Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Leksell Frame-Based Stereotactic Biopsy for Infratentorial Tumor : Practical Tips and Considerations

  • Tae-Kyu Lee (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Sa-Hoe Lim (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Jangshik Jeong (Department of Biomedical Engineering, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Su Jee Park (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Yeong Jin Kim (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Kyung-Sub Moon (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • In-Young Kim (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Shin Jung (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Tae-Young Jung (Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School)
  • Received : 2023.05.30
  • Accepted : 2023.08.08
  • Published : 2024.03.01
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Abstract

The Leksell frame-based transcerebellar approach was proposed with the arc support frame attached upside down to the Z coordinate. This study presented practical tips and considerations for obtaining adequate tissue samples for deep-seated cerebellar lesions or lower brainstem lesions specifically those accessible via the cerebellar peduncle. For practical insights, the Leksell coordinate frame G was fixed to prevent the anterior screw implantation within the temporalis muscle, to avoid interference with the magnetic resonance (MR)-adapter, and taking into account the magnetic field of MR in close proximity to the tentorium. After mounting of indicator box, the MR imaging evaluation should cover both the indicator box and the infratentorial region that deviated from it. The coordinates [X, Y, Za, Arc0, Ringa0] obtained from Leksell SurgiPlan® software (Elekta, Stockholm, Sweden) with arc 00 located on the patient's right side were converted to [X, Y, Zb=360-Za, Arc0, Ringb0=Ringa0-1800]. The operation was performed in the prone position under general anesthesia in four patients with deep cerebellar (n=3) and brainstem (n=1) tumors. The biopsy results showed two cases of diffuse large B-cell lymphoma, one metastatic braintumor and one glioblastoma. One patient required frame repositioning as a complication. Drawing upon the methodology outlined in existing literature, we anticipate that imparting supplementary expertise could render the stereotactic biopsy of infratentorial tumors more consistent and manageable for the practitioner, thereby facilitating adequate tissue samples and minimizing patient complications.

Keywords

Acknowledgement

We would like to express our gratitude to Dr. Kanghee Ahn, a fourth-year Neurosurgery Resident, for revising the figures. We wish for his successful attainment of specialist credentials, paving the way for him to flourish as an esteemed physician.

References

  1. Abernathey CD, Camacho A, Kelly PJ : Stereotaxic suboccipital transcerebellar biopsy of pontine mass lesions. J Neurosurg 70 : 195-200, 1989  https://doi.org/10.3171/jns.1989.70.2.0195
  2. Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V : Accuracy of varioguide frameless stereotactic system against frame-based stereotaxy: prospective, randomized, single-center study. World Neurosurg 104 : 831-840, 2017  https://doi.org/10.1016/j.wneu.2017.04.104
  3. Chen SY, Chen CH, Sun MH, Lee HT, Shen CC : Stereotactic biopsy for brainstem lesion: comparison of approaches and reports of 10 cases. J Chin Med Assoc 74 : 110-114, 2011  https://doi.org/10.1016/j.jcma.2011.01.024
  4. Coca HA, Cebula H, Benmekhbi M, Chenard MP, Entz-Werle N, Proust F : Diffuse intrinsic pontine gliomas in children: interest of robotic frameless assisted biopsy. A technical note. Neurochirurgie 62 : 327-331, 2016  https://doi.org/10.1016/j.neuchi.2016.07.005
  5. Coffey RJ, Lunsford LD : Stereotactic surgery for mass lesions of the midbrain and pons. Neurosurgery 17 : 12-18, 1985  https://doi.org/10.1227/00006123-198507000-00003
  6. Giese H, Hoffmann KT, Winkelmann A, Stockhammer F, Jallo GI, Thomale UW : Precision of navigated stereotactic probe implantation into the brainstem. J Neurosurg Pediatr 5 : 350-359, 2010  https://doi.org/10.3171/2009.10.PEDS09292
  7. Guthrie BL, Steinberg GK, Adler JR : Posterior fossa stereotaxic biopsy using the Brown-Roberts-Wells stereotaxic system. Technical note. J Neurosurg 70 : 649-652, 1989  https://doi.org/10.3171/jns.1989.70.4.0649
  8. Haegelen C, Touzet G, Reyns N, Maurage CA, Ayachi M, Blond S : Stereotactic robot-guided biopsies of brain stem lesions: experience with 15 cases. Neurochirurgie 56 : 363-367, 2010  https://doi.org/10.1016/j.neuchi.2010.05.006
  9. Horisawa S, Nakano H, Kawamata T, Taira T : Novel use of the leksell gamma frame for stereotactic biopsy of posterior fossa lesions. World Neurosurg 107 : 1-5, 2017  https://doi.org/10.1016/j.wneu.2017.07.087
  10. Jung IH, Chang KW, Park SH, Moon JH, Kim EH, Jung HH, et al. : Stereotactic biopsy for adult brainstem lesions: a surgical approach and its diagnostic value according to the 2016 World Health Organization Classification. Cancer Med 10 : 7514-7524, 2021  https://doi.org/10.1002/cam4.4272
  11. Lefranc M, Capel C, Pruvot-Occean AS, Fichten A, Desenclos C, Toussaint P, et al. : Frameless robotic stereotactic biopsies: a consecutive series of 100 cases. J Neurosurg 122 : 342-352, 2015  https://doi.org/10.3171/2014.9.JNS14107
  12. Lu L, Yang X, Raterman B, Jiang X, Meineke M, Grecula J, et al. : Assessment of MRI image distortion based on 6 consecutive years of annual QAs and measurements on 14 MRI scanners used for radiation therapy. J Appl Clin Med Phys 24 : e13843, 2023 
  13. Mathisen JR, Giunta F, Marini G, Backlund EO : Transcerebellar biopsy in the posterior fossa: 12 years experience. Surg Neurol 28 : 100-104, 1987  https://doi.org/10.1016/0090-3019(87)90080-2
  14. Neal JH, Van Norman AS : Transcerebellar biopsy of posterior fossa lesions using the Leksell gamma model stereotactic frame. Neurosurgery 32 : 473-474; discussion 474-475, 1993  https://doi.org/10.1097/00006123-199303000-00024
  15. Parker P, Levesque MF, Bittoun J, Doyon D, Tadie M : Stereotactic transcerebellar approach to pontine lesions through the middle cerebellar peduncle. Interv Neuroradiol 5 : 19-25, 1999  https://doi.org/10.1177/159101999900500103
  16. Phi JH, Chung HT, Wang KC, Ryu SK, Kim SK : Transcerebellar biopsy of diffuse pontine gliomas in children: a technical note. Childs Nerv Syst 29 : 489-493, 2013  https://doi.org/10.1007/s00381-012-1933-3
  17. Sanai N, Wachhorst SP, Gupta NM, McDermott MW : Transcerebellar stereotactic biopsy for lesions of the brainstem and peduncles under local anesthesia. Neurosurgery 63 : 460-466; discussion 466-468, 2008  https://doi.org/10.1227/01.NEU.0000324731.68843.74
  18. Smith JS, Quinones-Hinojosa A, Barbaro NM, McDermott MW : Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol 73 : 173-179, 2005 https://doi.org/10.1007/s11060-004-4208-3