Ondrej Bradac1, Anna Steklacova2, Katerina Nebrenska2, Jiri Vrana3, Patricia de Lacy4, Vladimir Benes2. 1. Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic. Electronic address: ondrej.bradac@uvn.cz. 2. Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic. 3. Department of Neuroradiology, Military University Hospital, Prague, The Czech Republic. 4. Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Abstract
INTRODUCTION: Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS: Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS: The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS: The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
RCT Entities:
INTRODUCTION: Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS: Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS: The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS: The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
Authors: Randy S D'Amico; Justin A Neira; Jonathan Yun; Nikita G Alexiades; Matei Banu; Zachary K Englander; Benjamin C Kennedy; Timothy H Ung; Robert J Rothrock; Alexander Romanov; Xiaotao Guo; Binsheng Zhao; Adam M Sonabend; Peter Canoll; Jeffrey N Bruce Journal: J Neurosurg Date: 2019-08-02 Impact factor: 5.115
Authors: Joshua D Bernstock; Zachary Wright; Asim K Bag; Florian Gessler; George Yancey Gillespie; James M Markert; Gregory K Friedman; James M Johnston Journal: World Neurosurg Date: 2018-11-24 Impact factor: 2.104
Authors: Barbara Ladisich; Lukas Machegger; Alexander Romagna; Herbert Krainz; Jürgen Steinbacher; Markus Leitinger; Gudrun Kalss; Niklas Thon; Eugen Trinka; Peter A Winkler; Christoph Schwartz Journal: Acta Neurochir (Wien) Date: 2021-02-13 Impact factor: 2.216
Authors: Hani J Marcus; Vejay N Vakharia; Sebastien Ourselin; John Duncan; Martin Tisdall; Kristian Aquilina Journal: Childs Nerv Syst Date: 2018-05-10 Impact factor: 1.475
Authors: Sarah Gutmann; Dirk Winkler; Marcel Müller; Robert Möbius; Jean-Pierre Fischer; Peter Böttcher; Ingmar Kiefer; Ronny Grunert; Thomas Flegel Journal: J Vet Intern Med Date: 2020-02-24 Impact factor: 3.333