Navigation-Guided Endoscopic Biopsy for Intraparenchymal Brain Tumor

Abstract

To evaluate the efficacy of intraparenchymal brain tumor biopsy using endoscopy and a navigation system (navigation-guided endoscopic biopsy) as a diagnostic tool, a case series of intraparenchymal tumor biopsies was reviewed. Navigation-guided endoscopic biopsy was applied in 9 cases, stereotactic needle biopsy in 16 cases, and open biopsy with or without navigation system in 34 cases. In all biopsy cases, 84.7% of biopsy points were sampled accurately, and 93.2% of diagnoses by biopsy were correct. Comparison of each type of biopsy showed that the resected volumes in navigation-guided endoscopic biopsy and open biopsy tended to be larger than those in stereotactic biopsy, and the mean operation time for the open biopsy procedure was the longest. To define the most applicable device or examination method to increase sampling accuracy, various factors were analyzed in 59 procedures. Navigation-guided endoscopic biopsy was the most accurate of the three types of biopsy, although the statistical difference was not significant. Older patients, histological diagnosis of high-grade glioma or malignant lymphoma, positive photodynamic diagnosis, and positive intraoperative pathology were significant factors in improving the sampling accuracy. Navigation-guided endoscopic biopsy could provide a larger sample volume within a relatively short operation time. The biopsy can be easily combined with both photodynamic diagnosis and intraoperative pathology, significantly improving the histological diagnostic yield.

Three-dimensional, computer simulated navigation in endoscopic neurosurgery

“…12 There was no difference between endoscopic biopsies that employed navigation versus open or stereotactic biopsies with navigation, but there was a trend toward higher accuracy in neuroendoscopy, warranting further investigation with an appropriately powered study. 21 Brain shift did not present a problem for intraoperative accuracy in the studies included in this review 11,27,28 (Table 3). …”

“…Of the reviewed studies, 4,12,14,21,24–26 the most accurate target registration had a minimum error of 0.8 mm and mean error of 1.2 mm. 4 Registration accuracy was found to be study-dependent, with toleration of inaccuracies up to 3.5 mm reported.…”

“…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). 21 Further investigation is still needed into the effect of intraoperative navigation on the avoidance of injury, with very limited reporting on safety outcomes at present. 22,23 …”

“…The possibility of a timesaving effect has previously been reported, 5,11,14,23 and Tsuda et al included a statistical analysis showing a timesaving effect, with the procedure duration of open biopsy of 4.4 hours, endoscopic biopsy 2.2 hours, and stereotactic biopsy 1 hour (p<0.01). 21 Further investigations into the effect of stereotactic navigation on procedure duration with statistical analysis powered to detect differences in operative time are necessary, as shorter operative times could translate to substantial cost savings.…”

Osthole Enhances the Therapeutic Efficiency of Stem Cell Transplantation in Neuroendoscopy Caused Traumatic Brain Injury

“…In present endoscopic surgery instruments must avoid vital vessels and avert damage to tissue around the wound. 58,59) Here we choose the 0.7 mm needle, which is close to the mainstream diameter endoscope adopt by clinical surgery 60) and we did not observe any side-effect conditions, such as haemorrhage and death. Previous studies suggested that all kinds of trauma could influence neural function in a certain extent.…”