Intraoperative MRI-guidance in Frameless Stereotactic Biopsies
Background: The aim of the study was to assess the safety and effectiveness of stereotactic brain tumour biopsy (STx biopsy) guided by low-field intraoperative MRI (iMRI) in comparison with its frameless classic analogue based on a prospective randomized trial.
Patients are prospectively randomized into a low-field iMRI group and a control group that undergo a frameless STx biopsy. The primary endpoints of the analysis are: postoperative complication rate and diagnostic yield, and the secondary endpoints: length of hospital stay and duration of operation.
|Primary Brain Tumour||Device: iMRI-guided brain tumour biopsy Device: Stereotactic frameless brain tumour biopsy|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||The Safety and Effectiveness of Low Field Intraoperative MRI-guidance in Frameless Stereotactic Biopsies of Brain Tumours - a Prospective Randomized Trial|
- Number of Participants Presenting With Complications [ Time Frame: Patients were followed for the duration of hospital stay (average 2 days) and again 2 weeks after the operation. ]The presence of acute postoperative complication is noted if any of following findings is present: wound site infection up to two weeks after the operation, a new neurological deficit developed up to 24 hours following the operation and present in a follow up clinical examination 2 weeks postoperatively, intraparenchymal hematoma with radiological or clinical signs of the intracranial expansion.
- Diagnostic Yield [ Time Frame: For each patient 2 weeks after the operation ]The diagnostic yield is expressed as the number of patients in whom the histopathological diagnosis was made based of the biological material obtained during the operation.
- Length of Hospital Stay [ Time Frame: From date of hospitalization until the date of discharge, assessed up to 2 days. ]The preoperative (LOSpre), postoperative (LOSpost) and total length of hospital stay (LOS)
- Time [ Time Frame: From moment of the transfer to the OR until the moment of transfer out of it, assessed on the day of operation. ]the preparation (Tprep), operation (Top) and total operating room (TOR) time
|Study Start Date:||June 2009|
|Study Completion Date:||October 2015|
|Primary Completion Date:||October 2015 (Final data collection date for primary outcome measure)|
Active Comparator: iMRI-guided
Intervention: iMRI-guided brain tumour biopsy. The PoleStar N20 iMRI system (Medtronic Navigation, Louisville, CO, USA) with a 0.15-T constant magnet imager will be used in all cases. After the patient's positioning, the preoperative reference examination is routinely carried out. The entry point, target and optimal biopsy trajectory are then defined by the operator on the basis of the obtained iMRI images. Serial tissue samples are collected. Following each operation, a control iMRI (T1-weighted, axial, 4 mm scan examination) is routinely performed to confirm and document the proper targeting and to exclude postoperative hyperacute intraparenchymal bleeding.
Device: iMRI-guided brain tumour biopsy
The PoleStar N20 iMRI system (Medtronic Navigation, Louisville, CO, USA) with a 0.15-T constant magnet was used in all procedures.
Other Name: iMRI
Active Comparator: non-iMRI
Intervention: Stereotactic frameless brain tumour biopsy. A frameless STx biopsy is performed for each patient from the control group with the use of a neuronavigation system. The entry point, target and optimal biopsy trajectory are defined by the operator before the operation on the basis of the preoperatively obtained high-field MR images with the use of a neuronavigation workstation (Cranial 5, StealthStation Application Software, Medtronic Navigation, Louisville, CO, USA).
Device: Stereotactic frameless brain tumour biopsy
The entry point, target and optimal biopsy trajectory were defined by the operator before the operation on the basis of the preoperatively obtained high-field MR images with the use of a neuronavigation workstation (Cranial 5, StealthStation Application Software, Medtronic Navigation, Louisville, CO, USA).
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01779219
|Department of Neurosurgery, Wroclaw Medical University|
|Wroclaw, Poland, 50-556|
|Study Chair:||Wlodzimierz Jarmundowicz, Professor||Wroclaw Medical University|