Neurosurgery practice · 2025
Usefulness of Frameless Neuronavigation-Guided Stereotactic Biopsy for Brain Lesions Under Local Anesthesia: Surgical Outcomes and Feasibility for Molecular Diagnosis-Case Series.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Osawa Sho, Ohno Makoto, Miyakita Yasuji, Takahashi Masamichi, Yanagisawa Shunsuke, Honda-Kitahara Mai, Nakashima Takuma, Fujita Shohei, Tsuchiya Takahiro, Sato Tetsufumi, Sugino Hirokazu, Yoshida Akihiko, Ichimura Koichi, Suzuki Hiromichi, Narita Yoshitaka
Аннотация
BACKGROUND AND OBJECTIVES: Frameless neuronavigation-guided stereotactic biopsy (SB) is a common surgical technique for diagnosing intracranial lesions. A frameless SB is generally performed under general anesthesia; however, no reports are available on the efficacy and safety of frameless SBs under local anesthesia (LA). This study reports the surgical outcomes, diagnostic yield, and feasibility of molecular analyses after performing a frameless SB under LA (SB-LA).
METHODS: The study retrospectively included patients who underwent a frameless SB-LA at our institute between March 2015 and January 2024. The clinical characteristics, intraoperative findings, completion rate of surgical procedure, complications, diagnostic yield, and feasibility of molecular analysis were analyzed retrospectively.
RESULTS: The study included 80 patients. Surgical procedures were completed in 79 patients (98.7%); the diagnosis was confirmed in 76 cases (95.0%). The diagnoses included diffuse gliomas (n = 38, 47.5%), primary central nervous system lymphomas (PCNSL; n = 27, 33.8%), other brain tumors (n = 4, 5.0%), demyelinating diseases (n = 2, 2.5%), and normal brain/gliosis (n = 5, 6.3%). All samples were sufficient for basic molecular analyses of isocitrate dehydrogenase 1/2, telomerase reverse transcriptase promoter, H3 histone family 3A, serine/threonine kinase B-RAF, and O-6-methylguanine deoxyribonucleic acid methyltransferase promoter methylation in gliomas and myeloid differentiation primary response gene 88 for PCNSLs. A comprehensive genomic profiling test using next-generation sequencing was attempted in 9 cases and was feasible in 8. Asymptomatic hemorrhages occurred in 14 patients (17.5%); no symptomatic hemorrhage occurred. Neurological deficits were observed in 1 patient (1.3%) who developed symptomatic small cerebral infarction. The median period from the first visit to our hospital to surgery was 3 days (range 0-12) for PCNSL and 6.5 days (range 0-21) for primary glioblastoma, isocitrate dehydrogenase wild-type.
CONCLUSION: Frameless SB-LAs can be performed safely with a high diagnostic yield and feasibility for molecular analysis. Frameless SB-LAs improve early diagnoses and therapeutic interventions without compromising molecular information.
METHODS: The study retrospectively included patients who underwent a frameless SB-LA at our institute between March 2015 and January 2024. The clinical characteristics, intraoperative findings, completion rate of surgical procedure, complications, diagnostic yield, and feasibility of molecular analysis were analyzed retrospectively.
RESULTS: The study included 80 patients. Surgical procedures were completed in 79 patients (98.7%); the diagnosis was confirmed in 76 cases (95.0%). The diagnoses included diffuse gliomas (n = 38, 47.5%), primary central nervous system lymphomas (PCNSL; n = 27, 33.8%), other brain tumors (n = 4, 5.0%), demyelinating diseases (n = 2, 2.5%), and normal brain/gliosis (n = 5, 6.3%). All samples were sufficient for basic molecular analyses of isocitrate dehydrogenase 1/2, telomerase reverse transcriptase promoter, H3 histone family 3A, serine/threonine kinase B-RAF, and O-6-methylguanine deoxyribonucleic acid methyltransferase promoter methylation in gliomas and myeloid differentiation primary response gene 88 for PCNSLs. A comprehensive genomic profiling test using next-generation sequencing was attempted in 9 cases and was feasible in 8. Asymptomatic hemorrhages occurred in 14 patients (17.5%); no symptomatic hemorrhage occurred. Neurological deficits were observed in 1 patient (1.3%) who developed symptomatic small cerebral infarction. The median period from the first visit to our hospital to surgery was 3 days (range 0-12) for PCNSL and 6.5 days (range 0-21) for primary glioblastoma, isocitrate dehydrogenase wild-type.
CONCLUSION: Frameless SB-LAs can be performed safely with a high diagnostic yield and feasibility for molecular analysis. Frameless SB-LAs improve early diagnoses and therapeutic interventions without compromising molecular information.