Are stereotactic sample biopsies still of value in the modern management of pineal region tumours? Lessons from a single-department, retrospective series

Abstract

To guide subsequent treatment, we believe that histological diagnosis is paramount. Stereotactic biopsies are currently the safest and the most efficient way of obtaining this essential information. Recent improvements in stereotactic technology (particularly robotic techniques) appear to be very valuable, with almost no permanent morbidity or mortality risk and no decrease in the accuracy rate. In our opinion, other available neurosurgical techniques (such as endoscopic neurosurgery, stereotactic neurosurgery and open microsurgery) are complementary and not competitive.

Robot-assisted procedures in pediatric neurosurgery

“…There were no deaths, infections, or permanent postsurgical sequelae. These results are in line with those of Lefranc et al 38,39 and other groups that have reported a complication rate ranging between 0% and 9.3%. 9,28,36,57 In summary, our results confirm that stereotactic biopsy under ROSA guidance combines the advantages of both frameless and frame-based methods, in terms of technical aspects, timing, and diagnostic accuracy.…”

“…38,39 We have mainly used frameless surface registration, and bone fiducial registration only for DBS procedures, as indicated by the manufacturer. Moreover, as suggested in the literature, 5 we did not observe any influence of other factors (such as the visual system, the height of the camera from the surface, and illumination) on the robot's accuracy.…”

“…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. 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.…”

“…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.…”

Can stereotactic sample biopsies accurately diagnose mixed germ cell tumors?

“…Lessons from a single-department, retrospective series" by Lefranc et al [2]. The authors retrospectively analyzed a series of 88 consecutive patients who underwent stereotactic biopsies for pineal region tumors.…”