title: Diffuse intrinsic pontine gliomas in children: Interest of robotic frameless assisted biopsy. A technical note.
abstract: BACKGROUND
  Diffuse intrinsic pontine gliomas (DIPG) constitute 10-15% of all brain tumors in the pediatric population; currently prognosis remains poor, with an overall survival of 7-14 months. Recently the indication of DIPG biopsy has been enlarged due to the development of molecular biology and various ongoing clinical and therapeutic trials. Classically a biopsy is performed using a stereotactic frame assisted procedure but the workflow may sometimes be heavy and more complex especially in children. In this study the authors present their experience with frameless robotic-guided biopsy of DIPG in a pediatric population.
  
  
  METHODS
  Retrospective study on a series of five consecutive pediatric patients harboring DIPG treated over a 4-year period. All patients underwent frameless robotic-guided biopsy via a transcerebellar approach.
  
  
  RESULTS
  Among the 5 patients studied 3 were male and 2 female with a median age of 8.6 years [range 5 to 13 years]. Clinical presentation included ataxia, hemiparesis and cranial nerve palsy in all patients. MRI imaging of the lesion showed typical DIPG features (3 of them located in the pons) with hypo-intensity on T1 and hyper-intensity signal on T2 sequences and diffuse gadolinium enhancement. The mean procedure time was 56minutes (range 45 to 67minutes). No new postoperative neurological deficits were recorded. Histological diagnosis was achieved in all cases as follows: two anaplastic astrocytomas (grade III), two glioblastomas, and one diffuse astrocytoma (grade III).
  
  
  CONCLUSIONS
  Frameless robotic assisted biopsy of DIPG in pediatric population is an easier, effective, safe and highly accurate method to achieve diagnosis.
authors.affiliation: Service de neurochirurgie CHU Hautepierre, 67098, Strasbourg cedex, France. Electronic address: andrescoca@hotmail.com.
authors.forename: H A
authors.initials: HA
authors.lastname: Coca
authors.affiliation: Service de neurochirurgie CHU Hautepierre, 67098, Strasbourg cedex, France.
authors.forename: H
authors.initials: H
authors.lastname: Cebula
authors.affiliation: Service de neurochirurgie CHU Hautepierre, 67098, Strasbourg cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Benmekhbi
authors.affiliation: Service de pathologie CHU Hautepierre, 67098, Strasbourg cedex, France.
authors.forename: M P
authors.initials: MP
authors.lastname: Chenard
authors.affiliation: Service de pédiatrie, unité d'hématologie-oncologie CHU Hautepierre, 67098, Strasbourg cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Entz-Werle
authors.affiliation: Service de neurochirurgie CHU Hautepierre, 67098, Strasbourg cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001706:Biopsy / Q000379:methods*; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics
keywords: Biopsy; Brainstem tumor; Frameless; Pediatric neurosurgery; Robotics