Stereotactic biopsy

Stereotactic tumor biopsy may be considered the safest neurosurgical procedure in terms of anticipated results and potential surgical complications.

It is a versatile, minimally invasive technique to obtain tissue safely from intracranial lesions for their histologic diagnosis and therapeutic management.

Navigated transcranial magnetic stimulation can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium 1).

Müller et al., presented a paper to demonstrate a new method of stereotactic biopsy, based on a patient-specific 3D printed platform in dogs. The system was tested on two canine cadavers, a small (Shih Tzu) and a large (Labrador) breed. Imaginary biopsy targets were defined in a superficial (caudate nucleus) and a deep (piriform lobe) position. Based on 3 Tesla MRI, individualized stereotactic platforms were designed using a semi-automatic approach, and manufactured additively using ABS M30. A pre- and intra-operative CT was performed to compare the planned vs. the realized needle position for precision analyses of the procedure. The target points varied with a precision between 0.09 mm and 0.48 mm. Manufacturing time required 480 to 700 min per platform. The presented patient-specific stereotactic system seems a suitable instrument for application in small animal neurosurgery. In particular, the implementation of relevant stereotactic data may help performing the procedure in rapid sequence and with higher precision than currently-used systems. Required adjustments and adaptions to the respective anatomical conditions are omitted and make the procedure reliable and safe 2).

Both the frame-based and the frameless stereotactic (navigation) systems are currently used for biopsy of intracranial tumors. However, all these equipment are very expensive 3) 4).

Frame based stereotactic brain biopsy

Glioma heterogeneity and the limitations of conventional structural MRI for identifying aggressive tumor components can limit the reliability of stereotactic biopsy and, hence, tumor characterization, which is a hurdle for developing and selecting effective treatment strategies.

In vivo MR spectroscopy (MRS) and PET enable noninvasive imaging of cellular metabolism relevant to proliferation and can detect regions of more highly active tumor.

18F-FET-PET imaging is considered to identify metabolically active tumor tissue and to differentiate it from therapy-associated changes.

18F-FET-PET image-guided surgical targeting yielded histological diagnosis with decent specificity and high sensitivity in our cohort of pediatric brain tumor patients. Our results warrant further evaluation of 18F-FET-PET imaging for surgical guidance 5).

Microrecording is useful to delineate the brain tumor from its surroundings. Stereotactic diagnostic biopsy and removal of the brain tumor were facilitated by this adjuvant method 6).

Image-guided stereotactic biopsy performed using depth microrecording was safe, it provided accurate positional information in real-time, and it could distinguish the tumor from brain structures during surgery. Moreover, this technique has potential for studying the epileptogenicity of the brain tumor 7).

see Stereotactic brain biopsy in dog.

1. coagulation disorders

a) coagulopathies: bleeding diatheses, iatrogenic (heparin or coumadin)

b) low platelet count (PC): PC < 50,000/ml is an absolute contraindication, it is desirable to get the PC ≥ 100,000

2. inability to tolerate general anesthesia and to cooperate for local anesthesia.

Bartek J Jr, Cooray G, Islam M, Jensdottir M. Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report. Oper Neurosurg (Hagerstown). 2018 Oct 26. doi: 10.1093/ons/opy321. [Epub ahead of print] PubMed PMID: 30371829.
Müller M, Winkler D, Möbius R, Sauerstein T, Scholz S, Gutmann S, Flegel T, Meixensberger J, Drossel WG, Grunert R. A concept for a 3D-printed patient-specific stereotaxy platform for brain biopsy -a canine cadaver study. Res Vet Sci. 2019 Feb 25;124:79-84. doi: 10.1016/j.rvsc.2019.02.007. [Epub ahead of print] PubMed PMID: 30856434.
Jones AP, Sofat A, Davis CH, Denton S, Gurusinghe NT. A low cost modification of an old Leksell stereotactic frame to allow CT-guided stereotaxy. Br J Neurosurg. 1990;4:193–7.
Moseley JI, Giannotta SL, Renaudin JW. A simple, inexpensive technique for accurate mass localization by computerized tomography: Technical note. J Neurosurg. 1980;52:733–5.
Misch M, Guggemos A, Driever PH, Koch A, Grosse F, Steffen IG, Plotkin M, Thomale UW. (18)F-FET-PET guided surgical biopsy and resection in children and adolescence with brain tumors. Childs Nerv Syst. 2014 Sep 18. [Epub ahead of print] PubMed PMID: 25231277.
Ohye C, Shibazaki T, Hirai T, Matsumura M, Kawashima Y, Hirato M. Microrecording for the study of thalamic organization, for tumor biopsy and removal. Stereotact Funct Neurosurg. 1989;52(2-4):136-44. PubMed PMID: 2657936.
Iijima K, Hirato M, Miyagishima T, Horiguchi K, Sugawara K, Hirato J, Yokoo H, Yoshimoto Y. Microrecording and image-guided stereotactic biopsy of deep-seated brain tumors. J Neurosurg. 2015 Mar 27:1-11. [Epub ahead of print] PubMed PMID: 25816085.
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