L Gossett | PubMed Health

PubMed1998

Stereotactic biopsy of intracranial brain lesions. High diagnostic yield without increased complications: 65 consecutive biopsies with early postoperative CT scans.

Diagnostic yield and complication rate were analyzed for a series of 65 consecutive stereotactic biopsies of intra-axial brain lesions. The diagnostic yield was 98.5 +/- 1.5% and the complication rate was 1.5%. A median number of 14 biopsies (range 1-48) were taken per lesion. The biopsy sites followed a clockwise pattern, going from the superficial margin to the center and the deep margin of the lesion with respect to the inner table of the skull. A side window cannula biopsy needle was used. All patients underwent immediate postoperative CT scans within 4 h of biopsy to rule out intracranial complications. All patients were discharged within 24 h after biopsy, unless medical reasons unrelated to the biopsy required further hospitalization. We attribute the high diagnostic yield in our series to the high number of systematically taken biopsies per lesion. The higher number of biopsies did not lead to an increase in complications. From our experience, it appears safe to discharge patients the same day or within 24 h after a stereotactic biopsy if the postoperative CT shows no complication. Stereotactic biopsy could often safely be performed on an outpatient basis.

Adolescent↗

PubMed1996

LINAC-based spinal stereotactic radiosurgery.

The authors' report on the use of a prototype spinal stereotactic radiosurgery frame which was employed for the treatment of 9 patients who presented with recurrent neoplastic involvement of the spinal column. All patients had failed standard therapy consisting of surgery, external fractionated radiation therapy, and/or chemotherapy. Eight of the lesions represented metastatic tumors in the vertebral column, one of the lesions was a primary osteosarcoma involving multiple vertebral bodies. The lesions were found at multiple levels, from the cervical through the sacral region. Six out of the 9 patients presented with epidural compression: 4 of the 9 patients with evidence of myelopathy: 2 of the 9 patients with radicular symptoms secondary to compression from the tumor, and 1 patient was free of any compressive symptoms. All patients had pain requiring narcotics. Patients were treated with a median radiosurgical dose of 800 cGy (range 800-1.000) with a median of 1 isocenter (range 1-7 isocenters) and median normalization of 80% to the isodose contour (range 80-160). Median dose delivered to the already prior irradiated spinal cord was 179 cGy (range 52-320 cGy) with a median spinal cord dose of 34 (range 4-68). To date, there have been three minor complications: one radiation-induced esophagitis which was treated medically: one wound infection, and 1 patient requiring an additional 24 h of hospitalization stay. There have been no major complications. To date, 5 of the 9 patients have died, all from causes unrelated to the spinal radiosurgery. Three out of the 9 patients have been followed for more than 1 year. In all 3, there was radiographic regression of the tumor and epidural compression. In 2 patients, there was histologic confirmation of absence of tumor in the treated site: in 1 patient. no tumor was found at postmortem. 12 months after treatment, when the patient died of unrelated causes. Although the number of patients followed is limited, the phase I study clearly shows the technical feasibility of spinal radiosurgery for the control of metastatic involvement of the vertebral column even in the face of epidural compression.

Adult↗