David S Hersh1,2, Rahul Kumar3, Kenneth A Moore3, Luke G F Smith4, Christopher L Tinkle5, Jason Chiang6, Zoltan Patay7, Amar Gajjar8, Asim F Choudhri3,9,10,11, Jorge A Lee-Diaz3,9,10,11, Brandy Vaughn11, Paul Klimo3,11,12. 1. 1Division of Neurosurgery, Connecticut Children's, Hartford. 2. 2Department of Surgery, UConn School of Medicine, Farmington, Connecticut. 3. 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee. 4. 4Department of Neurosurgery, The Ohio State University, Columbus, Ohio; Departments of. 5. 5Radiation Oncology. 6. 6Pathology, and. 7. 7Diagnostic Imaging, and. 8. 8Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis. 9. 9Department of Radiology, University of Tennessee Health Science Center, Memphis. 10. 10Division of Neuroradiology, Le Bonheur Neuroscience Institute, Memphis. 11. 11Le Bonheur Children's Hospital, Memphis; and. 12. 12Semmes Murphey, Memphis, Tennessee.
Abstract
OBJECTIVE: Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection. METHODS: All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected. RESULTS: A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis. CONCLUSIONS: Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.
OBJECTIVE: Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection. METHODS: All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected. RESULTS: A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis. CONCLUSIONS: Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.
Authors: In-Ho Jung; Kyung Won Chang; So Hee Park; Ju Hyung Moon; Eui Hyun Kim; Hyun Ho Jung; Seok-Gu Kang; Jong Hee Chang; Jin Woo Chang; Won Seok Chang Journal: Cancer Med Date: 2021-09-12 Impact factor: 4.452
Authors: Pablo E Baquero-Herrera; Manuel A Ardila-Martínez; Nadín J Abdalá-Vargas; Jorge Racedo; Edgar G Ordóñez-Rubiano Journal: J Neurosci Rural Pract Date: 2022-06-08
Authors: Liang Zhang; Cody L Nesvick; Charlie A Day; Jonghoon Choi; Victor M Lu; Timothy Peterson; Erica A Power; Jacob B Anderson; Feda H Hamdan; Paul A Decker; Renae Simons; John P Welby; Ruby Siada; Jizhi Ge; Tatiana Kaptzan; Steven A Johnsen; Edward H Hinchcliffe; David J Daniels Journal: Neuro Oncol Date: 2022-10-03 Impact factor: 13.029