Dataset Information

Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations.

ABSTRACT:

Background

Open and stereotactic transfrontal or transcerebellar approaches have been used to biopsy brainstem lesions.

Method

In this report, a stereotactic posterior and midline approach to the distal medulla oblongata under microscopic view is described. The potential advantages and limitations are discussed, especially bilateral damage of the X nerve nuclei.

Conclusion

This approach should be considered for biopsy of distal and posterior lesions. We strongly recommend the use of direct microscopic view to identify the medullary vessels, confirm the midline entry point, and avoid potential shift of the medulla. Further experience is needed to confirm safety and success rate of this approach.

SUBMITTER: Schlaeppi JA

PROVIDER: S-EPMC8195946 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations.

Schlaeppi Janine-Ai JA Andereggen Lukas L Nowacki Andreas A Pollo Claudio C

Acta neurochirurgica 20201013 7

<h4>Background</h4>Open and stereotactic transfrontal or transcerebellar approaches have been used to biopsy brainstem lesions.<h4>Method</h4>In this report, a stereotactic posterior and midline approach to the distal medulla oblongata under microscopic view is described. The potential advantages and limitations are discussed, especially bilateral damage of the X nerve nuclei.<h4>Conclusion</h4>This approach should be considered for biopsy of distal and posterior lesions. We strongly recommend t ...[more]

PMID: 33047205

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Project description:Background and purposeWhile brain MR imaging is routinely performed, the MR imaging assessment of spinal cord pathology in multiple sclerosis (MS) is less frequent in clinical practice. The purpose of this study was to determine whether measurements of medulla oblongata volume (MOV) on routine brain MR imaging could serve as a biomarker of spinal cord damage and disability in MS.Materials and methodsWe identified 45 patients with MS with both head and cervical spinal cord MR imaging and 29 age-matched and sex-matched healthy control subjects with head MR imaging. Disability was assessed by the expanded disability status scale (EDSS) and ambulation index (AI). MOV and upper cervical cord volume (UCCV) were manually segmented; semiautomated segmentation was used for brain parenchymal fraction (BPF). These measures were compared between groups, and linear regression models were built to predict disability.ResultsIn the patients, MOV correlated significantly with UCCV (r = 0.67), BPF (r = 0.45), disease duration (r = -0.64), age (r = -0.47), EDSS score (r = -0.49) and AI (r = -0.52). Volume loss of the medulla oblongata was -0.008 cm(3)/year of age in patients with MS, but no significant linear relationship with age was found for healthy control subjects. The patients had a smaller MOV (mean +/- SD, 1.02 +/- 0.17 cm(3)) than healthy control subjects (1.15 +/- 0.15 cm(3)), though BPF was unable to distinguish between these 2 groups. MOV was smaller in patients with progressive MS (secondary- progressive MS, 0.88 +/- 0.19 cm(3) and primary-progressive MS, 0.95 +/- 0.30 cm(3)) than in patients with relapsing-remitting MS (1.08 +/- 0.15 cm(3)). A model including both MOV and BPF better predicted AI than BPF alone (P = .04). Good reproducibility in MOV measurements was demonstrated for intrarater (intraclass correlation coefficient, 0.97), interrater (0.79), and scan rescan data (0.81).ConclusionMOV is associated with disability in MS and can serve as a biomarker of spinal cord damage.

Dataset Information

Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations.

Background

Method

Conclusion

Publications

Stereotactic posterior midline approach under direct microscopic view for biopsy of medulla oblongata tumors: technical considerations.

Similar Datasets

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