Computed Tomography-guided Stereotactic Surgery in the Management of Brain Lesions: A Single-center Experience

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2023 Jun 9

PMID 37292393

Authors

Mohamed Salah

Ahmed Shalaby

Affiliations

Soon will be listed here.

Abstract

Background: The present study presents our experience with computed tomography (CT)-guided stereotactic surgery in managing deep-seated brain lesions and provides a background in the expanding fields of morphological stereotactic neurosurgery.

Methods: We conducted this retrospective cohort study on 80 patients managed at the Department of Neurosurgery, Zagazig University Hospitals, Zagazig, Egypt, between January 2019 to January 2021. We targeted patients with morphological stereotactic surgeries performed as the primary management modality of their treatment.

Results: A total of 80 patients, with a mean age of 44.3 years, were included in the study. The stereotactic targets were supratentorial in 71 patients (88.75%), infratentorial in seven patients (8.75%), and both supraand infratentorial in two patients (2.5%). The lesions showed enhancements with IV contrast in 55 patients (68.75%). Stereotactic procedures were performed under local anesthesia in 64 patients and general anesthesia in 16 patients. Of the 80 stereotactic procedures, 52 were biopsies (65%). We observed a significant improvement in the postoperative Karnofsky performance score compared to the postoperative score (63.4 ± 19.8 vs. 56.7 ± 15.4, = 0.001). The level of agreement between clinical, radiological, and final pathological diagnosis was assessed; it was complete in 47.5% of the patients. The postprocedural CT scan demonstrated intracranial hemorrhage in five patients (6.25%); four (5%) were silent with no neurological complications.

Conclusion: This study provided evidence that the stereotactic procedure is easy to perform, accurate in targeting the lesion, and spares patients from undergoing major surgical procedures. Stereotactic applications of spontaneous intracerebral hemorrhage, deep-seated abscesses, encysted tumors, or medically refractory benign intracranial hypertension can improve the outcome even in medically high-risk patients.

Citing Articles

Comparison of surgical outcomes between primary and secondary brain abscess.

Fotakopoulos G, Gatos C, Paterakis K, Georgakopoulou V, Spiliotopoulos T, Christodoulidis G Med Int (Lond). 2024; 4(4):36.

PMID: 38756455 PMC: 11097135. DOI: 10.3892/mi.2024.160.

Epidemiology, Diagnostic Strategies, and Therapeutic Advances in Diffuse Midline Glioma.

Miguel Llordes G, Medina Perez V, Curto Simon B, Castells-Yus I, Vazquez Sufuentes S, Schuhmacher A J Clin Med. 2023; 12(16).

PMID: 37629304 PMC: 10456112. DOI: 10.3390/jcm12165261.

References

Mamelak A, Mampalam T, Obana W, Rosenblum M . Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery. 1995; 36(1):76-85; discussion 85-6. DOI: 10.1227/00006123-199501000-00010. View

Dooms G, Hecht S, Brant-Zawadzki M, Berthiaume Y, Norman D, Newton T . Brain radiation lesions: MR imaging. Radiology. 1986; 158(1):149-55. DOI: 10.1148/radiology.158.1.3940373. View

Bisdas S, Naegele T, Ritz R, Dimostheni A, Pfannenberg C, Reimold M . Distinguishing recurrent high-grade gliomas from radiation injury: a pilot study using dynamic contrast-enhanced MR imaging. Acad Radiol. 2011; 18(5):575-83. DOI: 10.1016/j.acra.2011.01.018. View

Chao S, Ahluwalia M, Barnett G, Stevens G, Murphy E, Stockham A . Challenges with the diagnosis and treatment of cerebral radiation necrosis. Int J Radiat Oncol Biol Phys. 2013; 87(3):449-57. DOI: 10.1016/j.ijrobp.2013.05.015. View

Broggi G, Franzini A, Peluchetti D, Servello D . Treatment of deep brain abscesses by stereotactic implantation of an intracavitary device for evacuation and local application of antibiotics. Acta Neurochir (Wien). 1985; 76(3-4):94-8. DOI: 10.1007/BF01418467. View

McGirt M, Woodworth G, Coon A, Frazier J, Amundson E, Garonzik I . Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg. 2005; 102(5):897-901. DOI: 10.3171/jns.2005.102.5.0897. View

Kutlay M, Colak A, Yildiz S, Demircan N, Akin O . Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery. 2008; 62 Suppl 2:540-6. DOI: 10.1227/01.neu.0000316257.21478.5b. View

Dammers R, Schouten J, Haitsma I, Vincent A, Kros J, Dirven C . Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir (Wien). 2010; 152(11):1915-21. PMC: 2956059. DOI: 10.1007/s00701-010-0752-0. View

Linskey M, Andrews D, Asher A, Burri S, Kondziolka D, Robinson P . The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2009; 96(1):45-68. PMC: 2808519. DOI: 10.1007/s11060-009-0073-4. View

10.

Chang E, Wefel J, Hess K, Allen P, Lang F, Kornguth D . Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009; 10(11):1037-44. DOI: 10.1016/S1470-2045(09)70263-3. View

11.

Lunsford L, Martinez A . Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol. 1984; 22(3):222-30. DOI: 10.1016/0090-3019(84)90003-x. View

12.

Nagelhus Hernes T, Ommedal S, LIE T, Lindseth F, Lango T, Unsgaard G . Stereoscopic navigation-controlled display of preoperative MRI and intraoperative 3D ultrasound in planning and guidance of neurosurgery: new technology for minimally invasive image-guided surgery approaches. Minim Invasive Neurosurg. 2003; 46(3):129-37. DOI: 10.1055/s-2003-40736. View

13.

Gildenberg P . The birth of stereotactic surgery: a personal retrospective. Neurosurgery. 2003; 54(1):199-207. DOI: 10.1227/01.neu.0000309602.15208.01. View

14.

Takahashi H, Sugai T, Uzuka T, Kano M, Honma J, Grinev I . [Complications and diagnostic yield of stereotactic biopsy for the patients with malignant brain tumors]. No Shinkei Geka. 2004; 32(2):135-40. View

15.

Paglioli Ferreira M, Ferreira N, Pereira Filho A, Pereira Filho G, Franciscatto A . Stereotactic computed tomography-guided brain biopsy: diagnostic yield based on a series of 170 patients. Surg Neurol. 2006; 65 Suppl 1:S1:27-1:32. DOI: 10.1016/j.surneu.2005.11.036. View

16.

Jain D, Sharma M, Sarkar C, Gupta D, Singh M, Mahapatra A . Comparative analysis of diagnostic accuracy of different brain biopsy procedures. Neurol India. 2006; 54(4):394-8. DOI: 10.4103/0028-3886.28113. View

17.

Soliman H, Das S, Larson D, Sahgal A . Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases. Oncotarget. 2016; 7(11):12318-30. PMC: 4914287. DOI: 10.18632/oncotarget.7131. View

18.

Rogers L, Barnett G . Percutaneous aspiration of brain tumor cysts via the Ommaya reservoir system. Neurology. 1991; 41(2 ( Pt 1)):279-82. DOI: 10.1212/wnl.41.2_part_1.279. View

19.

KEPES J . Pitfalls and problems in the histopathologic evaluation of stereotactic needle biopsy specimens. Neurosurg Clin N Am. 1994; 5(1):19-33. View

20.

Arbit E, Galicich J . Importance of image-guided stereotactic biopsy to confirm diagnosis in an oncological setting. Ann Surg Oncol. 1994; 1(5):368-72. DOI: 10.1007/BF02303807. View