Transcerebellar Stereotactic Biopsy for Lesions of the Brainstem and Peduncles Under Local Anesthesia

Sanai, Nader; Wachhorst, Scott; Gupta, Nalin; McDermott, Michael W.

doi:10.1227/01.neu.0000324731.68843.74

Cited by 32 publications

(31 citation statements)

References 49 publications

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“…Sanai et al [9] published on a series of 13 patients submitted to biopsy of the brainstem via the suboccipital transcerebellar trajectory. The rate of diagnosis obtained by biopsy was 92%, and the rate of complications 8%.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Dellaretti¹,

Reyns

Touzet

et al. 2012

Stereotact Funct Neurosurg

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Background: An important aspect of evaluating patients submitted to stereotactic biopsy of the brainstem is the trajectory used. The literature describes two principal approaches: the suboccipital transcerebellar and the transfrontal; however, no studies exist comparing these two techniques. Objective: The purpose of this study was to compare diagnosis success rates and complications between the suboccipital transcerebellar and transfrontal trajectories. Methods: The study evaluated 142 patients submitted to stereotactic biopsy. The patients presented brainstem tumors in the following areas: pons (n = 31), midbrain (n = 36), medulla (n = 2), pons-medulla (n = 30), pons-midbrain (n = 33), and midbrain-pons-medulla (n = 10). On 123 patients, the transfrontal approach was used, and on 19 the suboccipital transcerebellar approach. Results: Comparing success rates between the two approaches, it was observed that in the group of patients submitted to the transfrontal approach, 95.1% (117 cases) were successful, while in those submitted to the suboccipital transcerebellar approach, 84.2% (16 cases) were successful. Despite a higher success rate among patients in the first group, the difference was not statistically significant. Regarding complications, in patients who were biopsied via the transfrontal trajectory, the morbidity rate was 9.8% (12 cases), while in patients submitted to the suboccipital transcerebellar approach, the morbidity rate was 5.3% (1 case) and the mortality rate 5.3% (1 case). Conclusions: This study verified a higher diagnosis rate in patients submitted to the transfrontal approach than in those submitted to the suboccipital transcerebellar approach (95.1 vs. 84.2%); however, the difference was not statistically significant. Regarding complications, the rate was similar in both groups of patients.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Dellaretti¹,

Reyns

Touzet

et al. 2012

Stereotact Funct Neurosurg

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“…Usually, the suboccipital transcerebellar trajectory to the brainstem in people is placed through one of the middle cerebellar peduncles [13,16,17,19,20,23,24,40-43]. This approach, however, is not feasible in domestic mammals because of the more lateral position of these structures [28].…”

Section: Discussionmentioning

confidence: 99%

“…Another important advantage is the shortness of the trajectory [12,13,16,17,19,21,23,40], which results in minimized tissue trauma as well as increased accuracy [17,46]. …”

Section: Discussionmentioning

confidence: 99%

“…Three different approaches to the brainstem have been described in people: the transtentorial, transfrontal and suboccipital transcerebellar route [11-13]. Since traversing the tentorium might cause pain and/or hemorrhage at the pial surfaces of the cerebellum or mesencephalon [9,11] and potentially damage vital blood vessels and cranial nerve nuclei, the transtentorial route is no longer used [11].…”

Section: Introductionmentioning

confidence: 99%

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Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem

et al. 2014

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BackgroundAnatomical differences between humans and domestic mammals preclude the use of reported stereotactic approaches to the brainstem in animals. In animals, brainstem biopsies are required both for histopathological diagnosis of neurological disorders and for research purposes. Sheep are used as a translational model for various types of brain disease and therefore a species-specific approach needs to be developed. The aim of the present study was to establish a minimally invasive, accurate and reproducible stereotactic approach to the brainstem of sheep, using the magnetic resonance imaging guided BrainsightTM frameless stereotactic system.ResultsA transoccipital transcerebellar approach with an entry point in the occipital bone above the vermis between the transverse sinus and the external occipital protuberance was chosen. This approach provided access to the target site in all heads. The overall mean needle placement error was 1.85 ± 1.22 mm.ConclusionsThe developed transoccipital transcerebellar route is short, provides accurate access to the ovine caudal cranial fossa and is a promising approach to be further assessed in live animals.

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“…Obtaining tissue confirms diagnosis and guides therapy in patients with brain tumors, not to mention finding a diagnosis that defies preoperative expectations. 16 Intraoperative MRI is uniquely able to improve the diagnostic yield and safety of stereotactic biopsy, by confirming that the cannula is located within the lesion and that blood vessels and ventricles are avoided (a case illustration follows).…”

Section: Stereotactic Biopsymentioning

confidence: 99%

Intracranial Surgery With a Compact, Low-Field-Strength Magnetic Resonance Imager

Schulder¹

2008

Topics in Magnetic Resonance Imaging

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Intraoperative magnetic resonance imaging (iMRI) has been a reality for more than a decade. As technology has begun to mature, the focus on practicality and user-friendliness has sharpened. In addition, the need for well-designed and well-executed outcome studies remains so that expensive new instruments such as iMRI can be justified. We present our experience with the PoleStar system, a compact, low-field-strength iMRI designed to make intraoperative imaging a routine component of intracranial neurosurgery. The advantages and limitations of this approach are discussed in the context of different clinical applications.

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Transcerebellar Stereotactic Biopsy for Lesions of the Brainstem and Peduncles Under Local Anesthesia

Cited by 32 publications

References 49 publications

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach

Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem

Intracranial Surgery With a Compact, Low-Field-Strength Magnetic Resonance Imager

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