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Graeme F. Woodworth, Matthew J. McGirt, Amer Samdani, Ira Garonzik, Alessandro Olivi, and Jon D. Weingart

morbidity associated with stereotactic biopsy procedures, 2 , 9 , 11 continued evaluation of this new technique is critical. 1 , 7 Furthermore, analysis of preoperative predictors of the diagnostic yield or direct comparison of the differences in the diagnostic yield and morbidity rate between the frameless and frame-based methods has not been performed. In the present study we reviewed our 8-year experience with stereotactic biopsy procedures, including a detailed analysis of the frameless technique, an analysis of preoperative radiographic/neuroimaging predictors of

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Hillier L. Baker Jr.

P osterior fossa myelography was designed to demonstrate lesions of the craniospinal junction and in the cerebellopontine angle cisterns. The first descriptions of the technique in 1958–1960 involved two separate examinations. 12–15 We combined both examinations in a modified form and reported our early experience in 1963. 1 Today, posterior fossa myelography is used principally for evaluating the cerebellopontine angles when the presence of an acoustic neurilemoma is suspected. 2–9, 17–27 This report summarizes our experience with posterior fossa

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Christoph Ostertag, Fritz Mundinger, Dennis McDonnell, and Thorwald Hoefer

autofluoroscope of Bender * added only supplementary information regarding classification of the tumor. 24 These diagnostic techniques have limited value and should not be the sole or routine methods used; generally they do not take the place of angiography. 7 Acknowledgment All histological results were reviewed and confirmed by Prof. H. Noetzel from the Department of Neuropathology of the Institute of Pathology of the University of Freiburg. We are grateful to him for allowing the use of these results. References 1. Baum S : The site

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Simon Goldstein, Mary Katherine Gumerlock, and Edward A. Neuwelt

returned a diagnosis of low-grade astrocytoma. One patient had a medium-grade glioma diagnosed by free-hand biopsy and underwent irradiation; 4 years later she had another biopsy by the free-hand method and was found to have a high-grade glioma. A patient with cyst fluid characteristic of craniopharyngioma underwent cyst aspiration by the free-hand technique, and 20 months later tissue biopsy and cyst aspiration were performed stereotaxically with subcutaneous catheter insertion. TABLE 1 Diagnostic results in free-hand and stereotaxic needle biopsies in this

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Pierre Laumonerie, Stepan Capek, Kimberly K. Amrami, P. James B. Dyck, and Robert J. Spinner

we can improve the diagnostic yield of nerve biopsy in proximal or asymmetrical neuropathy by performing a targeted proximal biopsy. Targeting the most pathologically involved segment of the nerve based on meticulous preoperative planning may be considered to guide the choice of site of the biopsy and maximize its diagnostic accuracy. 5 To a large extent this technique has been facilitated by a wide utilization of new high-resolution imaging techniques. 3 , 5 , 11 Such guidance allows us to improve selectivity of a nerve biopsy site. 4 , 5 , 9 , 19 Our group

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Marc Levivier, Serge Goldman, Benoît Pirotte, Jean-Marie Brucher, Danielle Balériaux, André Luxen, Jerzy Hildebrand, and Jacques Brotchi

degree of malignancy, as well as information related to prognosis. 10 Thus, when present, FDG-PET—defined hypermetabolic foci in brain tumors may best represent the lesion and should help in determining the biopsy sites most likely to provide an accurate diagnosis. Accordingly, in an attempt to improve the diagnostic yield of stereotactic brain biopsy, we have developed a technique allowing routine integration of FDG-PET data in the planning of intracranial stereotactic procedures. 24 With this technique, the selection of targets on stereotactic FDG

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Thomas J. Leipzig and Sean F. Mullan

denervation. Although these procedures are normally devoid of morbidity or mortality, the risk for either is present in a patient with a significant medical problem such as cardiac disease. Prior to surgery, reversible blocks are used to determine the effectiveness of sympathetic denervation. Local ganglionic blockade is more comfortable than the regional intravenous administration of guanethidine. Since there is no correlation between the effectiveness of these two techniques, we prefer reversible stellate ganglion blockade as a diagnostic screen for upper extremity

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Nader Sanai, Susan Chang, and Mitchel S. Berger

, 140 with frequencies as high as 90% when using strict diagnostic criteria ( Fig. 2 ). Unbalanced 1p/19q translocations have been reported and may also have prognostic value. 62 Status with respect to 1p and 19q has been assessed using a variety of molecular techniques, including loss of heterozygosity, comparative genomic hybridization, quantitative microsatellite analysis, and fluorescence in situ hybridization. 34 , 47 Initial results suggested that 1p/19q status is a predictive (in addition to prognostic) marker of response to PCV chemotherapy. 145 Subsequent

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Nader Sanai, Susan Chang, and Mitchel S. Berger

FDG, l-methyl- 11 C-methionine, FET, 18 F-choline and 11 C-choline PET, or 201 thallium SPECT was used. These techniques, which range in diagnostic yield from 80% to 100%, have drawbacks, including radiation exposure, excessive time requirements, poor anatomical resolution, technological complexity, and financial expense, which limit their general use. Alternatively, 1 H-MR spectroscopy is a noninvasive and sensitive study that can be performed at the time of routine MR imaging. For LGGs, the diagnostic yield of 1 H-MR spectroscopy–supported stereotactic tissue

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Katrina S. Firlik, A. Julio Martinez, and L. Dade Lunsford

were 20 false-negative findings in which the intraoperative slides consisted of normal cells or were otherwise nondiagnostic, whereas the permanent sections revealed a pathological diagnosis ( Table 4 ). TABLE 4 Data from which sensitivity, specificity, and positive and negative predictive values were derived * Final Histological Finding Cytological Finding Diagnostic Nondiagnostic † abnormal 523 13 normal or insufficient 20 39 total 543 52 * The cytological technique proved to have a sensitivity of 96%, a specificity of 75%, a positive predictive value of 98%, and a