Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem

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Abstract

Background

Anatomical differences between humans and domestic mammals preclude the use of reported stereotactic approaches to the brainstem in animals. In animals, brainstem biopsies are required both for histopathological diagnosis of neurological disorders and for research purposes. Sheep are used as a translational model for various types of brain disease and therefore a species-specific approach needs to be developed. The aim of the present study was to establish a minimally invasive, accurate and reproducible stereotactic approach to the brainstem of sheep, using the magnetic resonance imaging guided Brainsight ^TM frameless stereotactic system.

Results

A transoccipital transcerebellar approach with an entry point in the occipital bone above the vermis between the transverse sinus and the external occipital protuberance was chosen. This approach provided access to the target site in all heads. The overall mean needle placement error was 1.85 ± 1.22 mm.

Conclusions

The developed transoccipital transcerebellar route is short, provides accurate access to the ovine caudal cranial fossa and is a promising approach to be further assessed in live animals.

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Most cited references 56

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Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases.

Alessandro Olivi, Matthew McGirt, Jon D. Weingart … (2005)

Image-guided stereotactic brain biopsy is associated with transient and permanent incidences of morbidity in 9 and 4.5% of patients, respectively. The goal of this study was to perform a critical analysis of risk factors predictive of an enhanced operative risk in frame-based and frameless stereotactic brain biopsy. The authors reviewed the clinical and neuroimaging records of 270 patients who underwent consecutive frame-based and frameless image-guided stereotactic brain biopsies. The association between preoperative variables and biopsy-related morbidity was assessed by performing a multivariate logistic regression analysis. Transient and permanent stereotactic biopsy-related morbidity was observed in 23 (9%) and 13 (5%) patients, respectively. A hematoma occurred at the biopsy site in 25 patients (9%); 10 patients (4%) were symptomatic. Diabetes mellitus (odds ratio [OR] 3.73, 95% confidence interval [CI] 1.37-10.17, p = 0.01), thalamic lesions (OR 4.06, 95% CI 1.63-10.11, p = 0.002), and basal ganglia lesions (OR 3.29, 95% CI 1.05-10.25, p = 0.04) were in'dependent risk factors for morbidity. In diabetic patients, a serum level of glucose that was greater than 200 mg/dl on the day of biopsy had a 100% positive predictive value and a glucose level lower than 200 mg/dl on the same day had a 95% negative predictive value for biopsy-related morbidity. Pontine biopsy was not a risk factor for morbidity. Only two (4%) of 45 patients who had epilepsy before the biopsy experienced seizures postoperatively. The creation of more than one needle trajectory increased the incidence of neurological deficits from 17 to 44% when associated with the treatment of deep lesions (those in the basal ganglia or thalamus; p = 0.05), but was not associated with morbidity when associated with the treatment of cortex lesions. Basal ganglia lesions, thalamic lesions, and patients with diabetes were independent risk factors for biopsy-associated morbidity. Hyperglycemia on the day of biopsy predicted morbidity in the diabetic population. Epilepsy did not predispose to biopsy-associated seizure. For deep-seated lesions, increasing the number of biopsy samples along an established track rather than performing a second trajectory may minimize the incidence of morbidity. Close perioperative observation of glucose levels may be warranted.

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Rhombencephalitis Caused by Listeria monocytogenes in Humans and Ruminants: A Zoonosis on the Rise?

Anna Oevermann, Andreas Zurbriggen, Marc Vandevelde (2010)

Listeriosis is an emerging zoonotic infection of humans and ruminants worldwide caused by Listeria monocytogenes (LM). In both host species, CNS disease accounts for the high mortality associated with listeriosis and includes rhombencephalitis, whose neuropathology is strikingly similar in humans and ruminants. This review discusses the current knowledge about listeric encephalitis, and involved host and bacterial factors. There is an urgent need to study the molecular mechanisms of neuropathogenesis, which are poorly understood. Such studies will provide a basis for the development of new therapeutic strategies that aim to prevent LM from invading the brain and spread within the CNS.

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Stereotactic biopsy of diffuse pontine lesions in children.

Thomas Roujeau, Guilherme Machado, Matthew R. Garnett … (2007)

Empirical radiotherapy is the current treatment for children with diffuse pontine lesions that have imaging characteristics of an infiltrative malignant astrocytoma. The use of chemotherapeutic agents is, however, currently under investigation in the treatment of these tumors. To be included into a trial, patients need a definitive histological diagnosis. The authors present their prospective study of the stereotactic biopsy of these lesions during a 4-year period. A suboccipital, transcerebellar approach was used to obtain biopsy samples in 24 children. Two patients suffered deficits. Both had a transient (< 2 months) new cranial nerve palsy; one of these patients also experienced an exacerbation of a preoperative hemiparesis. No patient died during the perioperative period. A histological diagnosis was made in all 24 patients as follows: 22 had a malignant infiltrative astrocytoma, one had a low-grade astrocytoma, and one had a pilocytic astrocytoma. The diagnosis of the latter two patients affected the initial treatment after the biopsy. The findings of this study imply that stereotactic biopsy sampling of a diffuse pontine tumor is a safe procedure, is associated with minimal morbidity, and has a high diagnostic yield. A nonmalignant tumor was identified in two of the 24 patients in whom the imaging findings were characteristic of a malignant infiltrative astrocytoma. With the advent of new treatment protocols, stereotactic biopsy sampling, which would allow specific tumor characterization of diffuse pontine lesions, may become standard.

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Author and article information

Contributors

Anne Staudacher: anne.staudacher@vetsuisse.unibe.ch

Anna Oevermann: anna.oevermann@vetsuisse.unibe.ch

Michael H Stoffel: michael.stoffel@vetsuisse.unibe.ch

Daniela Gorgas: daniela.gorgas@vetsuisse.unibe.ch

Journal

Journal ID (nlm-ta): BMC Vet Res

Journal ID (iso-abbrev): BMC Vet. Res

Title: BMC Veterinary Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1746-6148

Publication date (Electronic): 22 September 2014

Publication date PMC-release: 22 September 2014

Publication date Collection: 2014

Volume: 10

Issue: 1

Electronic Location Identifier: 216

Affiliations

[ ]Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Berne, Längassstrasse 128, CH 3012 Berne, Switzerland

[ ]Divison of Neurological Sciences, Department of Clinical Research and Veterinary Public Health, Vetsuisse-Faculty, University of Berne, 3012 Berne, Switzerland

[ ]Institute of Veterinary Anatomy, Vetsuisse-Faculty, University of Berne, 3012 Berne, Switzerland

Article

Publisher ID: 216

DOI: 10.1186/s12917-014-0216-5

PMC ID: 4177427

PubMed ID: 25241810

SO-VID: dbfe8cc8-c837-4965-9a6d-d523fda2300a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 February 2014

Date accepted : 10 September 2014

Custom metadata

ScienceOpen disciplines: Veterinary medicine

Keywords: sheep,brainstem,stereotaxy,transcerebellar route,large animal model

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ScienceOpen disciplines: Veterinary medicine

Keywords: sheep, brainstem, stereotaxy, transcerebellar route, large animal model

Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem

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Abstract

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Horses and Humans Research Foundation

Most cited references 56

Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases.

Rhombencephalitis Caused by Listeria monocytogenes in Humans and Ruminants: A Zoonosis on the Rise?

Stereotactic biopsy of diffuse pontine lesions in children.

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