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Open Access 01-01-2014 | Original Article

The safety and effectiveness of low field intraoperative MRI guidance in frameless stereotactic biopsies of brain tumours—design and interim analysis of a prospective randomized trial

Authors: M. Czyż, P. Tabakow, A. Weiser, B. E. Lechowicz-Głogowska, L. W. Zub, W. Jarmundowicz

Published in: Neurosurgical Review | Issue 1/2014

Abstract

The aim of the study was to assess the safety and effectiveness of stereotactic brain tumour biopsy (STx biopsy) guided by low-field intraoperative magnetic resonance imaging (iMRI) in comparison with its frameless classic analogue based on a prospective randomized trial. A pilot group of 42 brain tumour patients was prospectively randomized into a low-field iMRI group and a control group that underwent a frameless STx biopsy. The primary endpoints of the analysis were postoperative complication rate and diagnostic yield, and the secondary endpoints were length of hospital stay and duration of operation. The iMRI group (21 patients) and the control group (21 patients) did not differ significantly according to demographic and epidemiological data. No major postoperative complications were noted in either group. In addition, no significant differences in the diagnostic yield (p = 1.00) and length of hospital stay (p = 0.16) were observed. The mean total OR time was 111 ± 24 min in iMRI and 78 ± 29 min in the control group (p = 0.0001). Usage of iMRI may prolong the time of the procedure but seems to be comparable in safety and effectiveness to the standard frameless STx biopsy.

Arle JE (2011) Evidence-based medicine: fact or fiction? World Neurosurg 76:45–47PubMedCrossRef

Atlas SW, Thulborn KR (1998) MR detection of hyperacute parenchymal hemorrhage of the brain. AJNR Am J Neuroradiol 19:1471–1477PubMed

Baumann F, Schmid C, Bernays RL (2010) Intraoperative magnetic resonance imaging-guided transsphenoidal surgery for giant pituitary adenomas. Neurosurg Rev 33:83–90PubMedCrossRef

Bernays RL, Kollias SS, Khan N, Brandner S, Meier S, Yonekawa Y (2002) Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging. J Neurosurg 97:354–362PubMedCrossRef

Bradley WG Jr (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26PubMed

Charles P, Giraudeau B, Dechartres A, Baron G, Ravaud P (2009) Reporting of sample size calculation in randomised controlled trials: review. BMJ 338:b1732PubMedCentralPubMedCrossRef

Czyz M, Tabakow P, Jarmundowicz W, Lechowicz-Glogowska B (2012) Intraoperative magnetic resonance—guided frameless stereotactic biopsies—initial clinical experience. Neurol Neurochir Pol 46:157–160PubMed

Frati A, Pichierri A, Bastianello S, Raco A, Santoro A, Esposito V, Giangaspero F, Salvati M (2011) Frameless stereotactic cerebral biopsy: our experience in 296 cases. Stereotact Funct Neurosurg 89:234–245PubMedCrossRef

Gerlach R, du Mesnil de Rochemont R, Gasser T, Marquardt G, Reusch J, Imoehl L, Seifert V (2008) Feasibility of PoleStar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 63:272–284, discussion 284–275PubMedCrossRef

10.

Han B, Enas NH, McEntegart D (2009) Randomization by minimization for unbalanced treatment allocation. Stat Med 28:3329–3346PubMedCrossRef

11.

Hayman LA, McArdle CB, Taber KH, Saleem A, Baskin D, Lee HS, Kirkpatrick JB, Herrick RC, Bryan RN (1989) MR imaging of hyperacute intracranial hemorrhage in the cat. AJNR Am J Neuroradiol 10:681–686PubMed

12.

Isaacs D, Fitzgerald D (1999) Seven alternatives to evidence-based medicine. BMJ 319:1618PubMedCrossRef

13.

Jain D, Sharma MC, Sarkar C, Gupta D, Singh M, Mahapatra AK (2006) Comparative analysis of diagnostic accuracy of different brain biopsy procedures. Neurol India 54:394–398PubMedCrossRef

14.

Kuker W, Thiex R, Rohde I, Rohde V, Thron A (2000) Experimental acute intracerebral hemorrhage. Value of MR sequences for a safe diagnosis at 1.5 and 0.5 T. Acta Radiol 41:544–552PubMedCrossRef

15.

Kundt G (2009) Comparative evaluation of balancing properties of stratified randomization procedures. Methods Inf Med 48:129–134PubMed

16.

Langen HJ, Kugel H, Ortmann M, Noack M, de Rochemont RM, Landwehr P (2001) Functional capacity of MRI-compatible biopsy needles in comparison with ferromagnetic biopsy needles. In vitro studies. Rofo 173:658–662PubMedCrossRef

17.

McGirt MJ, Woodworth GF, Coon AL, Frazier JM, Amundson E, Garonzik I, Olivi A, Weingart JD (2005) Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 102:897–901PubMedCrossRef

18.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655PubMedCrossRef

19.

Quinn J, Spiro D, Schulder M (2011) Stereotactic brain biopsy with a low-field intraoperative magnetic resonance imager. Neurosurgery 68:217–224, discussion 224PubMedCrossRef

20.

Sawin PD, Hitchon PW, Follett KA, Torner JC (1998) Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases. Surg Neurol 49:640–649PubMedCrossRef

21.

Scholler K, Licht S, Tonn JC, Uhl E (2009) Randomized controlled trials in neurosurgery—how good are we? Acta Neurochir (Wien) 151:519–527, discussion 527CrossRef

22.

Schulder M, Carmel PW (2003) Intraoperative magnetic resonance imaging: impact on brain tumor surgery. Cancer Control 10:115–124PubMed

23.

Schulder M, Spiro D (2011) Intraoperative MRI for stereotactic biopsy. Acta Neurochir Suppl 109:81–87PubMedCrossRef

24.

Seifert V, Gasser T, Senft C (2011) Low-field intraoperative MRI in glioma surgery. Acta Neurochir Suppl 109:35–41PubMedCrossRef

25.

Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V (2011) Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12:997–1003PubMedCrossRef

26.

Senft C, Franz K, Ulrich CT, Bink A, Szelenyi A, Gasser T, Seifert V (2010) Low-field intraoperative MRI-guided surgery of gliomas: a single center experience. Clin Neurol Neurosurg 112:237–243PubMedCrossRef

27.

Senft C, Seifert V, Hermann E, Gasser T (2009) Surgical treatment of cerebral abscess with the use of a mobile ultralow-field MRI. Neurosurg Rev 32:77–84, discussion 84–75PubMedCrossRef

28.

Shooman D, Belli A, Grundy PL (2010) Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. J Neurosurg 113:170–178PubMedCrossRef

29.

Stummer W, Nestler U, Stockhammer F, Krex D, Kern BC, Mehdorn HM, Vince GH, Pichlmeier U (2011) Favorable outcome in the elderly cohort treated by concomitant temozolomide radiochemotherapy in a multicentric phase II safety study of 5-ALA. J Neurooncol 103:361–370PubMedCrossRef

30.

Teixeira MJ, Fonoff ET, Mandel M, Alves HL, Rosemberg S (2009) Stereotactic biopsies of brain lesions. Arq Neuropsiquiatr 67:74–77PubMedCrossRef

31.

Weaver CS, Leonardi-Bee J, Bath-Hextall FJ, Bath PM (2004) Sample size calculations in acute stroke trials: a systematic review of their reporting, characteristics, and relationship with outcome. Stroke 35:1216–1224PubMedCrossRef

32.

Wittes J (2002) Sample size calculations for randomized controlled trials. Epidemiol Rev 24:39–53PubMedCrossRef

33.

Yarascavitch BA, Chuback JE, Almenawer SA, Reddy K, Bhandari M (2012) Levels of evidence in the neurosurgical literature: more tribulations than trials. Neurosurgery Rev 6:1131–1137, discussion 1137–1138CrossRef

34.

Zhong B (2009) How to calculate sample size in randomized controlled trial? J Thorac Dis 1:51–54PubMedCentralPubMed

35.

Zyed A, Hayman LA, Bryan RN (1991) MR imaging of intracerebral blood: diversity in the temporal pattern at 0.5 and 1.0 T. AJNR Am J Neuroradiol 12:469–474PubMed

Title: The safety and effectiveness of low field intraoperative MRI guidance in frameless stereotactic biopsies of brain tumours—design and interim analysis of a prospective randomized trial
Authors: M. Czyż
P. Tabakow
A. Weiser
B. E. Lechowicz-Głogowska
L. W. Zub
W. Jarmundowicz
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Neurosurgical Review / Issue 1/2014
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-013-0486-6

Keynote webinar | Spotlight on sleep in brain health

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The safety and effectiveness of low field intraoperative MRI guidance in frameless stereotactic biopsies of brain tumours—design and interim analysis of a prospective randomized trial

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

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