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Reinbacher, KE; Pau, M; Wallner, J; Zemann, W; Klein, A; Gstettner, C; Aigner, RM; Feichtinger, M.
Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: a new method.
J Craniomaxillofac Surg. 2014; 42(7):1184-1189 Doi: 10.1016/j.jcms.2014.02.006
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Leading authors Med Uni Graz: Reinbacher Knut
Co-authors Med Uni Graz: Aigner Reingard; Feichtinger Matthias; Gstettner Christian; Klein-Theyer Angelika Karin; Pau Mauro; Wallner Jürgen; Zemann Wolfgang
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Abstract:: Intraorbital tumours are often undetected for a long period and may lead to compression of the optic nerve and loss of vision. Although CT, MRI's and ultrasound can help in determining the probable diagnosis, most orbital tumours are only diagnosed by surgical biopsy. In intraconal lesions this may prove especially difficult as the expansions are situated next to sensitive anatomical structures (eye bulb, optic nerve). In search of a minimally invasive access to the intraconal region, we describe a method of a three-dimensional, image-guided biopsy of orbital tumours using a combined technique of hardware fusion between (18)F-FDG Positron Emission Tomography ((18)F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). We present 6 patients with a total of 7 intraorbital lesions, all of them suffering from diplopia and/or exophthalmos. There were 3 female and 3 male patients. The patients age ranged from 20 to 75 years. One of the patients showed beginning loss of vision. Another of the patients had lesions in both orbits. The decision to obtain image-guided needle biopsies for treatment planning was discussed and decided at an interdisciplinary board comprising other sub-specialities (ophthalmology, neurosurgery, maxillofacial surgery, ENT, plastic surgery). All patients underwent 3D imaging preoperatively ((18)F-FDG PET/CT or (18)F-FDG PET/CT plus MRI). Data was transferred to 3D navigation system. Access to the lesions was planned preoperatively on a workstation monitor. Biopsy-needles were then calibrated intraoperatively and all patients underwent three-dimensional image-guided needle biopsies under general anaesthesia. 7 biopsies were performed. The histologic subtype was idiopathic orbital inflammation in 2 lesions, lymphoma in 2, Merkel cell carcinoma in 1, hamartoma in 1 and 1 malignant melanoma. The different pathologies were subsequently treated in consideration of the actual state of the art. In cases where surgical removal of the lesion was performed the histological diagnosis was confirmed in all cases. There is a wide range of possible treatment modalities for orbital tumours depending on the nature of the lesion. Histological diagnosis is mandatory to select the proper management and operation. The presented method allows minimal-invasive biopsy even in deep intraconal lesions, enabling the surgeon to spare critical anatomical structures. Vascular lesions such as cavernous haemangioma, tumour of the lacrimal gland or dermoid cysts present a contraindication and have to be excluded. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing): Adult -; Aged -; Carcinoma, Merkel Cell - diagnosis; Carcinoma, Merkel Cell - pathology; Diplopia - diagnosis; Exophthalmos - diagnosis; Female -; Fluorodeoxyglucose F18 -; Hamartoma - diagnosis; Hamartoma - pathology; Humans -; Image-Guided Biopsy - methods; Imaging, Three-Dimensional - methods; Lymphoma - diagnosis; Lymphoma - pathology; Magnetic Resonance Imaging - methods; Male -; Melanoma - diagnosis; Melanoma - pathology; Middle Aged -; Minimally Invasive Surgical Procedures - methods; Multimodal Imaging - methods; Orbital Diseases - diagnosis; Orbital Diseases - pathology; Orbital Neoplasms - diagnosis; Orbital Neoplasms - pathology; Patient Care Planning -; Positron-Emission Tomography - methods; Radiopharmaceuticals -; Tomography, X-Ray Computed - methods; Young Adult -
Find related publications in this database (Keywords): Minimal invasive biopsy; Intraconal lesion; Image-guided surgery; Orbital