Stereotactic Biopsy for Diagnostic of Brain Astrocytoma in Germany
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Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of accurate diagnostics and surgical treatment of diseases of the central and peripheral nervous system. The department's surgeons annually perform over 5,000 surgical interventions, which indicates their high professionalism and tremendous experience. The key attention is paid to the treatment of cerebrovascular diseases, diseases of the spine and spinal cord, brain and skull base tumors, peripheral nerve lesions, cerebrospinal fluid circulation disorders, as well as pain therapy (functional neurosurgery). The treatment of neurosurgical diseases in children and adolescents is carried out by a specially trained team of experts.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of surgical treatment of diseases of the brain, spine, spinal cord and nerves in adults and children. The department keeps pace with new trends in medicine, as well as contributes significantly to their development. Therefore, the most modern diagnostic and therapeutic methods are available here. An individual approach to each clinical case is crucial to ensure optimal treatment results with the preservation of all neurological functions.
Department of Adult and Pediatric Neurosurgery
According to the Focus magazine, the Department of Adult and Pediatric Neurosurgery ranks among the top German medical facilities specializing in the surgical treatment of brain tumors! The department offers the full range of diagnostics and surgical treatment of diseases of the central and peripheral nervous system. A specially trained team of pediatric neurosurgeons provides treatment for various neurosurgical pathologies in children. During the treatment, the doctors use state-of-the-art equipment, in particular, imaging-guided neuronavigation, functional imaging (fMRI), intraoperative mapping, intraoperative videoangiography, etc.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the diagnostics and treatment of the entire spectrum of neurosurgical diseases. The department specializes in the treatment of brain tumors, vascular diseases and intracerebral hemorrhages, spinal diseases, deep brain stimulation, etc. Special competence lies in the field of pediatric neurosurgery. The department offers the very latest highly accurate and minimally invasive treatment methods.
Department of Neurosurgery
The Department of Neurosurgery offers the full range of surgical treatment of diseases of the nervous system and belongs to the largest medical facilities of this kind at the national level. The department has 4 state-of-art operating rooms where more than 2,700 interventions are performed annually. It has the progressive surgical equipment, for example, intraoperative monitoring, neuronavigation, tools for performing minimally invasive operations, which provide the most effective and reliable therapy. The department has earned the reputation of the Center of Competence in the field of tumor surgery of the nervous system and spine.
Department of Adult and Pediatric Neurosurgery, Epilepsy Surgery, Spinal Surgery
The Department of Adult and Pediatric Neurosurgery, Epilepsy Surgery, Spinal Surgery offers the full range of diagnostics and surgical treatment of diseases of the brain, spinal cord and peripheral nerves at the highest international level of modern medicine. The department has four high-tech operating rooms, in which more than 2,400 surgical interventions are performed annually. Surgery to treat tumors of the nervous system in childhood and adulthood is of particular interest to the department's specialists. In addition, the department's medical team has unique clinical experience in the surgical treatment of epilepsy, spinal pathologies and deformities, as well as neurovascular pathologies. The department's doctors have a perfect command of advanced surgical techniques, for example, navigational surgery, intraoperative neuromonitoring, hybrid surgical techniques, which are the basis of successful clinical practice. State-of-the-art computer-assisted systems allow neurosurgeons to plan each stage of surgical intervention as accurately as possible, thereby guaranteeing its high efficiency and safety.
Department of Adult and Pediatric Neurosurgery, Spinal Surgery
The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers modern diagnostics and effective treatment of the full range of diseases, injuries, inflammatory processes, tumors and malformations of the brain, spinal cord and their meninges, as well as spinal diseases. Spinal surgery is performed in collaboration with doctors from the Department of Adult and Pediatric Traumatology, Orthopedic Surgery. The department admits adults and children with malformations of the nervous system, brain and spinal cord tumors, drug-resistant epilepsy and other diseases. As one of the largest medical facilities of this kind in Germany, the department's doctors annually perform more than 2,500 surgical interventions on the brain and spinal cord, peripheral nerve endings. The department's specialists also perform over 400 spinal surgical procedures annually. To achieve high success rates of the surgical treatment, doctors use the very latest equipment, including neuronavigation systems. Thanks to this, surgeons not only successfully eliminate the pathology, but also guarantee the patient maximum safety. The department has 78 beds, including 14 beds in the Intensive Care Unit. The priority goal of the department's medical team is to provide high-quality treatment focused on the patient's needs.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the diagnostics and comprehensive treatment of neurosurgical pathologies, including tumors of the central and peripheral nervous system. The department is the leading Center of Neurosurgery in Northern Germany and is responsible for the implementation of new algorithms for the treatment of patients with brain tumors. To this end, there is an active participation in the international researches and the development of new surgical methods, for example, operations in the waking state. Close interdisciplinary cooperation also contributes to the achievement of optimal treatment results.
Department of Neurosurgery and Spinal Surgery
The Department of Neurosurgery and Spinal Surgery provides top-class medical care for patients with diseases of the central and peripheral nervous systems. The medical facility performs surgery of any complexity on the brain, spinal cord, spine, and peripheral nerves. The department is the largest healthcare facility of this kind in Germany and has a team of highly professional neurosurgeons with long clinical experience. The department's specialists focus on patients with brain tumors (gliomas, meningiomas, and brain metastases), neurovascular diseases (aneurysms, arteriovenous malformations, and dural arteriovenous fistulas), and traumatic brain injuries. Spinal surgeons operate on patients with herniated discs, spinal canal stenosis, spondylolisthesis, spondylodiscitis, spinal fractures, and spinal tumors. The department extensively uses minimally invasive surgical techniques that allow for good therapeutic results with high safety in surgical manipulations. The medical facility has two hybrid operating rooms with state-of-the-art equipment, including the Zeego® intraoperative robotic angiography system and the intraoperative Brainsuite® MRI.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of diagnostics and treatment of diseases of the central and peripheral nervous system. The medical institution occupies a leading position in this sector in Europe. The neurosurgeons of the department have at their disposal four high-tech operating rooms, in which more than 3,500 interventions are performed annually. Active clinical and experimental research activities, as well as close cooperation with national and international reputable research centers, promote the introduction of innovative treatment techniques that are available only in a few clinics in the world.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the widest range of surgical interventions for the treatment of diseases of the central and peripheral nervous system, including stereotactic surgery and endoscopy. With more than 2,400 operations every year, the department has a unique experience, which allows it to provide the high-quality medical care even in extremely complex clinical cases. The key focus of the department is pediatric neurosurgery. In addition to the high professionalism of doctors, the treatment success is facilitated by exclusively advanced medical equipment, for example, neuronavigation systems and intraoperative fluorescence navigation.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers the full range of modern services in this medical field. The high level of technical equipment in the department allows for the performance of all highly specialized surgical interventions to treat pathologies of the central and peripheral nervous system. The clinical practice mainly focuses on the diagnostics and surgical treatment of diseases, injuries of the brain, spine, spinal cord, intervertebral discs, nerve plexuses, functional neurosurgery and the treatment of neurosurgical pathologies in children.
Department of Neurosurgery
The Department of Neurosurgery offers the full range of diagnostics and surgical treatment of diseases of the nervous system. All operating rooms are equipped with the cutting-edge technology, which provides the most reliable and effective treatment of neurosurgical pathology. The department employs competent neurosurgeons with rich clinical experience and deep expert knowledge, who have in their arsenal many modern therapeutic methods.
Department of Adult and Pediatric Neurosurgery
The Department of Adult and Pediatric Neurosurgery offers all modern surgical interventions for the treatment of pathologies of the nervous system. The clinical focuses include the treatment of oncological diseases of the nervous system (neuro-oncology), skull base surgery, vascular neurosurgery, spinal surgery and functional neurosurgery, including the surgical treatment of epilepsy. As a state-of-the-art medical facility, the department has the advanced systems for deep brain stimulation, multimodal neuronavigation devices, intraoperative neuronavigation using CT, ultrasound systems, fluorescence imaging devices and endoscopy equipment. Thus, the department has all the possibilities to ensure effective treatment according to the international standards.
University Hospital of Ludwig Maximilian University of Munich
Department of Adult and Pediatric Neurosurgery, Spinal Surgery
The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers the full range of diagnostic examinations and surgical treatment of diseases of the central and peripheral nervous systems. The team of the department's neurosurgeons successfully performs operations for pathologies of the brain and spinal cord, spine, neurovascular pathologies, pituitary diseases, and epilepsy. The doctors specialize in surgery for malignant brain tumors. The department is part of the Gliome Competence Center Network and the German Cancer Aid. The department uses the latest minimally invasive microsurgical techniques, navigation systems, intraoperative systems, and other advanced technical resources that allow for an optimal therapy result. The department has 84 beds for its patients, 10 of which are intended for intensive care. Medical care is based on an individual approach with due consideration of the patient's specific clinical data and needs. The specialists working at the medical facility always devote enough time to personal communication with their patients and do everything possible so that they receive effective treatment and maintain a decent quality of life.
Department of Adult and Pediatric Neurosurgery, Spinal Surgery
The Department of Adult and Pediatric Neurosurgery, Spinal Surgery offers the full range of services in these fields and specializes in the surgical treatment of diseases of the brain and spinal cord, peripheral nervous system and spine. The important areas of the department's clinical activity also include neuro-oncology, vascular neurosurgery and pediatric neurosurgery. The treatment is provided in four state-of-the-art operating rooms equipped with all the necessary facilities. The department admits about 2,700 inpatients and 4,100 outpatients annually. The team of the department's neurosurgeons is distinguished by high professionalism, and performs many operations using sparing minimally invasive surgical techniques. Navigation systems, intraoperative monitoring devices, 5-ALA fluorescence are successfully used during the surgical treatment. Each operation is carefully planned using advanced navigation devices (under the guidance of CT and MRI scanning). In general, the department's surgeons annually perform more than 4,000 neurosurgical interventions, and therefore they are justifiably proud of their unique clinical experience and treatment results.
A brain biopsy is an invasive procedure that is used to diagnose an astrocytoma. Its goal is to obtain a tissue sample, which can then be examined to determine the histological type of the tumor and detect mutations in the genes. In Germany, stereotactic biopsy is informative and safe. It is performed by experienced neurosurgeons using modern stereotactic and neuronavigation systems.
Diagnostic principles
As a rule, it is not difficult to detect a brain tumor. This can be done not only with the help of CT and MRI scans. If a neoplasm of the central nervous system is large enough, it can be visible even on a simple X-ray image.
It is much more difficult to obtain additional information about the brain tumor, which is necessary for treatment planning. The doctor needs to clarify:
- Histological type of the neoplasm
- Grade, growth rate, metabolic activity
- Precise localization and relationship with important anatomical structures of the brain
- Mutations in genes (determines the prognosis and response to drug treatment)
Most tumors in the human body require a biopsy to be diagnosed. Doctors sample a piece of tissue in order to understand whether it is cancer or a benign neoplasm, to determine the histological and molecular biological type.
However, it is much more difficult to obtain a fragment of the brain tumor. This procedure requires breaking the integrity of the skull and introducing the instrument into the brain. There are certain risks associated with astrocytoma stereotactic biopsy. Therefore, it is not used in all patients with cancer of the central nervous system.
Most patients do not require a stereotactic biopsy for disease detection, since astrocytoma can be detected using magnetic resonance imaging. The standard diagnostic method is MRI with intravenous contrast medium enhancement. The procedure provides information about the size of the tumor, its location, shape and boundaries. The histological type of the neoplasm can also be determined with high reliability from the MRI scans.
Some patients have contraindications for the MRI. For example, some people may have metal implants in their bodies, live with artificial heart pacemakers, etc. In such cases, a CT scan is carried out, and if the information obtained is insufficient to make a decision about the preferred treatment method, an astrocytoma stereotactic biopsy will be performed.
Clarifying diagnostic interventions
The most detailed information about cancer the doctor receives from MRI. In addition to the standard diagnostic with intravenous contrast medium enhancement of astrocytoma, the well-equipped neurosurgery clinics use additional diagnostic procedures with nuclear magnetic resonance. These are the magnetic resonance spectroscopy, functional MRI, magnetic resonance angiography and venography.
Magnetic resonance spectroscopy. It allows the doctor to distinguish astrocytoma from non-neoplastic diseases of the brain. In patients who are being diagnosed for the first time, there may be a need for a differential diagnostic of a neoplasm with an inflammatory process in the brain. In the case of suspected relapse of astrocytoma after previous treatment, a recurrent tumor can be mimicked by a scar left after surgery, or a zone of radiation necrosis after radiation therapy. In addition, MR spectroscopy provides information on the metabolic activity of the astrocytoma, its growth rate, grade, as well as helps to assess the prognosis of the disease.
Functional MRI. It is usually performed before surgery or astrocytoma stereotactic biopsy: the astrocytoma is sometimes located in a hard-to-reach place, so an invasive intervention can cause complications due to damage to healthy nerve tissue. Functional MRI provides information about the location of functionally important areas of the brain. Based on this information, the point of introduction of the needle and the trajectory of its movement towards the tumor are planned.
Magnetic resonance angiography and venography (MRA and MRV). The techniques are aimed at assessing the blood supply to the tumor. Prior to surgery, a neurosurgeon can find out which vessels supply blood to the astrocytoma. The best possible preservation of blood vessels is necessary to reduce the risk of complications associated with impaired blood circulation in the brain tissue after surgical treatment.
In some hospitals, positron emission tomography of the brain is used instead of magnetic resonance spectrography. PET can be used in patients with contraindications for the MRI.
Indications for stereotactic biopsy of the brain
Most patients do not need the stereotactic biopsy, since astrocytoma can be detected using MRI. A sample for histological analysis will be obtained after its removal. However, here are some cases when it is recommended to perform the procedure:
- Suspected lymphoma
- If the operation to remove the astrocytoma is not planned
- When non-invasive diagnostic methods cannot determine whether the neoplasm found in the brain is a tumor
Lymphoma is the only group of tumors in the central nervous system that cannot be removed surgically. If suspected, a biopsy is performed. Should the diagnosis be confirmed, the patient will start chemotherapy.
The astrocytoma stereotactic biopsy is required if the patient will not undergo radical surgical treatment. Here are some of the main clinical situations when this is possible:
- Advanced tumors – very large, aggressive and fast-growing, multiple astrocytomas
- Contraindications for surgical treatment, such as concomitant diseases, elderly age and poor general health state
- Refusal of surgery, including in favor of radiation therapy
Based on the results of the biopsy, the doctor accurately determines the histological type of the neoplasm. The samples are also sent for molecular biological testing: the astrocytoma may have gene mutations, which affect the prognosis and treatment regimen.
How is the stereotactic biopsy performed?
A classical version of the brain biopsy involves the use of a stereotactic frame. Some German hospitals perform the procedure using a frameless method. To determine the coordinates of the tumor and calculate the trajectory of the needle, a neuronavigation system is used.
When using a frame, the procedure begins by adjusting it to the patient's head. The frame is fixed with screws to the periosteum. This manipulation is performed even before the patient is under anesthesia, and therefore local anesthesia is used for pain relief.
This is followed by an MRI scan, if necessary, a CT scan. Based on the data obtained, the system calculates three-dimensional coordinates on an individual basis, determines the best area for needle insertion, the shortest and safest trajectory for its forwarding to the tumor. According to the calculations of the system, a stereotactic arch is assembled on the frame.
This is followed by the biopsy itself. The essence of the procedure is the same for diseases of different origins. A hole about 4 mm in diameter is drilled in the skull, and the dura mater is coagulated. A biopsy needle is inserted into the hole. The doctor receives samples of about 1 cubic centimeter from 2 to 3 sites of the astrocytoma. He samples tissue from the peripheral area of the tumor, since the necrosis zone is often located in the center.
Why is it better to undergo the brain biopsy in Germany?
German medicine is considered one of the best in the world. This is evidenced by the fact that life expectancy in Germany is the highest in Europe.
It is better to undergo diagnostic procedures in one of the German hospitals for several reasons.
1. Accurate non-invasive diagnostic interventions. The doctors carefully examine the patient using CT, MRI, PET scans. The very latest techniques provide accurate information about the location, shape and type of the tumor. In many cases, the diagnosis is made even without the brain biopsy.
2. Safety of the procedure. The diagnostic or treatment procedure is carefully planned using modern stereotactic systems. The doctors use techniques that identify functionally important areas of the brain and avoid damage to them during the biopsy.
3. Minimal risk of error. The inexperienced doctors may not get enough tissue, or they may take samples incorrectly. The tumor may be displaced under the pressure of the needle, or the neurosurgeon may take samples from the central zone of the astrocytoma – the tissues in this area are often necrotized, so their examination is not informative. The leading hospitals in Germany employ the highly qualified specialists, so the risk of such errors is close to zero.
4. Modern technologies. The hospitals in Germany use the very latest stereotactic systems. Many hospitals use frameless stereotaxis: the coordinates of the tumor and the trajectory of the biopsy needle are calculated using a neuronavigation system. This procedure is better tolerated by patients, since it does not require fixing the frame to the head with screws.
5. Low cost of treatment. The prices in Germany are higher than in developing countries. Nonetheless, when compared with countries with the level of medicine equal to that in Germany, then the prices here are quite affordable. For example, the treatment in the United States or Japan is much more expensive.
Diagnostic procedures and treatment in Germany with Booking Health
You can travel to Germany for the highest level of medical services. The Booking Health website provides information about the main hospitals in this country, doctors, prices for various procedures. You can compare the cost of treatment in different hospitals and book the medical program at the best price.
Booking Health will help not only to reduce the cost of treatment abroad, but also to organize your trip to Germany. We offer the following services and benefits:
- Selection of the hospital that specializes in the diagnostic and treatment of astrocytoma of the brain
- Direct communication with the doctor of the Department of neurosurgery
- Reduced waiting time for the stereotactic biopsy and making an appointment on the most suitable dates
- Reduced cost of treatment – treatment prices are reduced due to avoiding additional coefficients for foreign patients
- Up-to-date information about your expenses, the cost of the procedures performed, the funds remaining on the account
- Preparation of a medical program without the need to repeat previously performed diagnostic procedures
- Communication with the neurosurgery clinic after the completion of the medical program
- Buying and forwarding medicines
- Possibility of additional diagnostic procedures or treatment in Germany
The Booking Health specialists provide high-quality service and treatment. We will book a hotel and airline tickets for you, organize your transfer from the airport to the hospital and back.