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Intraparenchymal brain lesion biopsy guided by a rigid endoscope and navigation system.

Ishikawa E, Yamamoto T, Matsuda M, Akutsu H, Zaboronok A, Kohzuki H, Miki S, Takano S, Matsumura A - Surg Neurol Int (2015)

Bottom Line: There was no postoperative mortality.In 2 patients, mild postoperative permanent morbidity (5.9%), presumably related to this technique, was observed in the early cases in the current group (34 case series).The method was estimated as safe and feasible for diagnostic tissue sampling of intraparenchymal brain lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

ABSTRACT

Background: The authors report a continuous case series of navigation-guided rigid endoscopic biopsy via the transcortical route for intraparenchymal brain lesions to assess the feasibility and efficacy of the method.

Methods: Thirty-four patients with intraparenchymal brain lesions found on neurovisualization underwent navigation-guided rigid endoscopic biopsy. Most of the preoperative diagnoses were glioma WHO Grade II-IV (16 cases) or malignant lymphoma (15 cases). Intraoperative photodynamic diagnosis and intraoperative pathological diagnosis were used in 28 and 29 cases, respectively. In 2 cases with small and deep lesions, intraoperative magnetic resonance imaging was used for confirming the accuracy of the biopsy point.

Results: The sampling accuracy determined by postoperative imaging and the definitive diagnosis ratio were 94% (32 out of 34 cases) and 97% (33 out of 34 cases), respectively. There was no postoperative mortality. In 2 patients, mild postoperative permanent morbidity (5.9%), presumably related to this technique, was observed in the early cases in the current group (34 case series).

Conclusion: The method was estimated as safe and feasible for diagnostic tissue sampling of intraparenchymal brain lesions.

No MeSH data available.


Related in: MedlinePlus

Procedures for rigid endoscopic biopsy using the single port technique (a-c). (a) A round-shaped burr-hole is made. (b) A transparent sheath with diameters of 6.8 mm (or 10.0 mm) is inserted into the front of the target lesion under the control of the navigation system. (c) Observed with a rigid endoscope (a blue column), the lesion is biopsied using a single instrument, such as a biopsy forceps (a green column). Each instrument excepting the rigid endoscope is usually inserted alternately. Procedures for rigid endoscopic biopsy using the dual port technique (d-f). (d) An infinity-shaped burr hole is made. (e) Two transparent sheaths with diameters of 6.8 mm with Nelaton catheters (Fr 18) as alternative inner tubes are inserted into the front of the target lesion under the control of the navigation system. (f) Observed with a rigid endoscope (a blue column), the lesion is biopsied or removed partially using a biopsy forceps (a green column) along with other instrument such as a suction tube (a red column)
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Figure 1: Procedures for rigid endoscopic biopsy using the single port technique (a-c). (a) A round-shaped burr-hole is made. (b) A transparent sheath with diameters of 6.8 mm (or 10.0 mm) is inserted into the front of the target lesion under the control of the navigation system. (c) Observed with a rigid endoscope (a blue column), the lesion is biopsied using a single instrument, such as a biopsy forceps (a green column). Each instrument excepting the rigid endoscope is usually inserted alternately. Procedures for rigid endoscopic biopsy using the dual port technique (d-f). (d) An infinity-shaped burr hole is made. (e) Two transparent sheaths with diameters of 6.8 mm with Nelaton catheters (Fr 18) as alternative inner tubes are inserted into the front of the target lesion under the control of the navigation system. (f) Observed with a rigid endoscope (a blue column), the lesion is biopsied or removed partially using a biopsy forceps (a green column) along with other instrument such as a suction tube (a red column)

Mentions: The method of navigation-guided rigid endoscopic biopsy was described in previous reports.[81318] In short, the patient's head was fixed with a Mayfield frame under general anesthesia. As shown in Figure 1, a single or dual transparent sheath was inserted into the front of the target lesion via the burr hole under control of the navigation system (StealthStation®; Medtronic, Inc., Minneapolis, MN, USA). S ingle port technique was typically selected for a deep lesion approximately 3–5 cm from the brain surface, and dual port technique was typically selected for a deeper (approximately 5–6 cm from the brain surface) and/or vascular rich deep lesion (approximately 4–6 cm from the brain surface) in the white matter. Preoperative MRI data were used to plan the entry point, target sites, and trajectories of the navigation system to avoid the eloquent or vascular structures. When the start of the lesion was visible through the rigid endoscope (EndoArm®; Olympus Corp., Tokyo, Japan), three or more sample sets of the suspected pathological tissue were obtained from the target sites of the lesion under control of the navigation system. In most cases, the intraoperative photodynamic diagnosis (PDD) using 5-aminolevulinic acid was performed, and the PDD positive tissue samples were submitted for frozen section intraoperative pathological diagnosis. The biopsy was repeated until the samples were confirmed to contain the pathological tissue.


Intraparenchymal brain lesion biopsy guided by a rigid endoscope and navigation system.

Ishikawa E, Yamamoto T, Matsuda M, Akutsu H, Zaboronok A, Kohzuki H, Miki S, Takano S, Matsumura A - Surg Neurol Int (2015)

Procedures for rigid endoscopic biopsy using the single port technique (a-c). (a) A round-shaped burr-hole is made. (b) A transparent sheath with diameters of 6.8 mm (or 10.0 mm) is inserted into the front of the target lesion under the control of the navigation system. (c) Observed with a rigid endoscope (a blue column), the lesion is biopsied using a single instrument, such as a biopsy forceps (a green column). Each instrument excepting the rigid endoscope is usually inserted alternately. Procedures for rigid endoscopic biopsy using the dual port technique (d-f). (d) An infinity-shaped burr hole is made. (e) Two transparent sheaths with diameters of 6.8 mm with Nelaton catheters (Fr 18) as alternative inner tubes are inserted into the front of the target lesion under the control of the navigation system. (f) Observed with a rigid endoscope (a blue column), the lesion is biopsied or removed partially using a biopsy forceps (a green column) along with other instrument such as a suction tube (a red column)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4590177&req=5

Figure 1: Procedures for rigid endoscopic biopsy using the single port technique (a-c). (a) A round-shaped burr-hole is made. (b) A transparent sheath with diameters of 6.8 mm (or 10.0 mm) is inserted into the front of the target lesion under the control of the navigation system. (c) Observed with a rigid endoscope (a blue column), the lesion is biopsied using a single instrument, such as a biopsy forceps (a green column). Each instrument excepting the rigid endoscope is usually inserted alternately. Procedures for rigid endoscopic biopsy using the dual port technique (d-f). (d) An infinity-shaped burr hole is made. (e) Two transparent sheaths with diameters of 6.8 mm with Nelaton catheters (Fr 18) as alternative inner tubes are inserted into the front of the target lesion under the control of the navigation system. (f) Observed with a rigid endoscope (a blue column), the lesion is biopsied or removed partially using a biopsy forceps (a green column) along with other instrument such as a suction tube (a red column)
Mentions: The method of navigation-guided rigid endoscopic biopsy was described in previous reports.[81318] In short, the patient's head was fixed with a Mayfield frame under general anesthesia. As shown in Figure 1, a single or dual transparent sheath was inserted into the front of the target lesion via the burr hole under control of the navigation system (StealthStation®; Medtronic, Inc., Minneapolis, MN, USA). S ingle port technique was typically selected for a deep lesion approximately 3–5 cm from the brain surface, and dual port technique was typically selected for a deeper (approximately 5–6 cm from the brain surface) and/or vascular rich deep lesion (approximately 4–6 cm from the brain surface) in the white matter. Preoperative MRI data were used to plan the entry point, target sites, and trajectories of the navigation system to avoid the eloquent or vascular structures. When the start of the lesion was visible through the rigid endoscope (EndoArm®; Olympus Corp., Tokyo, Japan), three or more sample sets of the suspected pathological tissue were obtained from the target sites of the lesion under control of the navigation system. In most cases, the intraoperative photodynamic diagnosis (PDD) using 5-aminolevulinic acid was performed, and the PDD positive tissue samples were submitted for frozen section intraoperative pathological diagnosis. The biopsy was repeated until the samples were confirmed to contain the pathological tissue.

Bottom Line: There was no postoperative mortality.In 2 patients, mild postoperative permanent morbidity (5.9%), presumably related to this technique, was observed in the early cases in the current group (34 case series).The method was estimated as safe and feasible for diagnostic tissue sampling of intraparenchymal brain lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

ABSTRACT

Background: The authors report a continuous case series of navigation-guided rigid endoscopic biopsy via the transcortical route for intraparenchymal brain lesions to assess the feasibility and efficacy of the method.

Methods: Thirty-four patients with intraparenchymal brain lesions found on neurovisualization underwent navigation-guided rigid endoscopic biopsy. Most of the preoperative diagnoses were glioma WHO Grade II-IV (16 cases) or malignant lymphoma (15 cases). Intraoperative photodynamic diagnosis and intraoperative pathological diagnosis were used in 28 and 29 cases, respectively. In 2 cases with small and deep lesions, intraoperative magnetic resonance imaging was used for confirming the accuracy of the biopsy point.

Results: The sampling accuracy determined by postoperative imaging and the definitive diagnosis ratio were 94% (32 out of 34 cases) and 97% (33 out of 34 cases), respectively. There was no postoperative mortality. In 2 patients, mild postoperative permanent morbidity (5.9%), presumably related to this technique, was observed in the early cases in the current group (34 case series).

Conclusion: The method was estimated as safe and feasible for diagnostic tissue sampling of intraparenchymal brain lesions.

No MeSH data available.


Related in: MedlinePlus