Computerized tomography guided stereotactic biopsy of intracranial lesions: report of consecutive 500 cases.

Abstract

mass should not be taken in consideration, especially in the diagnosis of deeply located, diffused infiltrative or multiple space-occupying lesions, computerized tomography (CT) or MRI-guided stereotactic biopsies have been proven to be safe and reliable by various studies (2,4,(7)(8)(9)(11)(12)(13)15,16,18,19,(21)(22)(23)(25)(26)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38) Despite the tremendous improvement in neuroradiology and nuclear medicine, especially in magnetic resonance imaging (MRI) and positron emission tomography (PET), definitive diagnosis in most brain lesions require histopathological examination. When a bulk excision of the AIm: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients. mATERIAl and mEThODS: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67). RESUlTS:Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures.CONClUSION: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.

Diagnóstico da Neurohistoplasmose por Biopsia Estereotáxica Guiada por Fusão Computacional de Imagens

“…A suspeita diagnóstica deve ser levantada seja pelo Brasil ser área endêmica para histoplasmose, seja por testes diagnósticos e provas terapêuticas excluírem outras causas mais comuns de infecção oportunista nos imunossuprimidos 12 . O desenvolvimento de métodos minimamente invasivos tem proporcionado avanços diagnósticos, seja no campo da neuroendoscopia, seja no da estereotaxia, como os encontrados até na literatura nacional 13,14,15 . A segurança da biopsia está demonstrada na morbidade muito baixa de 1,6% e mortalidade de 0,4%.…”

“…Aliado a isso, há alto potencial de conclusão diagnóstica histopatológica de 96,7%. O planejamento do procedimento com fusão de imagens e programação do trajeto e alvo é essencial para o sucesso do procedimento 15,16 . Vários trabalhos demonstraram o potencial diagnóstico e terapêutico auxiliar da técnica estereotáxica nos casos de infecção do sistema nervoso central 9,10,15,16 .…”

“…O planejamento do procedimento com fusão de imagens e programação do trajeto e alvo é essencial para o sucesso do procedimento 15,16 . Vários trabalhos demonstraram o potencial diagnóstico e terapêutico auxiliar da técnica estereotáxica nos casos de infecção do sistema nervoso central 9,10,15,16 . Nesse caso, a biopsia estereotáxica, para retirada de tecido cerebral para análise anatomopatológica (padrão ouro no diagnóstico) e para a cultura, foi indicada pela impossibilidade de realização da punção líquórica para análise sorológica e cultura, além da apresentação atípica e falha no tratamento empírico.…”

<p>High Level of IL-10 in Cerebrospinal Fluid is Specific for Diagnosis of Primary Central Nervous System Lymphoma</p>

“… 2 The diagnosis rates, mortality and morbidity rates depend on the experience of the surgical team and the neuropathologist. 5 , 7 Moreover, many lesions are not amenable to biopsy because of the small size, location in deep brain structures, risk of hemorrhage and other comorbidities. Early and less invasive diagnostic methods for PCNSL represent a challenge.…”

CT-guided Stereotactic Microsurgical Resection of Cerebral Mass Lesions

“…Meanwhile, Leksell established the basis of a novel system combining the cartesian system with other systems, which consisted of an apparatus fixed to Guiot et al 6,7 and Riechert and Mundinger 8 were the first investigators to introduce open stereotactic craniotomy, which was then enjoyed broader applications and further refinements owing to the advances in the field of medical imaging such as computerized tomography 9 and magnetic resonance imaging 10 . Current image-guided stereotactic procedures include biopsy [11][12][13][14][15] , cyst aspiration 16,17 , focal irradiation 18,19 , and hematoma evacuation [20][21][22] , neuroaugmentation 22,23 , stereotactic robotic microsurgery [24][25][26] and neural transplantation 27,28 . These techniques facilitate precise localization and resection of lesions in eloquent regions of brain and help minimize operative injury to the surrounding tissues.…”