Surgical navigation-assisted endoscopic biopsy is feasible for safe and reliable diagnosis of unresectable solid brain tumors

Abstract

Stereotactic biopsy has been validated for tissue sampling of deep-seated lesions that cannot be easily resected via open craniotomy. However, some inherent problems including the inability to directly observe the lesion and difficulty in confirming hemostasis limit its usefulness. To overcome these issues, we used the endoscope in brain tumor biopsy, for not only intraventricular tumors but also intraparenchymal tumors. The rigid scope was used in association with a surgical navigation system for intraparenchymal lesions via a transcortical route. There were no useful anatomical landmarks when the trajectory to the lesions was decided; therefore, surgical navigation system was required for the transcortical procedures. The endoscopic procedure described here was attempted in 21 cases of intraparenchymal lesions between January 2007 and February 2012. A definitive diagnosis was obtained in all cases, and genetic analysis was performed when required. Serious postsurgical hemorrhage or neurological deficits were not observed in any cases. Endoscopic surgery provides a clear view of the target and makes it easier to differentiate tumor tissue from normal brain tissue. Moreover, the endoscope helped to confirm hemostasis during the procedure. Thus, endoscopic biopsy has the potential to contribute toward safe and reliable diagnosis of brain tumors.

Endoscopic biopsy of brain tumors: Does the technique matter?

“…Except for one study by Husain et al . [ 16 ] published in 2010, only very few studies with scarce information[ 2 9 29 ] or single case reports[ 27 ] are available.…”

“…Unfortunately, a specific diagnostic yield based on the type of endoscopic device was rarely reported in these mixed studies. [ 15 17 29 34 36 ]…”

Three-dimensional, computer simulated navigation in endoscopic neurosurgery

“…In addition to the pre-operative advantages of navigation guidance in surgical planning, neuronavigation has been shown to have many advantages during surgery, including anatomical identification of key structures 2,5,15 and real-time intraoperative guidance 6,12,16 (Table 2). Neuronavigation allows for the real-time, accurate intraoperative sampling of multiple lesions using a single burr hole 16 and intraparenchymal tumor resection due to the difficulty of externally visualizing anatomic landmarks.…”

“…Neuronavigation allows for the real-time, accurate intraoperative sampling of multiple lesions using a single burr hole 16 and intraparenchymal tumor resection due to the difficulty of externally visualizing anatomic landmarks. 12,16,17 Neuronavigation is limited in its ability to display the sella’s relationship to surrounding anatomy and the sphenoid sinus’ contours when compared to 3D reconstructions.…”

“…Neuronavigation allows for the real-time, accurate intraoperative sampling of multiple lesions using a single burr hole 16 and intraparenchymal tumor resection due to the difficulty of externally visualizing anatomic landmarks. 12,16,17 Neuronavigation is limited in its ability to display the sella’s relationship to surrounding anatomy and the sphenoid sinus’ contours when compared to 3D reconstructions. 18 The use of neuronavigation may also impact the extent of tumor resection, 19 with a meta-analysis demonstrating an association between navigation and either near-complete or complete tumor resection (p<0.0003), 20 and an additional report of higher resection volumes in endoscopic biopsy when compared to open or stereotactic biopsies (p<0.05).…”