title: Robot-Assisted Stereotactic Biopsy of Diffuse Intrinsic Pontine Glioma: A Single-Center Experience.
abstract: BACKGROUND
  Diffuse intrinsic pontine glioma (DIPG) is a childhood tumor with a dismal prognosis. Emerging molecular signatures have paved the way for stereotactic biopsy in selected centers. We present our experience in DIPG stereotactic needle biopsy using the Robotic Stereotactic-Assisted system (ROSA) in a series of consecutive pediatric patients.
  
  
  METHODS
  All stereotactic biopsy procedures for DIPG performed during the last year at our institution were considered. All procedures were carried out using the ROSA surgical assistant through a precoronary approach. All children underwent a postoperative computed tomography scan to document possible surgical complications and confirm the site of biopsy. Postoperative clinical changes were recorded to test morbidity of the procedure.
  
  
  RESULTS
  In the last year, we performed 7 pontine needle biopsies. Specimens were diagnostic and useful for molecular analysis in all cases. No surgical complications were observed. One child showed a transient neurologic worsening related to the biopsy that resolved within 2 weeks. The combination of the precoronary approach and use of the stereotactic ROSA system allowed single-session surgeries in all cases.
  
  
  CONCLUSIONS
  Pontine biopsy for DIPG is a safe procedure in selected centers. The advantages of the single-session procedure we described might be of particular interest in the pediatric setting.
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carai
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Mastronuzzi
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: alessandro.debenedictis@opbg.net.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Benedictis
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Messina
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cacchione
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Evelina
authors.initials: E
authors.lastname: Miele
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Randi
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Trezza
authors.affiliation: Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Giovanna Stefania
authors.initials: GS
authors.lastname: Colafati
authors.affiliation: Intensive Care Unit, Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Savioli
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Pediatric Science, University of Pavia, Pavia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Carlo Efisio
authors.initials: CE
authors.lastname: Marras
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D011149:Pons / Q000000981:diagnostic imaging* / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013238:Stereotaxic Techniques / Q000295:instrumentation
keywords: Biopsy; Brainstem; DIPG; Pediatric brain tumor; Stereotactic