关键词: Brainstem biopsy Diffuse intrinsic pontine gliomas Neuronavigation Stereotactic biopsy

Mesh : Humans Male Female Adolescent Child Brain Stem Neoplasms / pathology surgery diagnostic imaging Adult Prospective Studies Biopsy / methods adverse effects Young Adult Diffuse Intrinsic Pontine Glioma / pathology Child, Preschool Middle Aged Stereotaxic Techniques / adverse effects Pons / pathology

来  源:   DOI:10.1016/j.wneu.2024.05.003

Abstract:
BACKGROUND: Diffuse intrinsic pontine gliomas are aggressive tumors that carry a poor prognosis with a 2-year survival rate of <10%. The imaging appearance is often pathognomonic, and surgical biopsy is not mandatory to initiate treatment in children. Studies of biopsy samples provide insight into the disease\'s molecular pathobiology and open prospects for targeted therapy. This study was conducted to determine the diagnostic yield and safety of stereotactic biopsies.
METHODS: This is a prospective observational study from a single tertiary health care center. All patients with clinical and radiological features diagnostic of diffuse intrinsic pontine gliomas (DIPGs) who underwent biopsy from July 2018 to June 2023 were included. Biopsies were performed using either stereotactic frame-based, frameless, or endoscopic techniques.
RESULTS: A total of 165 patients with DIPGs were evaluated in the study period. The option of biopsy with its associated risks and benefits was offered to all patients. A total of 76 biopsies were performed in 74 patients (40 children and 34 adults, including 2 repeat biopsies). The median age was 15 years. Diffuse midline gliomas, H3K27M altered, was the most common histopathological diagnosis (85% pediatric and 55.9% adults). The diagnostic efficacy of the procedure was 94.7%. The complication rate was 10.8%, with no permanent neurological deficits due to surgery. There was no procedure-related mortality.
CONCLUSIONS: Establishing the safety of the procedure could be an important step toward popularizing the concept, which might offer a better understanding of the disease. Brainstem eloquence and a lack of direct benefit to patients are the primary obstacles to brainstem biopsy.
摘要:
背景:弥漫性内在脑桥胶质瘤是侵袭性肿瘤,预后差,2年生存率<10%。成像外观通常是病理性的,和手术活检不是强制性的开始治疗儿童。活检样本的研究提供了对疾病分子病理学的了解,并为靶向治疗开辟了前景。进行这项研究是为了确定立体定向活检的诊断产量和安全性。
方法:这是一项来自单一三级卫生保健中心的前瞻性观察性研究。纳入2018年7月至2023年6月接受活检的所有临床和放射学特征诊断为弥漫性内在脑桥胶质瘤(DIPG)的患者。活检使用基于立体定向的框架进行,无框,或内窥镜技术。
结果:在研究期间共评估了165例DIPG患者。所有患者均可选择活检及其相关风险和益处。共进行了76例活检,共74例患者(40名儿童和34名成人,包括2次重复活检)。中位年龄为15岁。弥漫性中线胶质瘤,H3K27M改装,是最常见的组织病理学诊断(85%儿科和55.9%成人)。该程序的诊断效能为94.7%。并发症发生率为10.8%,没有手术引起的永久性神经功能缺损.没有与手术相关的死亡率。
结论:建立该程序的安全性可能是推广该概念的重要一步,这可能会更好地了解这种疾病。脑干口才和对患者缺乏直接益处是脑干活检的主要障碍。
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