Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

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

doi:10.1159/000335502

Cited by 54 publications

(44 citation statements)

References 32 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%

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%

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Lefranc¹,

Capel²,

Pruvot-Occéan³

et al. 2015

JNS

105

View full text Add to dashboard Cite

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“…In transcerebellar group, the complication rate was 21.1%, while the definitive morbidity was 5.3% and mortality was 5.3%. [32] The location of the lesion may partly dictate the approach chosen. Transfrontal approach is the preferred route in most of the cases, which reflects the predominance of upper brainstem lesions.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review

Manoj

Arivazhagan

Bhat

et al. 2014

Journal of Neurosciences in Rural Practice

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Background:Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children.Materials and Methods:The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed.Results:Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series.Conclusion:Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.

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“…In general, frameless biopsy offers more ergonomic properties and an easier surgical workflow, 21,25,71 especially in cases of supratentorial tumors and lesions larger than 15 mm. 3,49,57 On the other hand, frame-based biopsy envisages a more complex surgical workflow, 23,51,57 and it is still preferred in many centers for the deepest and smallest lesions, or for lesions located close to highly vascular areas, such as the pineal region. 39 So far, robot-assisted biopsies have been routinely performed at only a few centers in a limited number of patients.…”

Section: Stereotactic Biopsymentioning

confidence: 99%

“…39 So far, robot-assisted biopsies have been routinely performed at only a few centers in a limited number of patients. 6,23,32,39 Only one group has recently reported the use of the ROSA device for stereotactic biopsies in a series of 100 tumors with various locations and histological types. Different registration modalities have been adopted (frameless robotic surface registration, robotic bone fiducial marker registration, and scalp fiducial marker registration) for both supine and prone approaches.…”

Section: Stereotactic Biopsymentioning

confidence: 99%

Robot-assisted procedures in pediatric neurosurgery

Benedictis¹,

Trezza

Carai³

et al. 2017

Neurosurgical Focus

133

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OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.

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Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Cited by 54 publications

References 32 publications

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review

Robot-assisted procedures in pediatric neurosurgery

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