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Information × Registration Number 0216U006818, 0112U005765 , R & D reports Title Improvment of diagnosis and treatment of brain tumors with the use of minimalinvasive techniques popup.stage_title Head Dzyak Ludmila Antonovna, Registration Date 15-06-2016 Organization State organization "Dnepropetrovsk medikal akademy of Ministry Health Ukraine" popup.description2 The paper is devoted to improving the results of diagnosis and treatment of supratentorial brain neoplasms by developing novel and improving existing stereotactic techniques. The study is based on the results of clinical and instrumental examination and treatment of 139 patients aged from 19 to 74 years (mean age 46,2 ± 1,0 years) with focal supratentorial brain neoplasms. In 64,0% of patients neurological symptoms developed no earlier than 3 months prior to admission. Preoperative planning was performed basing on the modern neuroimaging techniques (spiral computed tomography, magnetic resonance imaging, cerebral angiography) with contrast. Frame-based stereotactic biopsy was used in 32 cases, frameless - in 107 patients. A comparative analysis of both frame-based and frameless STB was conducted with refining the indications for their use. It is shown that the STB is an effective and safe method of diagnosis in patients with focal brain lesions. Informativeness of frame-based biopsy is 96,9 ± 3,1%, frameless - 94,4 ± 2,2% (p = 0,918), in the absence of postoperative mortality. Frame-based biopsy is superior to frameless when used for small lesions (up to 2 cm in diameter) located in close proximity to intracranial vessels. Frameless STB is preferred due to the visibility of all phases of the operation on the monitor of the navigation station, elimination of the need to perform the CT with the frame in place, less operative time, ease of changing the trajectory and biopsy using multiple entry points. No significant difference in the incidence of perioperative complications was noted when using different STB methods. Concurrent CT and cerebral angiography by the author's method aided in better assessment of cortical vasculature at the biopsy instrument entry point, thereby decreasing the percentage of intraoperative hemorrhagic complications. Neurologic deterioration occurred in 7 out of 90 cases when the frameless technique was used, and in 1 out of 32 cases of the frame-based STB (p=0,619). We have analyzed the relationship between the data provided by preoperative neuroimaging and the precise location for STB. It was established that the zone of maximal accumulation of contrast material corresponds to the clusters of tumor cells, which get detected in 95-100% STB's. Serial layer-by-layer biopsies from multiple target-points allow to determine the extent of tumor's infiltration of the surrounding brain. We noted that the increase of tumor's grade positively correlated with the extent of neoplastic infiltration. It was established that the STB tissue diagnosis coincides with the surgical specimen diagnosis in 90,2 +-3%. Diagnostic discrepancies were related to insufficient specimen size in tumors with low cellular density, inadequate biopsy target location, the presence of several cell lines with various degrees of anaplasia. Biopsy from multiple targets and complementation of routine histology with immunohistochemical techniques increase the accuracy of tissue diagnosis. We have improved the techniques of STB and treatment of brain neoplasms with cystic component, which implies biopsying solid component first with subsequent cyst draining. The proposed sequence of surgical intervention allows to obtain tissue diagnosis and to improve patient's neurological condition by reducing tumor volume. We advocate the placement of OmSDSSmaya tank in order to prevent cystic fluid re-accumulation and in order to perform the intrathecal chemotherapy. Product Description popup.authors Зорін Микола Олександрович Шульга Олександр Миколайович popup.nrat_date 2020-04-02 Close