for three different three-dimensional (3D) reconstruction methods of cranial CT examinations in trauma patients. A total of 130 cranial CT examinations of patients with previous head trauma were subjected to 3D reconstruction of the skull base, using solid (SVR) and transparent (TVR) volume-rendering technique and maximum intensity projection (MIP). Three radiologists independently evaluated all reconstructions as well as standard high-resolution multiplanar reformations (HR-MPRs). Mean fracture detection rates for all readers reading rotating reconstructions were 39, 36, 61 and 64% for SVR, TVR, MIP and HR-MPR respectively. Although not significantly different from HR-MPR with respect to sensitivity (P = 0.9), MIP visualised 18% of fractures that were not reported in HR-MPR. Because of the relatively low detection rate using HR-MPRs alone, we recommend reading MIP reconstructions in addition to the obligatory HR-MPRs to improve fracture detection.

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“…The emissary veins of the foramina rotundum and ovale form a venous plexus surrounding the enclosed nerves [16,19,41]. The FO venous plexus is the main pathway of the cavernous sinus drainage to the pterygoid venous plexus [19] and it is the main factor influencing the FO size [31]. Williams et al [41] in their study regarding the trigeminal nerve and the perineural vascular plexus found that the dimensions of the venous plexus surrounding the mandibular nerve were larger compared to the dimensions of the venous plexus compassing the maxillary nerve.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, the ESF location and content forced Wood-Jones [42] to view the ESF as an extension of [31] mentioned that the confluence ESF-FO and the transmission of the sphenoidal emissary veins via the FO, in the absence of the ipsilateral ESF is a possible explanation for the FO asymmetry. The hypothesis tested in this paper, is that the ESF may alter the FO venous part and thus the FO size.…”

Section: Discussionmentioning

confidence: 99%

The size of the foramen ovale regarding to the presence and absence of the emissary sphenoidal foramen: is there any relationship between them?

et al. 2018

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Skull base: pseudolesion or true lesion?

Cited by 20 publications

References 22 publications

Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center

Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center

Three-dimensional fracture visualisation of multidetector CT of the skull base in trauma patients: comparison of three reconstruction algorithms

The size of the foramen ovale regarding to the presence and absence of the emissary sphenoidal foramen: is there any relationship between them?

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