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Klin Padiatr 2017; 229(03): 133-141
DOI: 10.1055/s-0043-101908
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility, Risk Profile and Diagnostic Yield of Stereotactic Biopsy in Children and Young Adults with Brain Lesions

Durchführbarkeit, Risikoprofil und diagnostischer Erfolg von stereotaktischen Biopsien bei Kindern und jungen Erwachsenen mit Hirntumoren
Christina Hamisch
1   Department of General Neurosurgery, University of Cologne, Cologne, Germany
,
Tobias Blau
2   Department of Neuropathology, University of Cologne, Cologne, Germany
,
Katharina Klinger
3   Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
,
Philipp Kickingereder
6   Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
,
Daniel Ruess
3   Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
,
Norbert Galldiks
4   Department of Neurology, University of Cologne, Cologne, Germany
7   Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
8   Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Germany
,
Frank Berthold
5   Department of Pediatric Hematology and Oncology, University of Cologne, Cologne, Germany
,
Thorsten Simon
5   Department of Pediatric Hematology and Oncology, University of Cologne, Cologne, Germany
,
Stefan Grau
1   Department of General Neurosurgery, University of Cologne, Cologne, Germany
,
Maximilian I. Ruge
3   Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
8   Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
30 May 2017 (online)

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Abstract

Objective To evaluate the feasibility, safety, and diagnostic yield of stereotactic biopsy (SB) in children and adolescents with cerebral lesions.

Methods We performed a systematic review of the literature and a retrospective analysis of all pediatric and adolescent patients who underwent SB for unclear brain lesions at our center. We collected patient and lesion-associated parameters, analysed the rate of procedural complications and diagnostic yield.

Results Our institutional series consisted of 285 SBs in 269 children and young adults between 1989 and 2016 (median age, 9 (range 1–18) years). There was no procedure-related mortality. Permanent and transient morbidity was 0.7% and 5.8%, respectively. Lesions were located in brain lobes (26.3%) and in midline structures (73.7%). The diagnostic yield was 97.5% and histology consisted low-grade gliomas (44.2%), high-grade gliomas (15.1%), non-glial tumors (22.8%), and non-neoplastic disease (15.4%). Morbidity was not associated with tumor location, age, histology or intraoperative position of the patient. In order to compare our findings with previous reports, we reviewed 25 studies with 1 109 children and young adults which had underwent SB. The diagnostic yield ranged between 83% and 100%. The reported morbidity and mortality rates range from 0–27% and 0–3.3%, respectively.

Conclusions SB in this particular patient population is a safe and a high-yield diagnostic procedure and indicates therefore its importance in the light of personalized medicine with the development of individual molecular treatment strategies.

Zusammenfassung

Zielsetzung Evaluation der Durchführbarkeit, Sicherheit und der diagnostischen Ausbeute von stereotaktischen Biopsien (SB) bei Kindern und jungen Erwachsenen mit zerebralen Läsionen.

Methoden Wir analysierten retrospektiv an einem einzelnen universitären Zentrum alle pädiatrischen und jugendlichen Patienten, die aufgrund einer unklaren zerebralen Läsion stereotaktisch biopsiert wurden. Ergebnisse dieser Erhebung wurden mit Ergebnissen einer systematischen Literaturrechereche zu diesem Thema verglichen.

Ergebnisse Die retrospektive Analyse identifizierte 285 SBs, die bei 269 Patienten (medianes Alter 9 (Spanne 1–18) Jahre) zwischen 1989 und 2016 durchgeführt wurden. Die behandlungsassoziierte Mortatilität betrug 0%. Die permanente und transiente Morbidität lag bei 0,7 bzw. 5,8%. Die Lokalisation der Läsionen war lobär (26.3%) bzw. in Mittellinienstrukturen (73,7%). Die histologische Aufarbeitung war in 97,5% der Fälle erfolgreich und ergab in 44,2% niedriggradige Gliome, 15,1% hochgradige Gliome, 22,8% nicht-gliale Tumore und 15,4% nicht-neoplastische Prozesse. Die Morbidität war weder mit der Tumorlokalisation noch dem Alter, der Histologie oder der intraoperativen Position des Patienten assoziiert. Um unsere Ergebnisse mit früheren Studien zu vergleichen führten wir einen Review durch, in den wir 25 Studien mit 1 109 Kindern und jugendliche Patienten einschließen konnten, bei denen eine SB durchgeführt werden konnte. Der diagnostische Erfolg lag zwischen 83 und 100%. Die Morbidität- und Mortalitätsrate war mit 0–27% und 0–3.3% angegeben.

Schlussfolgerung Die SB in dieser Population ist eine sichere und mit hoher diagnostischer Ausbeute einhergehende Methode und unterstreicht dadurch seine Wichtigkeit insbesondere im Zuge der personalisierten Medizin mit individuellen Behandlungsstrategien.

Schlüsselwörter

stereotaktische Biopsie - pädiatrische Hirntumoren - Morbidität - diagnostische Ausbeute - Sicherheit

Key words

stereotactic biopsy - pediatric brain tumors - morbidity - diagnostic accuracy - safety
 

  • References

  • 1 Air EL, Leach JL, Warnick RE. et al. Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 2009; 111: 820-824
    CrossrefPubMedGoogle Scholar
  • 2 Albright AL, Packer RJ, Zimmerman R. et al. Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children’s Cancer Group. Neurosurgery. 1993; 33: 1026-1029 discussion 1029–1030
    PubMedGoogle Scholar
  • 3 Bender S, Tang Y, Lindroth AM. et al. Reduced H3K27me3 and DNA hypomethylation are major drivers of gene expression in K27M mutant pediatric high-grade gliomas. Cancer cell 2013; 24: 660-672
    CrossrefPubMedGoogle Scholar
  • 4 Brastianos PK, Taylor-Weiner A, Manley PE. et al. Exome sequencing identifies BRAF mutations in papillary craniopharyngiomas. Nature genetics 2014; 46: 161-165
    CrossrefPubMedGoogle Scholar
  • 5 Broggi G, Franzini A, Migliavacca F. et al. Stereotactic biopsy of deep brain tumors in infancy and childhood. Child’s brain 1983; 10: 92-98
    PubMedGoogle Scholar
  • 6 Cartmill M, Punt J. Diffuse brain stem glioma. A review of stereotactic biopsies. Childs Nerv Syst 1999; 15: 235-237 discussion 238
    CrossrefPubMedGoogle Scholar
  • 7 Chico-Ponce de Leon F, Perezpena-Diazconti M, Castro-Sierra E. et al. Stereotactically-guided biopsies of brainstem tumors. Childs Nerv Syst 2003; 19: 305-310
    CrossrefPubMedGoogle Scholar
  • 8 Dellaretti M, Reyns N, Touzet G. et al. Stereotactic Biopsy for Brainstem Tumors: Comparison of Transcerebellar with Transfrontal Approach. Stereotact Funct Neurosurg 2012; 90: 79-83
    CrossrefPubMedGoogle Scholar
  • 9 Dellaretti MTG, Reyns N, Dubois F. et al. Correlation among magnetic resonance imaging findings, prognostic factors for survival, and histological diagnosis of intrinsic brainstem lesions in children. J Neurosurg Pediatr 2011; 8: 539-543
    CrossrefPubMedGoogle Scholar
  • 10 Frank FFA, Frankricci R, Spagnolli F. et al. Stereotactic brain biopsy in children. Childs Nerv Syst Meeting abstract 1988; 4: 191
    PubMedGoogle Scholar
  • 11 Furlanetti LL, Monaco BA, Cordeiro JG. et al. Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University’s experience from 99 consecutive cases. Clinical neurology and neurosurgery 2015; 130: 42-47
    CrossrefPubMedGoogle Scholar
  • 12 Godano U, Frank F, Fabrizi AP. et al. Stereotactic surgery in the management of deep intracranial lesions in infants and adolescents. Childs Nerv Syst 1987; 3: 85-88
    CrossrefPubMedGoogle Scholar
  • 13 Hennika T, Becher OJ. Diffuse Intrinsic Pontine Glioma: Time for Cautious Optimism. Journal of child neurology 2015; DOI: 10.1177/0883073815601495.
    CrossrefPubMedGoogle Scholar
  • 14 Iijima K, Hirato M, Miyagishima T. et al. Microrecording and image-guided stereotactic biopsy of deep-seated brain tumors. J Neurosurg 2015; 123: 978-988
    CrossrefPubMedGoogle Scholar
  • 15 Khuong-Quang DA, Buczkowicz P, Rakopoulos P. et al. K27M mutation in histone H3.3 defines clinically and biologically distinct subgroups of pediatric diffuse intrinsic pontine gliomas. Acta neuropathologica 2012; 124: 439-447
    CrossrefPubMedGoogle Scholar
  • 16 Kickingereder P, Willeit P, Simon T. et al. Diagnostic Value and Safety of stereotactic Biopsy for Brainstem Tumors: A Systematic Review and Meta-analysis of 1480 Cases. Neurosurgery 72: 873-882 2013;
    CrossrefPubMedGoogle Scholar
  • 17 Kratimenos GP. TD The role of image-directed biopsy in the diagnosis and management of brainstem lesions. Br J Neurosurg 1993; 7: 155-164
    CrossrefPubMedGoogle Scholar
  • 18 Louis DN, Perry A, Reifenberger G. et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131: 803-820
    CrossrefPubMedGoogle Scholar
  • 19 Manoj N. AA Bhat DI. et al. Stereotactic biopsy of brainstem lesions: techniques, efficacy, safety, and disease variation between adults and children: a single institutional series and review. J Neurosci Rural Pract 2014; 5: 32-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Meshkini A, Shahzadi S, Zali A. et al. Computed tomography-guided stereotactic biopsy of intracranial lesions in pediatric patients. Childs Nerv Syst 2011; 27: 2145-2148
    CrossrefPubMedGoogle Scholar
  • 21 Parreno MG, Bo X, Kanu OO. et al. Frameless stereotactic procedures in pediatric patients: safety and diagnostic efficacy. Childs Nerv Syst 2011; 27: 2137-2140
    CrossrefPubMedGoogle Scholar
  • 22 Patel P. BM Transcerebellar stereotactic biopsy for brainstem lesions in children. J Pediatr Neurosci 2009; 4: 17-19
    CrossrefPubMedGoogle Scholar
  • 23 Pattisapu JV, Walker ML, Heilbrun MP. Stereotactic surgery in children. Pediatric neuroscience 1989; 15: 62-65
    CrossrefPubMedGoogle Scholar
  • 24 Perez-Gomez JL. R-AC Marhx-Bracho A. et al. Stereotactic biopsy for brainstem tumors in pediatric patients. Childs Nerv Syst 2010; 26: 29-34
    CrossrefPubMedGoogle Scholar
  • 25 Phi JH, Chung HT, Wang KC. et al. Transcerebellar biopsy of diffuse pontine gliomas in children: a technical note. Childs Nerv Syst 2013; 29: 489-493
    CrossrefPubMedGoogle Scholar
  • 26 Pincus DW. RE Yachnis AT. et al. Brainstem stereotactic biopsy sampling in children. J Neurosurg 2006; 104: 108-114
    PubMedGoogle Scholar
  • 27 Pirotte BJ. LA Massager N. et al. Results of positron emission tomography guidance and reassessment of the utility of and indications for stereotactic biopsy in children with infiltrative brainstem tumors. J Neurosurg 2007; 107: 392-399
    CrossrefPubMedGoogle Scholar
  • 28 Preuss M, Werner P, Barthel H. et al. Integrated PET/MRI for planning navigated biopsies in pediatric brain tumors. Childs Nerv Syst 2014; 30: 1399-1403
    CrossrefPubMedGoogle Scholar
  • 29 Puget S, Beccaria K, Blauwblomme T. et al. Biopsy in a series of 130 pediatric diffuse intrinsic Pontine gliomas. Childs Nerv Syst 2015; 31: 1773-1780
    CrossrefPubMedGoogle Scholar
  • 30 Puget SBT, Grill J. Is Biopsy safe in children with newly diagnosed diffuse intrinsic pontine glioma?. Am Soc Clin Oncol Educ Book 2012; DOI: 629–633.
    CrossrefPubMedGoogle Scholar
  • 31 Quick-Weller J, Lescher S, Kashefiolasl S. et al. Benefit of Stereotactic Procedures in a Series of 43 Children. Journal of child neurology 2016; DOI: 10.1177/0883073815627883.
    CrossrefPubMedGoogle Scholar
  • 32 Rachinger W, Grau S, Holtmannspotter M. et al. Serial stereotactic biopsy of brainstem lesions in adults improves diagnostic accuracy compared with MRI only. Journal of neurology, neurosurgery, and psychiatry 2009; 80: 1134-1139
    CrossrefPubMedGoogle Scholar
  • 33 Rajshekhar V, Moorthy RK. Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients. Stereotact Funct Neurosurg 2010; 88: 360-366
    CrossrefPubMedGoogle Scholar
  • 34 Ruge MI, Suchorska B, Maarouf M. et al. Stereotactic 125iodine brachytherapy for the treatment of singular brain metastases: closing a gap?. Neurosurgery 2011; 68: 1209-1218
    CrossrefPubMedGoogle Scholar
  • 35 Ruge MI, Simon T, Suchorska B. et al. Stereotactic brachytherapy with 125Iodine seeds (SBT) for the treatment of inoperable low-grade gliomas in children: long-term outcome of 147 patients. J Clin Oncol 2011; 29: 4151-4159
    CrossrefPubMedGoogle Scholar
  • 36 Saratsis AM, Kambhampati M, Maarouf M. et al. Comparative multidimensional molecular analyses of pediatric diffuse intrinsic pontine glioma reveals distinct molecular subtypes. Acta neuropathologica 2014; 127: 881-895
    CrossrefPubMedGoogle Scholar
  • 37 Schumacher M. S-MJ Stoeter P. et al. Magnetic resonance imaging compared with biopsy in the diagnosis of brainstem diseases of childhood: a multicenter review. J Neurosurg 2007; 106: 111-119
    CrossrefPubMedGoogle Scholar
  • 38 St George EJ, Walsh AR, Sqouros S. Stereotactic biopsy of brain tumors in the pediatric population. Childs Nerv System 2004; 20: 163-167
    CrossrefPubMedGoogle Scholar
  • 39 Svolos P, Kousi E, Kapsalaki E. et al. The role of diffusion and perfusion weighted imaging in the differential diagnosis of cerebral tumors: a review and future perspectives. Cancer Imaging 2014; DOI: 10.1186/1470-7330-14-20.
    CrossrefPubMedGoogle Scholar
  • 40 Valdes-Gorcia J, Espinoza-Diaz DM, Paredes-Diaz E. Stereotactic biopsy of brain stem and posterior fossa lesions in children. Acta Neurochir (Wien) 1998; 140: 899-903
    CrossrefPubMedGoogle Scholar
  • 41 Wang ZJ, Rao L, Bhambhani K. et al. Diffuse intrinsic pontine glioma biopsy: a single institution experience. Pediatr Blood Cancer 2015; 62: 163-165
    CrossrefPubMedGoogle Scholar
  • 42 Worst B, van Tilburg CM, Balasubramanian GB. et al. Next-generation personalised medicine for high-risk paediatric cancer patients – The INFORM pilot study. European Journal of Cancer 2016; 65: 91-101
    CrossrefPubMedGoogle Scholar
  • 43 https://clinicaltrials.gov/ct2/home
    PubMed