Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms

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✓ Forty patients with previously untreated intracranial glial neoplasms underwent stereotaxic serial biopsies assisted by computerized tomography (CT) and magnetic resonance imaging (MRI). Tumor volumes defined by computer reconstruction of contrast enhancement and low-attenuation boundaries on CT and T1 and T2 prolongation on MRI revealed that tumor volumes defined by T2-weighted MRI scans were larger than those defined by low-attenuation or contrast enhancement on CT scans. Histological analysis of 195 biopsy specimens obtained from various locations within the volumes defined by CT and MRI revealed that: 1) contrast enhancement most often corresponded to tumor tissue without intervening parenchyma; 2) hypodensity corresponded to parenchyma infiltrated by isolated tumor cells or in some instances to tumor tissue in low-grade gliomas or to simple edema; and 3) isolated tumor cell infiltration extended at least as far as T2 prolongation on magnetic resonance images. This information may be useful in planning surgical procedures and radiation therapy in patients with intracranial glial neoplasms.

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Address reprint requests to: Patrick J. Kelly, M.D., Department of Neurosurgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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Figures

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    Upper: Display of biopsy trajectory on a venous digital angiogram. Note the 18 reference marks created by the angiographic reference system. Lower: The position of each intended 1-cm biopsy along the selected trajectory is indicated between each horizontal mark on the stereotaxic computerized tomography slice (left) and on the T1-weighted (center) and T2-weighted (right) magnetic resonance images.

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    Examples of reconstructed volumes defined by computerized tomography (CT) and magnetic resonance imaging (MRI) in a 63-year-old woman with a grade III astrocytoma in the right hemisphere. The data are shown in a slice perpendicular to the viewline corresponding to anteroposterior and lateral projections and displayed on the millimeter reference grid. The tumor contours defined by CT, T1-, and T2-weighted MRI, scaled by computer, are superimposed on a tracing of the stereotaxic teleradiograph. The position of each biopsy is indicated by numbers and the corresponding histological results are shown in the lower right corner. ITC = infiltrating tumor cells; C.E. = contrast-enhanced.

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    Biopsy locations in a patient with a left thalamic grade IV astrocytoma indicated by computer on the stereotaxic computerized tomography slice (left) and on the T1-weighted (center) and T2-weighted (right) magnetic resonance images.

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    Photomicrographs of tumor tissue from a gemistocytic astrocytoma. Left: The tumor cells are in contact, and neurovascularity is evident. H & E, × 400. Right: There is a virtual absence of intact parenchyma, which contains only rare residual axons. Bodian, × 400.

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    Photomicrographs of a specimen from the periphery of a gemistocytic astrocytoma. Isolated tumor cells (arrows) are seen in the intact white matter. Left: No neovascularity is seen. H & E, × 400. Right: The parenchyma and axons are intact. Bodian, × 400.

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