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To summarize the preliminary application experience of intraoperative ultrasound with burr hole probe in minimally invasive neurosurgery and to explore its application value. Thirty-one patients who underwent intraoperative ultrasound guided puncture with burr hole probe in our center from August 2018 to May 2024 were collected, including 16 cases of ventriculoperitoneal shunt operation, 6 cases of assisted stereotactic needle biopsy, 3 cases of intracranial pressure probe implantation in lateral ventricle, 3 cases of brain abscess puncture for external drainage, and 3 cases of intracranial cyst puncture and peritoneal drainage. During the procedures, the burr hole probe was used to locate the intracranial targets and guide the puncture. The postoperative computed tomography (CT) scans or combined postoperative pathological results could verify the accuracy of puncture. In addition, the intervention effect and recovery status of patients were also recorded. The intraoperative ultrasound with burr hole probe could clearly display all the purposed targets and accurately guide the puncture procedures in all cases. All patients achieved satisfactory diagnostic and therapeutic results without new neurological dysfunction and serious complications. The intraoperative ultrasound with burr hole probe is an effective device for demonstrating intracranial structures. It not only enables minimally invasive and precise diagnosis or treatment of many neurosurgical diseases, but also is simple and safe to operate, which has important promotional value in the neurosurgery. [ABSTRACT FROM AUTHOR]

Diffuse intrinsic pontine gliomas are aggressive tumors that carry a poor prognosis with a 2-year survival rate of <10%. The imaging appearance is often pathognomonic, and surgical biopsy is not mandatory to initiate treatment in children. Studies of biopsy samples provide insight into the disease's molecular pathobiology and open prospects for targeted therapy. This study was conducted to determine the diagnostic yield and safety of stereotactic biopsies. This is a prospective observational study from a single tertiary health care center. All patients with clinical and radiological features diagnostic of diffuse intrinsic pontine gliomas (DIPGs) who underwent biopsy from July 2018 to June 2023 were included. Biopsies were performed using either stereotactic frame-based, frameless, or endoscopic techniques. A total of 165 patients with DIPGs were evaluated in the study period. The option of biopsy with its associated risks and benefits was offered to all patients. A total of 76 biopsies were performed in 74 patients (40 children and 34 adults, including 2 repeat biopsies). The median age was 15 years. Diffuse midline gliomas, H3K27M altered, was the most common histopathological diagnosis (85% pediatric and 55.9% adults). The diagnostic efficacy of the procedure was 94.7%. The complication rate was 10.8%, with no permanent neurological deficits due to surgery. There was no procedure-related mortality. Establishing the safety of the procedure could be an important step toward popularizing the concept, which might offer a better understanding of the disease. Brainstem eloquence and a lack of direct benefit to patients are the primary obstacles to brainstem biopsy. [ABSTRACT FROM AUTHOR]

The factors on which the accuracy of stereotactic brain biopsy depends are the competence of the neurosurgeon in obtaining a representative sample and the ability of the neuropathologist to make a histological diagnosis from a minuscule sample. Over the years intraoperative frozen section has enhanced the diagnostic yield of this minimally invasive procedure. Use of fluorescence in achieving a greater extent of resection is well-established in contemporary neurosurgical practice. This ability of brain tumors to take up the fluorescein sodium dye and glow under the YELLOW 560-nm filter has been utilized in a handful of studies to increase the diagnostic accuracy of stereotactic biopsy. We performed a prospective study where the fluorescein sodium dye was injected at a low dose and fluorescence of the biopsied core was compared with that of a tissue obtained from the normal parenchyma. Sample was labeled 'truly fluorescent' only when the glow was more than that of the tissue from normal parenchyma. On cross-tabulating the index test (true fluorescence status) and the reference standard test (final histopathological report) the sensitivity of acquiring a representative sample was found to be 94.74%, specificity was 100%. The positive predictive value and negative predictive value were calculated to be 100% and 50% respectively. The diagnostic yield was comparable to that of the intraoperative frozen section. The use of the YELLOW 560-nm filter can make stereotactic biopsy faster, safer, less cumbersome, and more cost-effective, and can be used as a substitute for the frozen section in resource-constrained centers. [ABSTRACT FROM AUTHOR]

• Our data suggests a potential benefit of cytoreductive surgery for selected patients with PCNSL. • Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Cytoreductive surgery for Primary Central Nervous System Lymphoma (PCNSL) is controversial and is not routinely practiced. Cumulative literature in recent years, however, suggests a potential survival benefit associated with a greater extent of resection. A retrospective single institution cohort analysis of 58 consecutive patients with PCNSL was conducted between January 2011 and December 2020. Demographic, clinical, and radiographic characteristics were compared between patients with and without cytoreductive surgery following diagnosis of PCNSL. The primary outcome measures were progression-free survival (PFS) and overall survival (OS). Secondary outcome measures included time to remission (TTR), time to chemotherapy (TTC) and response to initial chemotherapy (RIC). Forty-six patients (79.3 %) received stereotactic biopsy and 12 (20.6 %) underwent cytoreductive surgery. There was a trend towards longer OS (29.8 vs 22.3 months, p = 0.672), shorter TTR (4.0 vs 4.7 months, p = 0.362), and greater complete or near-complete radiographic RIC (81.8 % vs 67.6 %, p = 0.367) for patients undergoing cytoreductive surgery. This correlated with a lesser need for whole brain radiotherapy (WBRT) (8.3 % vs 19.6 %, p = 0.359). Our data suggests a potential benefit of cytoreductive surgery for selected patients diagnosed with PCNSL. Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Further studies with better randomization and statistical power are needed to validate this correlation. [ABSTRACT FROM AUTHOR]

Stereotactic needle brain biopsy is a commonly used neurosurgical procedure. However, up to 15% of biopsies result in undiagnostic pathology reports. Repeat biopsy or continued management without a diagnosis are often considered after undiagnostic biopsies. There have been no reports about the role of postoperative imaging in predicting the diagnostic yield of stereotactic biopsies. We retrospectively assessed all stereotactic biopsies performed over an 11-year period. We performed fusion of immediate postoperative computed tomography (CT) with preoperative MRI, to document whether the air bubble in the postoperative CT was located within the targeted lesion. We then evaluated the association of this fusion-based accuracy assessment with the diagnostic yield of the biopsy. Fewer than 5% of biopsies did not have an air bubble on postoperative CT. A total of 226 biopsies were performed for 219 patients. In our sample, 213 of 226 biopsies were accurate (94.2% accuracy rate), and 203 of 226 biopsies gave a definitive diagnosis (89.8% diagnostic rate). In those cases where the fusion was accurate, the diagnostic rate was 93.9%. When the fusion was inaccurate, the diagnostic rate was only 23.1% (odds ratio 51.5, 95% confidence interval 12.6–210.44, P < 0.001). Of all patient, imaging, surgical, and admission parameters, the only parameter that correlated with diagnostic outcome of the biopsy was the fusion construct accuracy. Fusion of immediate postoperative CT with preoperative imaging is predictive of the diagnostic rate. In cases where the pathology report following a biopsy is not diagnostic, this fusion may be useful in making decisions regarding repeat biopsy or considering other diagnostic options. [ABSTRACT FROM AUTHOR]

• Robotic assisted biopsy lives up to its promises of increased safety, accuracy and reliability. • Robotic assisted biopsy allows a high diagnostic rate up to 97,4%. • Robotic biopsy has a very low hemorrhagic complication rate (3,5 %) with no permanent deficit. • Robotic assisted biopsy has very low mortality rate (0,3%). • Learning curve for Robotic biopsy is relatively short with a cut off of 10 procedures to get acquainted. A 12-year long, prospective, single center study was conducted, comparing two frameless systems for brain biopsies: ROSA robotic-assisted stereotaxy and BrainLab Varioguide image-guided stereotaxy (Image Guided Surgery, IGS). All consecutive adult and pediatric patients undergoing frameless brain biopsies were included. Successfully achieving diagnosis was the primary endpoint, analysis of all periprocedural complications was the secondary endpoint, and the tertiary endpoint was the length of the procedure, with the aim of assessing of the learning curve for each operator over time. The results for the ROSA robot and the Varioguide system were compared and benchmarked to data from the literature. We performed 526 on 516 patients, 314 with the ROSA robot (Group A) and 212 with the IGS Varioguide (Group B). Histological diagnosis was achieved in 97.4% of cases in Group A, versus 93.3% in Group B (p < 0.05). No statistically significant difference was found for secondary and tertiary endpoints. The complication rate appeared similar between the 2 frameless systems, with a hemorrhagic complications rate of 3.5% in Group A and 4.7% in Group B. Permanent neurological deterioration was only recorded in 0.8% of cases from Group B. Mortality was recorded in 0.3% in Group A and 0.4% in Group B. This study provides evidence to confirm that robotic surgery lives up to its promises of increased safety, accuracy, and reliability. [ABSTRACT FROM AUTHOR]

Biopsy of pineal region neoplasms is frequently accomplished by way of endoscopic transventricular access or using an image-guided, computer-assisted stereotactic approach. We evaluated a nonorthogonal lateral temporal approach for stereotactic biopsy of pineal region tumors as a variation of previously described stereotactic methods. Magnetic resonance imaging–guided frameless stereotaxy was used to plan and perform biopsies of pineal region tumors using a nonorthogonal trajectory extending from the superior or middle temporal gyri through the temporal stem, anterior to the atrium of the lateral ventricle, and posterior to the corticospinal tract. All patients had an uncomplicated postoperative course and remained at neurologic baseline. No parenchymal or ventricular hemorrhage was present on postoperative scans. A tissue diagnosis was obtained in all patients. This method appears to be a safe alternative to stereotactic biopsy using other trajectories and provides adequate tissue for definitive diagnosis. [ABSTRACT FROM AUTHOR]

Tissue diagnosis for lesions in the posterior fossa, such as the brainstem, cerebellar peduncle, and cerebellum, is an important determinant of the next treatment option. Herein, we present our 10-year experience with magnetic resonance imaging (MRI)–guided frame–based stereotactic biopsy for 39 patients with posterior fossa lesions, the largest case series in this matter. We performed a retrospective cross-sectional study on all patients with posterior fossa lesion admitted to 2 referral centers between 2006 and 2016. We used Leksell Frame G for stereotactic biopsy of all patients. MRI systems of both hospitals were 1.5 T. We performed analysis on the 39 cases (21 men and 18 women). Age of the patients ranged between 9 and 73 years (mean, 35.4 ± 15.7 years). Localization success rate was 100%. For 38 patients (97.4%), tissue sample size was enough for tissue diagnosis. For 1 case, it was insufficient and nondiagnostic. In this series, we had no surgery-related complications. We present the largest reported series of MRI-guided frame-based stereotactic biopsy of the posterior fossa lesions via a transcerebellar route. We prefer oblique positioning of the frame on the skull and use a transcerebellar route to reduce surgical complications and achieve a greater localization success rate. [ABSTRACT FROM AUTHOR]

• DIPG. • Stereotactic biopsy. • Convection enhanced delivery. • Targeted therapies. Diffuse intrinsic pontine gliomas (DIPG) are high grade gliomas of the brainstem with fatal outcomes. Radiation is known to be partially effective to control the immediate flare but relapse is frequent. There has been ongoing research to study the role of molecular subgroups and identification of specific targets but this is not possible with histopathological diagnosis alone. The authors' objective is to highlight the need for and discuss ongoing molecular research. There is an inherent need for the availability of tumor tissue to be able to conduct research studies. The authors advocate the use of neuronavigation assisted stereotactic technique for tumor biopsy. The technique is feasible with a predefined surgical trajectory. After obtaining tissue diagnosis further work can be performed to isolate and identify histone protein genetic mutations and methylation changes responsible for DIPG molecular subgrouping. Moreover, convection enhanced delivery of therapeutic agents is being developed for better instillation of future drug agents. Despite identification of genetic/epigenetic mutations, growth factors, receptors, and tissue biomarkers, the oncogenesis of DIPG remains elusive. The authors' effort to provide a comprehensive review on DIPG to better understand the disease, need for tissue diagnosis, described surgical technique, and need for pre-clinical and clinical future research is novel. [ABSTRACT FROM AUTHOR]

Abnormal tissue in stereotactic brain biopsies (SBB) is traditionally identified intraoperatively via pathological frozen section (FS), a time-consuming and error-prone process. The objective of this study was to assess the efficacy of 5-aminolevulinic acid (5-ALA) administration on SBB operation time, diagnostic yield, and the associated complication rate. We retrospectively evaluated all consecutive patients undergoing SBB with preoperative 5-ALA administration and intraoperative assessment of fluorescence (5-ALA group) between 2010 and 2017 in a single center. They were compared to all consecutive patients who underwent traditional brain biopsy with FS (control group). Demographics, clinical data, diagnostic yield of biopsies, and complication rates were documented. In all, 376 patients underwent SBB for suspected oncological pathology during the study period. All 34 of the 5-ALA-assisted SBB were diagnostic compared to 96.8% of the control group. The mean operative time was the same for both groups, but it was significantly shorter for the 5-ALA patients with florescent samples compared to patients with negative fluorescence (61 ± 25 min vs. 136 ± 54 min, P = 0.003) and compared to the control group (74 ± 34 min vs. 61 ± 25 min, P = 0.03). Symptomatic bleed was absent in the 5-ALA group and present in 5.4% of the controls. No adverse events were associated with preoperative 5-ALA administration. Preoperative administration of 5-ALA may improve the diagnostic yield of SBB and shortens operation time in cases of fluorescent pathological tissue. In addition, it may reduce the risk for associated postoperative symptomatic bleed. 5-ALA-assisted SBB is a viable alternative to traditional biopsies with FS. [ABSTRACT FROM AUTHOR]

To determine the malignancy rate in women without a concurrent breast cancer diagnosis at presentation who underwent stereotactic biopsies of distinct sites of suspicious calcifications. This retrospective study included 280 women without a concurrent breast cancer diagnosis who underwent 587 stereotactic biopsies of two or more distinct sites of suspicious calcifications in one or both breasts at our institution from 2010 to 2015. The overall malignancy rate was 27.9% (78/280, 95% CI, 22.7%–33.5%) at the patient level and 18.7% (110/587, 95% CI, 15.7%–22.1%) at the lesion level. Eighteen had invasive cancers (mean [range] diameter, 0.5 cm [0.1–1.7]; six grade I, ten grade II, two grade III), one of whom had multifocal and another bilateral malignancy. Sixty had ductal carcinoma in situ. Of the 171 with all calcifications of the same morphology, 139 (81.3%) had all calcifications in the same pathology category (benign, high-risk, or malignant). The malignancy rate is substantial in women who undergo stereotactic biopsies of two or more distinct calcification sites. Given the nearly 20% rate of dissimilar histopathology between calcification sites with similar morphology, if only one site is biopsied and results in a malignant pathology, biopsy of the additional calcifications is warranted. Even if the pathology result of the one site biopsy is benign, biopsy of additional sites may perhaps still be necessary. • Malignancy rate was 27.9% in women who underwent stereotactic guided biopsies of multiple separate suspicious calcifications in the same or both breasts. • When there were multiple distinct sites of similar-appearing suspicious calcifications, the calcifications were in the same pathology category in approximately 80% of patients • In women with two or more sites of suspicious calcifications, if the pathology result of the one site biopsy is benign, additional biopsy may perhaps still be necessary for the other sites [ABSTRACT FROM AUTHOR]

Clearpoint Smartframe is a magnetic resonance imaging−compatible stereotactic system often used to perform magnetic resonance imaging−guided biopsies. The system is typically mounted on the scalp through screws that pierce the skin and penetrate the outer table of the cranium. However, the frame can also be configured to be mounted directly onto the skull. Here, we describe the clinical context well suited for a skull-mount Clearpoint Smartframe surgery. The patient suffered from a subcentimeter right parafourth ventricular contrast-enhancing lesion with hydrocephalus and underwent a right suboccipital needle biopsy followed by an occipital ventriculoperitoneal shunt. Although the hydrocephalus resolved with the ventriculoperitoneal shunt, the biopsy sample proved nondiagnostic. The patient underwent a second procedure during which the Clearpoint Smartframe was mounted onto the skull through space dissected free during the previous surgery. Diagnostic biopsy (H3K27 glioma) was performed followed by stereotactic laser ablation of the lesion. We describe a case in which the skull mount Clearpoint Smartframe was used to biopsy and ablate a midline H3K27 glioma. [ABSTRACT FROM AUTHOR]

Objective Stereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy, some centers also use frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate robotic device. Methods Between March 2013 and April 2018, 102 robot-assisted frameless biopsies were performed in 100 consecutive patients (median age/range: 66/7–86 years, male: 64). Target lesions were deep-seated (insula, basal ganglia, thalamus, midbrain, cerebellar peduncle) in 29 (28.4%) and/or small (<15 mm) in 24 (23.5%) cases. We retrospectively analyzed the histopathologic results as well as complications and the duration of the procedures. Results A definite histologic diagnosis could be established in 94 of 102 procedures (92.2%; 94/100 patients = 94.0%), including 67 glial and glioneuronal tumors, 16 central nervous system lymphomas, 7 metastases, 1 primitive neuroectodermal tumor, and 5 cases with inflammatory or infectious disorders. There were no infectious complications. A total of 13 cases (12.7%) suffered from biopsy-related hemorrhages >10 mm; however, persistent surgery-related neurologic worsening was seen in only 3 (2.9%). The average operating time was 10 minutes for placement of the localizing device under local anesthesia and 30 minutes for the actual biopsy procedure. Conclusions Robot-assisted fameless stereotactic biopsies using the neuromate robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates. [ABSTRACT FROM AUTHOR]

Abstract Background There is currently no clear consensus recommendation for the use of short-interval follow-up mammography after a benign-concordant breast biopsy (BCBB), and practice patterns vary widely. The objectives of this study were to evaluate whether a short-interval follow-up mammogram provided clinical utility after stereotactic BCBB and to examine the costs associated with this surveillance strategy. Methods A retrospective review of women who underwent a stereotactic breast biopsy yielding benign-concordant results between January 2005 and October 2014 was performed to evaluate findings on subsequent imaging, to calculate compliance with recommended short-interval imaging, and to examine whether subsequent imaging revealed an abnormality at the site of the initial stereotactic BCBB. A cost analysis was performed utilizing Medicare reimbursement rates to calculate projected and actual costs of short-interval follow-up imaging after stereotactic BCBB. Results Of the 470 stereotactic BCBB performed, a short-interval mammogram was completed in 207 (44.0%), 9 (4.3%) of which had suspicious mammographic findings at the initial biopsy site, and 6 subsequently underwent biopsy, with none resulting in malignant or high-risk pathology. The cost of short-interval mammographic follow-up (n = 207) was calculated at $28,541.16. Conclusions This study provides evidence that 6-month follow-up mammography has low clinical utility and unnecessarily increases costs after stereotactic BCBB. A safe and more cost-effective strategy may be resumption of routine mammography at 12 months post-biopsy. Highlights • Only 44% underwent planned mammogram six months after benign breast biopsy. • Short-interval mammogram follow-up identified a new lesion at the biopsy site in 4%. • Biopsy of new findings did not yield any malignant or high-risk lesions. • The significant cost of performing 6-month post-biopsy mammography was unnecessary. [ABSTRACT FROM AUTHOR]

Breast cancer is the leading cause of death amongst women in Singapore. Stereotactic Vacuum-assisted breast biopsy (VABB) is an established alternative to surgical biopsy for histological diagnosis of microcalcification and nonpalpable lesions. Stereotactic VABB utilizes Digital breast tomosynthesis (DBT) or Prone stereotactic (PS) systems for tissue sampling. However, clinical performance and patient complication outcomes between both systems are indeterminate. As such, we aim to examine indices affecting clinical performance in both systems and identify one that would contribute to higher technical success rates for VABB procedure. Patient complication and relative radiation exposure will also be reviewed. Using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) methodology, we performed a systematic literature search from databases: PubMed-MEDLINE, Cochrane Library, CINAHL and ScienceDirect. Applied search strategies resulted in 102 articles, of which 7 were included and critically evaluated. A total of 2285 VABB procedures were enrolled from 7 eligible studies. 1094 and 1191 VABB were performed using PS and upright DBT systems respectively. Significantly reduced mean procedural, targeting, and sampling time were observed in upright DBT systems. Technical success rates were higher in DBT upright (97-100%) than in PS systems (93-95.1%). Whilst increased exposures were required in PS systems (p <0.001), equipment malfunction and architectural distortions were less prevalent. Higher occurrences of vasovagal reaction and hematoma incidence are reported in upright DBT systems albeit with non-statistical significance (p >0.05). Upright DBT systems are associated with higher clinical performance, technical success rates and reduced exposures. However, visibility of sharp biopsy devices in upright systems may induce anxiety and emotional stress, thus contributing to increased vasovagal reactions. PS systems are useful in patients with spinal conditions or the aged with a compromised vasovagal tolerance. Newer unconventional alternatives such as lateral decubitus position in upright DBT should warrant more studies to evaluate clinical utility. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence.Materials and Methods: This Institutional Review Board-approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher's exact, Mann-Whitney, and χ2 tests.Results: There were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively).Conclusion: The findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described "harms" of false-positive mammography and biopsy may be exaggerated. [ABSTRACT FROM AUTHOR]

Objective Stereotactic procedures are performed in many neurosurgical departments in order to obtain tumor tissue from brain lesions for histopathological evaluation. Biopsies can be performed frame-guided and frame less. Some departments use a biopsy needle (cylinder probe), others a forceps for repetitive smaller tissue samples. Although the applied techniques are somehow different, it is still unclear how many tissue samples have to be taken to establish reliably a final diagnosis based on histopathological and genetic examinations. Only precise histopathological diagnosis results in adequate therapy. Methods We included 43 consecutive patients who underwent stereotactic biopsy of a suspected glioblastoma between 02/2013 and 07/2015. All patients showed contrast enhancing tumors in the MRI. The patients underwent stereotactic biopsy with the Leksell frame attached to their head. All stereotactic procedures were performed in the presence of a neuropathologist. Target and Entry Points were calculated with BrainLab iplan software (BrainLab iplan 1.0, Munich, Germany). First the two samples 5mm before the Target (pre-target) and the “Targetpoint” itself were analyzed (group 1), then a histopathological evaluation of all samples was performed (group 2). Results Mean number of extracted samples was 14. Using classical hematoxylin-eosin stainings, in group 1 histopathological diagnosis was correct in only 30 cases accounting for 73%. Contrariwise a final diagnosis was made in 100% in group 2. Conclusion If only two tissue samples were evaluated in this group of patients with suspected glioblastoma, a correct diagnosis was possible in only 73% of the cases. We conclude that two samples are not enough to establish a final diagnosis even in a subgroup of suspected glioblastoma. [ABSTRACT FROM AUTHOR]

Background Stereotactic transcerebellar biopsies of brainstem tumors have often been reported. The Leksell frame or Cosman-Roberts-Wells frame is often used in transcerebellar approaches. However, to access lesions via the cerebellum, these frames should be secured as inferiorly on the cranium as possible, which can require exaggerated neck flexion and limit the flexible trajectory to the target. To overcome these disadvantages, we have devised a new way to use the Leksell frame for transcerebellar approaches. Methods The frame was fixed to the upper part of the head and arc support by attaching the frame upside down, which gives surgeons a wide operative field and permits flexible trajectory planning. Results Under local anesthesia, the surgery was performed in a sitting position. Air was observed in the target site on postoperative computed tomography and magnetic resonance imaging, which confirmed that a specimen had been successfully sampled from the site as planned. Conclusions Our devised transcerebellar approach provided a generous operative field and a flexible trajectory, which enabled minimally invasive biopsy of a posterior fossa lesions to be performed in a short amount of time with the patient under local anesthesia. [ABSTRACT FROM AUTHOR]

Background Stereotactic biopsy of brain lesions with unknown entities is a common neurosurgical procedure to obtain tumor tissue. Pathologists can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy, or chemotherapy, can be based. These procedures can be performed under local or general anesthesia. In this prospective study, we aim to show whether stress levels are higher for patients who undergo stereotactic biopsy under local or general anesthesia. Methods Between January 2013 and December 2014, we screened 157 patients. Of these, 43 were included and evaluated in this study. Twenty-one patients gave their written consent and were randomized for either local or general anesthesia. A Post Traumatic Stress Score (PTSS) questionnaire was filled out by the patients preoperatively and postoperatively. Also, patients who did not agree to randomization had an opportunity to fill out the PTSS questionnaire. Twenty-two patients agreed only to fill out the stress-level questionnaire but refused randomization. These patients were evaluated as a subgroup. Scores achieved in the PTSS were compared by using the Fisher exact test. Results Among the randomized patients, 9 underwent the procedure under local anesthesia and 12 under general anesthesia. Median PTSS was 24 preoperatively in the patients who received local anesthesia versus 20 among the patients with general anesthesia ( P = 0.37; Fisher exact test). Postoperatively, PTSS was 29.5 in median for patients with local anesthesia versus 23 for patients with general anesthesia ( P = 0.30; Fisher exact test). Postoperatively, the PTSS showed a median increase of 5.5 points in the LA and 3 points in the GA group ( P = 0.87; Fisher exact test). P values of 0.05 and lower were considered statistically significant. Conclusions The willingness of patients to undergo randomization in this setting was low (13.3%). Within this highly selective group of patients, there was no significant difference for stress levels in patients who underwent stereotactic biopsy under local anesthesia versus general anesthesia. However, median values indicate a trend for higher stress-level values for patients undergoing local anesthesia. [ABSTRACT FROM AUTHOR]

Background Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis and treatment. These procedures go in hand with high accuracy, high diagnostic yield, and low complication rates. Objectives The aim of this study is to evaluate the results and complications of stereotactic biopsies carried out for lesions of the pineal region. Methods We performed a retrospective analysis of our prospective database and included 14 patients who underwent stereotactic biopsy of a pineal lesion between 2006 and February 2016. The Leksell stereotactic frame was used in all patients, and entry and target points were calculated using the BrainLab stereotactic system. We evaluated histopathologic results and postoperative complications such as hydrocephalus and hemorrhage. Results Histopathologic diagnosis was established in all patients. On postoperative computed tomography, 7 patients (50%) showed a circumscribed blood collection at the site of biopsy. Six patients (42.8%) required a cerebrospinal fluid drain preoperatively. Two patients needed external ventricular drain postoperatively (14.2%). One of these patients showed a small hemorrhage area that caused the hydrocephalus. The other patient showed only postoperative swelling. Preoperatively, 2 patients (14.2%) already had a ventriculoperitoneal (VP) shunt, whereas postoperatively, another 4 patients (28.5%) needed a VP shunt. Thus, of the 14 patients, 6 (42.8%) required a VP shunt. Conclusions Because of their localization, pineal lesions may result in emergence of a hydrocephalus. Stereotactic biopsies in this area may increase this effect and, thus, even VP shunts are necessary in some patients. [ABSTRACT FROM AUTHOR]

Little is known about the localized inflammation that patients experience after gamma knife stereotactic radiosurgery (GKSR) or a stereotactic biopsy (SB) procedure. This study was conducted to gather and compare baseline data of local pin-site inflammation in patients with GKSR and SB in the early postprocedural period. This was a prospective, nonrandomized observational study of current practice. Eligible patients were consented and surveyed in-person or via phone, 24 hr and 7 days after procedure, regarding inflammation at pin sites. This study included a total of 59 subjects aged 26-77 years. Inflammation of at least one pin site was seen in 37 subjects. One subject developed a superficial infection requiring oral antibiotics. There was no statistical difference in inflammation between SB and GKSR subjects. There was a higher rate of inflammation at 1 week for frontal pin sites. Localized inflammation was more common than hypothesized after GKSR and SB. Patients should be educated about pin-site inflammation after GKSR. Early post-treatment follow-up should be performed and include assessment for pin-site inflammation. Pin-site inflammation that persists after 7 days should be visually assessed for possible localized infection. [ABSTRACT FROM AUTHOR]

Objective The management of pineal region tumors depends on the histologic subtypes. Two minimally invasive techniques are available: endoscopic intraventricular biopsies and stereotactic biopsies. The recent Southampton and Lille series are the largest endoscopic and stereotactic series of pineal region tumors reporting both diagnosis rate and accuracy rate, respectively; we elaborated on these results in the light of other recent studies. Methods We compared the Southampton endoscopic series with the Lille series, reflecting our 25-year experience of stereotactic biopsies, and the metadata of the literature for both approaches, as reported in the 2013 Report of the French-Speaking Society of Neurosurgery on tumors of the pineal region. Results The results of the Southampton series match the endoscopic literature, in particular regarding the diagnosis rate (81.2%) and the perioperative morbidity (25.0%), and provide a rarely reported accuracy rate (78.6%), giving access to the overall efficacy rate (63.8%). The results of the Lille series match the stereotactic literature and show better results than endoscopic biopsies concerning the diagnosis rate (98.9%), accuracy rate (100%), resulting overall efficacy rate (98.9%), and perioperative morbidity (6.4%). Conclusions The Southampton and Lille series provide a unique opportunity to compare the overall efficacy rates of endoscopic and stereotactic biopsies, respectively. The stereotactic approach is safer and more effective for biopsies of pineal region tumors. To improve the safety and reliability of endoscopic biopsies, various methods have to be evaluated: alternative burr-hole strategies, use of neuronavigation, and a combination of flexible and rigid endoscopes. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Core needle biopsy results of segmental calcifications on mammography can have direct impact on surgical management. Although dependent on breast size, cancer spanning greater than 5 cm is usually treated with mastectomy, and cancer less than 5 cm is managed with lumpectomy. Approach to stereotactic biopsy of morphologically similar segmental calcifications that span more than 5 cm on mammography varies geographically and is currently largely based on preference of the surgical or medical oncology colleagues. Some clinicians prefer biopsy of the anterior and posterior aspects of the abnormality, whereas others believe a single biopsy within the abnormality is adequate. There is insufficient data to support whether a single biopsy of calcifications is adequate to establish the need for mastectomy, or if pathology-proven cancer in the anterior and posterior components to define the extent of disease is required. This study aims to evaluate concordance rates of paired biopsies of suspicious segmental mammographic calcifications.Materials and Methods: From a 5-year review of our imaging database, 32 subjects were identified with breast imaging reporting and data system (BI-RADS) 4 or 5 segmental calcifications on mammography who underwent anterior and posterior stereotactic biopsies. The paired biopsy results were independently analyzed for concordance on benign, high-risk, or malignant pathology.Results: Of the 32 cases, there was perfect agreement (32/32 cases = 100% concordance, 95% confidence interval = 89.3-100%) in anterior and posterior pairs in benign, high-risk, or malignant findings (kappa = 1, P < 0.001).Conclusions: The absence of data on pathological concordance in anterior and posterior aspects of suspicious, morphologically similar, segmental calcifications spanning 5 cm or more has led to a varied clinical approach to stereotactic biopsy. The 100% rate of pathological concordance in our study suggests that a single biopsy is adequate for diagnosis and representative of the whole mammographic abnormality. Implementation of this approach will potentially reduce unnecessary biopsies and surgeries, minimize healthcare costs, and decrease patient morbidity. [ABSTRACT FROM AUTHOR]

Background Frame-based stereotactic biopsy has proven to be a safe procedure with a high diagnostic yield for patients. Different supratentorial localizations can easily be accessed by standardized stereotactic approaches. Cerebellar and brainstem lesions, however, are not easy to reach because the positioning of the frame pins often makes it impossible to address the entry point properly. Methods By oblique positioning of the frame, cerebellar and brainstem lesions also can easily be accessed to take tissue samples. Conclusion Modification of the standardized positioning of the frame allows for safe and straightforward stereotactic access even to cerebellar and brainstem lesions. [ABSTRACT FROM AUTHOR]

Objective During their disease a significant number of human immunodeficiency virus (HIV)-infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found are toxoplasmosis, lymphomas, or progressive multifocal leukoencephalopathy. In some patients, diagnosis is not feasible with imaging alone, requiring biopsy. The objective of this study was to evaluate the impact of stereotactic biopsy in HIV patients on adjustment of therapy. Methods Between January 2004 and May 2015 at our clinic, 26 HIV-infected patients underwent stereotactic biopsy. Thin-layer magnetic resonance images were obtained and fused with computed tomography scans, taken with the stereotactic frame (Leksell) mounted. Biopsy material was evaluated pathologically and microbiologically. Results Histologic analysis revealed B-cell lymphoma in 6 patients (23.1%) and progressive multifocal leukoencephalopathy in 2 patients (7.7%). Abscess and toxoplasmosis were found in 3 patients each (11.5% and 11.5%), and encephalitis occurred in 4 patients (15.4%). In 2 patients each (7.7%), vasculitis, metastasis, and glioblastoma were diagnosed. Further findings comprised non-Hodgkin lymphoma and Burkitt lymphoma in 1 patient each. After biopsy, treatment was significantly changed in 18 (69.2%) patients ( P < 0.01). Antibiotic therapy was adjusted in 6 patients (23.1%), and chemotherapy in 3 patients (16.7%). Other changes included antibiotic/antiviral therapy to chemotherapy in 3 patients (16.7%), chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in 1 patient each. One patient with glioblastoma underwent resection, and another patient received radiation. One patient underwent palliative care. Conclusion Stereotactic biopsy in HIV-infected patients results in significant changes of therapy in more than two thirds of the patients. [ABSTRACT FROM AUTHOR]

Abstract: Aberrant epigenetic landscapes and their involvement in genesis and progression of tumors, as well as in treatment responses and prognosis, indicate one of the most emerging fields in cancer research. In gliomas, the most common human primary brain tumors, and in particular in glioblastoma, the most malignant and devastating brain tumor entity in adults, the elucidation of distinct patterns of aberrant DNA methylation, histone modification, and miRNA expression and their interrelationship has fundamentally changed our point of view on these highly heterogeneous tumors. In the current review article, we address the basic principles of epigenetic control in gliomas, their current and putative future role in prognostic and predictive models and possible interactions within the epigenetic network. We discuss diagnostic and therapeutic opportunities appearing at horizon of epigenetic research. Moreover, we present current and propose future clinical workflow models for molecular characterization of malignant gliomas. [Copyright &y& Elsevier]

Background: There are concerns in the literature about the accuracy of histopathological diagnosis obtained by stereotactic biopsy in patients with brain tumours. The aim of this study was to analyse intraindividually the histopathological accuracy of stereotactic biopsies of intracerebral lesions in comparison to open surgical resection. Materials and methods: Between 2007 and 2011 a total of 635 patients underwent stereotactic serial biopsy in our department. Among these patients we identified 51 patients, who underwent magnetic resonance (MR) based stereotactic biopsy and subsequent open resection within 30 days. Mortality and morbidity data as well as final histopathological diagnoses of both procedures were compared with regard to tumour grade and tumour cell type. Patients with discrepancies between the histological diagnosis obtained by biopsy and open resection were classified into three subgroups (same cell type but different grading; same grading but different cell type and different grading as well as different cell type). Results: The mean number of tissue samples taken by stereotactic serial biopsy from each patient was 12 (range 7-21). Minor morbidity was 6% and major morbidity was 14% after open surgery compared to no morbidity after stereotactic biopsy. Mortality was 2% after stereotactic biopsy (one patient died after stereotactic biopsy as a result of a fatal bleeding) compared to 0% in the resection group. Silent bleeding rate without any clinical symptoms was 8% in the biopsy group. A complete correlation of histopathological findings between the biopsy group and the resection group was achieved in 76% and was increased to 90% by analyzing clinical and neuroradiological information. In patients with recurrence the correlation was higher (94%) than for patients with primary brain lesions (67%). The discrepancies between the open resection group and biopsy group were analysed. Conclusion: Stereotactic MR guided serial biopsy is a minimal invasive procedure with low morbidity and high diagnostic accuracy for diagnosis and grading of brain tumours. Diagnostic accuracy of stereotactic biopsy can be enhanced further by careful interpretation of neuroradiological and clinical information. [ABSTRACT FROM AUTHOR]

Abstract: Tuberculosis is among the oldest and most devastating infectious diseases worldwide. Nearly one third of the world’s population has active or latent disease, resulting in 1.5million deaths annually. Central nervous system involvement, while rare, is the most severe form of tuberculosis. Manifestations include tuberculoma and tuberculous meningitis, with the majority of cases occurring in children and immunocompromised patients. Despite advancements in imaging and laboratory diagnostics, tuberculomas of the central nervous system remain a diagnostic challenge due to their insidious nature and nonspecific findings. On imaging studies tuberculous meningitis is characterized by diffuse basal enhancement, but tuberculomas may be indistinguishable from neoplasms. Early diagnosis is imperative, since clinical outcomes are largely dependent on timely treatment. Stereotactic biopsy with histopathological analysis can provide a definitive diagnosis, but is only recommended when non-invasive methods are inconclusive. Standard medical treatment includes rifampicin, isoniazid, pyrazinamide, and streptomycin or ethambutol. In cases of drug resistance, revision of the treatment regimen with second-line agents is recommended over the addition of a single drug to the first-line regimen. Advances in genomics have identified virulent strains of tuberculosis and are improving our understanding of host susceptibility. Neurosurgical referral is advised for patients with elevated intracranial pressure, seizures, or brain or spinal cord compression. This review synthesizes pertinent findings in the literature surrounding central nervous system tuberculoma in an effort to highlight recent advances in pathophysiology, diagnosis, and treatment. [Copyright &y& Elsevier]

Background: Focal brain lesions (FBL) in HIV/AIDS frequently pose a diagnostic dilemma as the etiology varies from infective (tuberculoma, toxoplasmosis and tuberculous abscesses) to neoplastic lesions like lymphoma. For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. Stereotactic biopsy (STB) of the lesions is reserved for lesions unresponsive to appropriate therapy. Objective and methods: In this study, the diagnostic yield of neuroimaging [cranial CT (n = 25), MRI (n = 24), and Th201/99Tc SPECT scan (n = 18)] is compared with histopathological diagnosis obtained by STB (n = 21) or autopsy (n = 4) in 25 HIV-1 subtype C seropositive individuals with FBL identified by neuroimaging with special reference to cerebral toxoplasmosis in an eighteen month study period (2006-2007). Results and conclusion: Cerebral toxoplasmosis was the most frequent cause of FBL (21/25, 84%), followed by one case each of tuberculoma, progressive multifocal leukoencephalopathy (PML), primary central nervous system lymphoma (PCNSL) and measles inclusion body encephalitis (MIBE), the last two diagnosed at autopsy. Of the 21 cases of cerebral toxoplasmosis, definitive diagnosis with histopathological confirmation was available in 14/21 (66.6%), with indirect evidence suggesting probable toxoplasmosis in seven, all of whom responded to antitoxoplasma therapy. CT and MRI had comparable specificities (75%), while MRI had marginally higher sensitivity (85% versus 80.9%) in detecting multiple lesions. The positive predictive value of both CT and MRI was identical (94.4%), suggesting that CT maybe a cost effective screening tool in resource restricted settings, for evaluating FBL. Sensitivity of 99Tc SPECT scan for diagnosing inflammatory lesions was 75% but failed to differentiate PCNSL from toxoplasmosis. This study is the first of its kind from India analyzing FBL with specific focus on cerebral toxoplasmosis in the setting of HIV-1 subtype C. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The compare the performance and ability to obtain a correct diagnosis on needle biopsy between 11 gauge and 8 gauge vacuum assisted biopsy devices. Materials and methods: Hospital records of all consecutive stereotactic core biopsies performed over five years were retrospectively reviewed in compliance Health Insurance Portability and Accountability Act (HIPPA) policy and with approval from the hospital institutional review board (IRB). Pathology from core biopsy was compared with surgical pathology and/or imaging follow-up. A histological underestimation was defined if the surgical excision yielded a higher grade on pathology which changed management. Results: 828 needle core biopsies (47.5%, 393/828 with 11 gauge and 52.5%, 435/828 with 8 gauge) yielded 471 benign, 153 high risk and 204 malignant lesions. 30/193 (15.5%) 11 gauge lesions and 16/185 (8.6%) 8 gauge lesions demonstrated higher grade pathology on surgical excision. The difference in the rates of the number of correct diagnoses on core needle biopsy between 11 gauge (363/393, 92.4%) and 8 gauge (419/435, 96.3%) based on either surgical or clinical/imaging follow up and the difference in the number of discordant benign core biopsies between 11 (17/217, 7.8%) and 8 gauge (4/254, 1.6%) necessitating a surgical biopsy was significant (P =0.013; P =0.001). Although there were more underestimations with the 11 gauge (25/193, 13.0%) than 8 gauge (15/185, 8.1%) needle, this was not significant. Conclusion: Our study demonstrates improved performance and increased diagnostic ability of 8 gauge needle over 11 gauge in obtaining a correct diagnosis on needle biopsy. [Copyright &y& Elsevier]

Abstract: Objective: Comparative evaluation of diagnostic efficacy of stereotactic brain biopsy performed with and without additional use of spectroscopic imaging (1H-MRS) for target selection was done. Methods: From 2002 to 2006, 30 patients with parenchymal brain lesions underwent 1H-MRS-supported frame-based stereotactic biopsy, whereas in 39 others MRI-guided technique was used. Comparison of diagnostic yield of the procedure in these two groups was performed. Additionally, the diagnostic accuracy was evaluated in 37 lesions, which were surgically resected within 1 month thereafter. Results: Stereotactic biopsy permitted establishment of a definitive histopathological diagnosis in 57 cases and diagnosis of low-grade glioma without specific tumor typing in 8 cases. In 4 cases tissue sampling was non-diagnostic. In 5 out of 8 cases with incomplete diagnosis and in all non-diagnostic cases target selection was performed without the use of 1H-MRS (P =0.2073). The diagnostic yields of 1H-MRS-supported and MRI-guided procedures were 100% and 90%, respectively (P =0.1268). Comparison of the histopathological diagnoses after stereotactic biopsy and surgical resection revealed complete diagnostic agreement in 13 cases, minor disagreement in 14 cases, and major disagreement in 10 cases. Among these last 10 cases, initial undergrading of non-enhancing WHO grade III gliomas was the most common (7 cases). The diagnostic accuracy of 1H-MRS-supported and MRI-guided procedures was 67% and 79%, respectively (P =0.4756). Conclusion: While in the present study the diagnostic yield of 1H-MRS-supported frame-based stereotactic brain biopsy was 100%, its statistically significant diagnostic advantages over MRI-guided technique were not proved. Optimal selection of the spectroscopic target for tissue sampling remains unclear. [Copyright &y& Elsevier]

Abstract: Background: The aim of this study was to describe pneumocephalus as a rare complication of stereotactic biopsy and as a possible cause of acute neurogenic pulmonary edema. Case Description: A case of frameless stereotactic biopsy complicated by pneumocephalus presenting with acute lung injury 48 hours after the procedure. A frameless stereotactic procedure was performed in the standard fashion. Immediate postoperative CT showed no intracranial air except for a gas inclusion at the biopsy site within the lesion. The skin staple placed at the end of surgery on the skin incision was removed 36 hours later. A CT scan performed 48 hours postoperatively showed new pneumocephalus. The patient exhibited acute respiratory distress but no new neurologic symptoms. There was no detectable systemic cause for the pulmonary edema. The patient received supportive respiratory treatment and fully recovered. Conclusion: Pneumocephalus is apparently a rare complication of stereotactic brain biopsy and one that may result from early removal of the skin staple or suture. The occurrence of acute neurogenic pulmonary edema may be attributed to the pneumocephalus. [Copyright &y& Elsevier]

Summary: Stereotactic biopsy is a minimally invasive method of reaching a pathological diagnosis. However, it is not always possible with this method to obtain the tissue samples required for an exact pathological diagnosis. The factors that can make histological diagnoses uncertain are the heterogeneity of tumors and/or brain shifts in the case of small tumors. In this study, we investigated the usefulness of fluorescence in determining the existence of tumor components in obtained tissues. Six patients underwent stereotactic biopsy. 5-Aminolevulinic acid (5-ALA) was administered orally prior to operation. Frameless stereotactic biopsies were performed. The obtained samples were irradiated with 405nm light and all samples showed red light excitation. Intraoperative rapid pathological diagnosis was made in each case by microscopic examination of frozen section samples. The final pathological diagnoses were of three glioblastomas, one astrocytoma grade 3, and two malignant lymphomas. One case was initially thought to be gliosis on rapid pathological diagnosis, but the final pathological diagnosis reached by examination of a permanent HE stained section was astrocytoma grade 3. Another case, finally diagnosed as malignant lymphoma, was initially diagnosed as infiltration of lymphocytes. The discrepancies between rapid and permanent pathological diagnoses might be caused by the destruction of cells. 5-ALA photodynamic diagnosis is not influenced by the destruction of tissues, simply because it does not depend on the structure of tissues. Stereotactic fluorescence biopsy is very useful in that it enables rapid and exact biopsy and obviates the necessity of waiting for an intraoperative report from a pathologist. [Copyright &y& Elsevier]

: BackgroundStereotactic biopsies of the brainstem (SBB) are a selected group of stereotactic operations owing to the lower incidence of brainstem lesions requiring biopsy, the greater complexity, and the higher risks of these procedures. Usually, the lower the lesion in the brainstem, the greater the risks involved. The approach of the different target locations by distinct routes, transcerebral and transcerebellar, is still a matter of debate. Moreover, pure medullary lesions are seldom biopsied, whereas diffuse brainstem lesions, typical of children''s brainstem gliomas and rather frequent in most published series, depend less and less on the histopathological confirmation for treatment. In this study, the authors present their own experience on SBB aiming to discuss mainly their indications, approach routes choice, and procedure techniques.: MethodsThe authors reviewed a series of 30 SBB (27 adults and 3 children) out of 450 stereotactic biopsies of the central nervous system performed for the last 10 years. All cases but one presented as focal brainstem masses, 19 mainly in the pons and 10 in the midbrain. Eleven lesions (10 in the midbrain and one midbrain-pontine) were approached by a transfrontal route. All the others were approached by a suboccipital transcerebellar route.: ResultsTwenty-six (87%) out of the 28 cases (93%) where a positive histopathological result was obtained had a specific diagnosis: 18 tumors (14 astrocytomas, 2 primary brain lymphomas, 1 oligodendroglioma, and 1 ganglioglioma), 2 toxoplasmosis, 2 sarcoidosis, 1 aspergillus abscess, 1 vasculitis, 1 acute inflammatory demyelinating disease, and 1 progressive multifocal leucoencephalopathy. Four nontumoral lesions arose in patients with AIDS. Morbidity was restricted to 2 cases consisting of transient cranial nerve deficits.: ConclusionsStereotactic biopsies are specially useful for the diagnosis of focal brainstem lesions. Midbrain and midline lesions should be approached through the cerebrum, whereas most of the pontine lesions through the cerebellum. Overall, this procedure should be performed with “functional-like” precision and require some technical refinements to reach maximal accuracy with minimal morbidity. [Copyright &y& Elsevier]

The history of a 73-year-old woman with an anaplastic oligodendroglioma is presented, in whom cerebral magnetic resonance imaging (MRI) and brain single-photon emission tomography (SPECT) revealed an intracerebral lesion 17 months before, which was misinterpreted as cerebral infarction. Stereotactic biopsy confirmed the diagnosis, but 4 days after biopsy an unexpected fatal subdural and intraparenchymal bleeding occurred on the biopsy site. Neuroradiological aspects in the differential diagnosis of cerebral lesions as well as the role of small silent postbiopsy haematoma concerning further clinical deterioration are discussed. [Copyright &y& Elsevier]

: BackgroundAlthough there has been a dramatic increase in the accessibility and utilization of high-resolution MRI techniques for the evaluation of brain tumors, there is currently only a single report comparing stereotactic brain biopsy specimen to subsequent resection specimen exclusively in the management of gliomas.: MethodsThe diagnoses in 43 cases of astrocytic brain tumors were derived using MRI-guided stereotactic biopsy followed by open resection of the lesion. The histologic diagnoses yielded by biopsy were compared with subsequent histologic diagnosis after open tumor resection. All biopsies and histologic diagnoses were made by the same surgeon and pathologist, respectively.: ResultsIn 23 patients undergoing resection <60 days after biopsy, the biopsy diagnosis was consistent with resection diagnosis in 18 cases (79%) and led to the correct treatment in 22 cases (96%). Recurrent glioblastoma multiforme (GBM) was undergraded as anaplastic astrocytoma in 4 patients. GBM was misdiagnosed as radiation necrosis in 1 patient. MR-nonenhancing lesions [10/10 (100%)] yielded histology that correlated with subsequent craniotomy, while only 8/13 (61%) MR-enhancing lesions yielded histology that was consistent with that at craniotomy (p < 0.05). In 20 patients undergoing resection because of radiologic tumor progression (mean 7 months after biopsy), 6/6 (100%) biopsy diagnoses of a specific glioma grade correlated with resection diagnosis, while only 6/14 (43%) biopsy diagnoses of radiation effect correlated with resection diagnosis (p < 0.01).: ConclusionMRI-guided stereotactic brain biopsy specimen accurately represents the grade of the larger glioma mass sufficiently to guide subsequent therapy. Enhancement on MR may be a negative prognostic indicator of biopsy accuracy. [Copyright &y& Elsevier]

To prove feasibility of proton chemical shift imaging (1H CSI) during stereotactic procedure, authors performed 1H CSI in combination with a stereotactic headframe and selected targets according to local metabolic information, evaluated the pathologic results. The 1H CSI directed stereotactic biopsy was performed in four patients. 1H CSI and conventional Gd-enhancement stereotactic MRI were performed simultaneously after the fitting of a stereotactic headframe. Focal areas of increased phosphocholine(Cho)/phosphocreatine(Cr) and Lactate/Cr ratios were selected as target sites in the stereotactic MR images. 1H CSI is possible with the stereotactic headframe in place. Pathologic samples taken from areas of increased Cho/Cr ratios and decreased NAA/Cr ratios provided information upon increased cellularity, mitoses and cellular atypism, and facilitated diagnosis. Pathologic samples taken from areas of increased Lac/Cr ratio showed predominant feature of necrosis. 1H CSI was feasible with the stereotactic headframe in place. The final pathologic results obtained were concordant with the local metabolic information from 1H CSI. We believe that 1H CSI-directed stereotactic biopsy has the potential to significantly improve the accuracy of stereotactic biopsy targeting. [Copyright &y& Elsevier]

BACKGROUNDA stereotactic computer with a mechanical, proprioceptive arm was acquired in 1996. The aim of this report is to review the 4-year experience with frameless, computer-aided stereotaxy in a small neurosurgical department.METHODSFrom 1996 to 1999 the computer was used for 121 operations. The surgical files from these operations were either retrospectively or prospectively registered. Patient and computer data, type of surgery, complications and number of surgeons were noted. The versatility, benefits, and drawbacks of the stereotactic computer were evalued based on these findings.RESULTSSeven surgeons performed a total of 121 computer-assisted operations. The procedures consisted of 63 stereotactic tissue samplings, 44 craniotomies, 7 abscess punctures and 3 insertions of intracerebral devices (shunts and microelectrodes). Technical complications were seen in 6 cases (4.8%), but this did not affect the surgical outcome.CONCLUSIONSThe stereotactic computer has enabled the department to broaden its spectrum of procedures. High precision surgery such as stereotactic biopsy has been possible without the use of a framebased system. The results indicate that even small neurosurgical units with a limited number of procedures can safely and successfully implement neuronavigation in daily routines. [Copyright &y& Elsevier]

Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible. Local anaesthesia combined with intravenous sedation is often used, but general anaesthesia is more comfortable and secure. Since awakening during the procedure is generally planed, it has to be quick, reliable and of excellent quality. These requirements are fulfilled by the association of propofol by target-controlled infusion (TCI) and a continuous infusion of remifentanil. [Copyright &y& Elsevier]

BACKGROUNDCerebral germinomas and their occasional recurrences can usually be cured by irradiation, chemotherapy, or a combination of the two treatment modalities. Late recurrences, as in our case, are distinctly rare.CASE DESCRIPTIONThis patient presented at age 24 with a calcified tumor in the pineal area. The radiological diagnosis was germinoma. No tissue diagnosis was obtained. Radiation therapy was given, and there was a complete response. The patient’s symptoms reappeared 13 years later. Imaging studies revealed a lesion in the anterior corpus callosum. A germinoma was diagnosed by stereotactic biopsy. Because of complications attributed to the initial course of radiation therapy, no further radiation was given. Five courses of chemotherapy resulted in a partial remission lasting six months. The patient later died because of massive tumor progression with intracerebral, intraventricular, cerebellar, and meningeal dissemination.CONCLUSIONSAs this case illustrates, exceptional recurrences of cerebral germinomas may appear even many years after adequate initial treatment with radiation and chemotherapy. [Copyright &y& Elsevier]

Rationale and Objective: Use of digital breast tomosynthesis (DBT) in breast imaging has necessitated DBT-guided biopsy, however, a single DBT acquisition may result in a greater radiation dose than a single DM acquisition. Our objective was to compare the number of images acquired and the resulting radiation dose of DBT versus DM-guided breast biopsies.Method: All biopsies performed on our DM unit from 8/2016 to 1/2017 and on our DM-DBT unit from 8/2017 to 1/2018 were retrospectively reviewed. The number of image acquisitions, average glandular dose (AGD) per acquisition and per procedure were computed and stratified by guidance modality and lesion type.Results: 25 DM-guided biopsies were performed on the DM-only unit, 58 biopsies were performed with DM guidance on the dual unit (DM-DU) and 29 were performed with DBT. The average number of images acquisitions was 10.9 for DM-only unit biopsies, 9.3 images for DM-DU biopsies and 4.3 images for DBT-guided biopsies. Mean procedure AGD for DM-only unit biopsies was 28.77 mGy, versus 22.06 mGy for DM-DU and 10.18 mGy for DBT biopsies. Mean procedure AGD for biopsied calcification-only lesions was 22.3 mGy for DM-DU versus 10.7 mGy for DBT guidance (p < 0.001), with an average of 8.1 images per procedure for DM-DU versus 4.2 for DBT.Conclusion: Fewer image acquisitions were obtained with DBT compared with DM guidance, therefore, the overall dose of DBT-guided procedures was less. The dose reduction obtained with DBT is possible across all lesion types, even for calcification-only lesions. [ABSTRACT FROM AUTHOR]

The article describes the case report of a 68-year-old right-handed male patient with a history of progressive balance difficulties and who was diagnosed with brain ischemia associated with a developmental venous anomaly (DVA). The condition was confirmed by biopsy using a Leksell stereotactic frame with neuropathologic examination. The possible development derangements in vascular remodeling related to altered hemodynamics in the region of a DVA is mentioned.

Purpose: To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability.Methods: This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions.Results: SVAB decreased the direct cost by $90.3 (10.1 %) per diagnosis. The indirect cost was decreased by $560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources.Conclusions: SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3. [ABSTRACT FROM AUTHOR]

Objective To evaluate the diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome (AIDS) patients with intracranial lesions via meta-analysis. Methods Relevant cohort studies were identified through a literature search in PubMed, Embase, and Ovid from 1985 to October 1, 2016. Appropriate studies were identified per search criteria. Systematic review and meta-analysis were used to assess the diagnostic success rate, changed management rate, clinical improvement rate, mortality rate, morbidity rate, hemorrhage rate, hemorrhage in morbidity rate, and final histologic diagnosis results. Study-specific outcomes were combined per a random effects model. Outcomes were compared between the pre-highly active antiretroviral therapy (HAART) and post-HAART groups. Correlations between outcomes were assessed via meta-regression analysis. Results A total of 19 cohort studies with 820 patients were included in this meta-analysis. The weighted proportions per the random effects model were 92.2% (95% confidence interval [CI; 89.3%–94.5%]) for diagnostic success rate, 5.1% (95% CI [2.5%–8.3%]) for morbidity, and 0.7% (95% CI [0%–1.9%]) for mortality. The most common procedure-related morbidity was hemorrhage at 3.3% (95% CI [1.1%–6.3%]). Hemorrhage in morbidity was 78.0% (95% CI [51.4%–97.4%]). Management changed and clinical improvement were 60.4% (95% CI [49.4%–71.0%]) and 34.0% (95% CI [22.2%–46.8%]), respectively. The 4 most common diagnoses were primary central nervous system lymphoma (27.8%; 95% CI [20.2%–36.1%]), progressive multifocal leukoencephalopathy (PML) (21.0%; 95% CI [14.3%–28.4%]), toxoplasma encephalitis (TE) (20.3%; 95% CI [14.3%–27.0%]), and human immunodeficiency virus (HIV) encephalitis (4.1%; 95% CI [1.4%–7.6%]). Multiple diagnoses rate was 1.2% (95% CI [0.0%–3.6%]). HIV encephalitis rate was significantly higher in the post-HAART group than the pre-HAART group (17.9% vs. 3.2%, respectively; P = 0.0024). Conclusions Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patients with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. The 4 most common intracranial lesions in patients with AIDS are lymphoma, PML, TE, and HIV encephalitis. [ABSTRACT FROM AUTHOR]

The article describes the case of a 47-year-old male patient with implantation metastases of the primary parenchymal sarcoma of the central nervous system (CNS) following stereotactic brain biopsy. The medical history of the patient and the symptoms he manifested are presented. Physical examination, laboratory tests and imaging done on the patient are mentioned. Background information on the condition is provided.

Objective: The stereotactic biopsy is widely integrated into clinical practice as an efficient and safe procedure for histologic diagnoses. However, the surgical risk increases when the lesions are close to the eloquence of the adjacent brain. The present report describes two patients with deep-seated brain tumors who underwent a stereotactic biopsy with electrical monitoring and demonstrates the importance of this technique. Methods: The tentative target and trajectory were determined on a stereotactic map from the Schaltenbrand and Wahren atlas. A Cosman–Roberts–Wells stereotactic frame was applied to the patient. Electrical recording along a single trajectory was used to identify the circumscribed neuronal structures, and electrical simulation was administered to the target. The biopsy point was decided when no adverse events were observed with a low electric current level. Results: A 34-year-old male patient with anaplastic astrocytoma in the putamen and thalamus and an 81-year-old female patient with malignant lymphoma in the midbrain underwent stereotactic biopsies with electrical monitoring. The biopsies were successfully performed without any resulting neurologic deficits. Conclusions: This report describes two patients with deep-seated brain tumors who underwent stereotactic biopsies with electrical recording and stimulation. The electrical monitoring appears to be a useful technique to complement the ordinary image-guided biopsy. [ABSTRACT FROM AUTHOR]

Gliomas are more or less diffuse tumours with the ability to infiltrate surrounding functional brain tissue. Thus, curative surgical treatment generally cannot be achieved. Despite these limitations, open tumour resection represents one of the mainstays in glioma treatment settings. Beyond tissue sampling for accurate histological and molecular genetic evaluation, decompressive effects in the case of space occupying tumours and oncologically relevant cytoreductive effects of microsurgery have been reported in selected patients with glioma of different grades. This paper provides practical considerations in order to integrate the concept of a personalized surgical therapy into the prognostic network of low- and high-grade gliomas, covering both microsurgery and stereotactic biopsy techniques. [ABSTRACT FROM AUTHOR]