Minimal invasive biopsy of intraconal expansion by PET/CT/MRI image-guided navigation: A new method

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 les...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2014-10, Vol.42 (7), p.1184-1189
Main Authors: Reinbacher, Knut E, Pau, Mauro, Wallner, Jürgen, Zemann, Wolfgang, Klein, Angelika, Gstettner, Christian, Aigner, Reingard M, Feichtinger, Matthias
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma, Merkel Cell - diagnosis
Carcinoma, Merkel Cell - pathology
Dentistry
Diplopia - diagnosis
Exophthalmos - diagnosis
Female
Fluorodeoxyglucose F18
Hamartoma - diagnosis
Hamartoma - pathology
Humans
Image-Guided Biopsy - methods
Image-guided surgery
Imaging, Three-Dimensional - methods
Intraconal lesion
Lymphoma - diagnosis
Lymphoma - pathology
Magnetic Resonance Imaging - methods
Male
Melanoma - diagnosis
Melanoma - pathology
Middle Aged
Minimal invasive biopsy
Minimally Invasive Surgical Procedures - methods
Multimodal Imaging - methods
Orbital
Orbital Diseases - diagnosis
Orbital Diseases - pathology
Orbital Neoplasms - diagnosis
Orbital Neoplasms - pathology
Patient Care Planning
Positron-Emission Tomography - methods
Radiopharmaceuticals
Surgery
Tomography, X-Ray Computed - methods
Young Adult
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Summary: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 between18 F-FDG Positron Emission Tomography (18 F-FDG PET), magnetic resonance imaging (MRI) and Computed Tomography (CT). Method and material 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 or18 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. Results 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. Conclusion 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 haemangi
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2014.02.006