Intraoperative Magnetic Resonance Imaging-Guided Biopsy in the Diagnosis of Suprasellar Langerhans Cell Histiocytosis

Kate T Carroll; Bryson C Lochte; James Y Chen; Vivian S Snyder; Bob S Carter; Clark C Chen

doi:10.1016/j.wneu.2017.12.184

Intraoperative Magnetic Resonance Imaging-Guided Biopsy in the Diagnosis of Suprasellar Langerhans Cell Histiocytosis

World Neurosurg. 2018 Apr:112:6-13. doi: 10.1016/j.wneu.2017.12.184. Epub 2018 Jan 6.

Authors

Kate T Carroll¹, Bryson C Lochte¹, James Y Chen², Vivian S Snyder³, Bob S Carter⁴, Clark C Chen⁵

Affiliations

¹ School of Medicine, University of California, San Diego, California, USA.
² Department of Radiology, University of California, San Diego, California, USA; Department of Radiology, San Diego Veterans Administration Medical Center, La Jolla, California.
³ Department of Pathology, Division of Neuropathology, University of California, San Diego, California, USA.
⁴ Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Moores Cancer Center, University of California, San Diego, California, USA; Department of Neurosurgery, University of California, San Diego, California, USA. Electronic address: clarkchen@ucsd.edu.

PMID: 29317365
DOI: 10.1016/j.wneu.2017.12.184

Abstract

Background: Magnetic resonance imaging (MRI)-guided biopsy is an emerging diagnostic technique that holds great promise for otherwise difficult to access neuroanatomy.

Case description: Here we describe MRI-guided biopsy of a suprasellar lesion located posterior and superior to the pituitary stalk. The approach was implemented successfully in a 38-year-old woman who had developed progressive visual deterioration.

Conclusion: Intraoperative MRI revealed the need for trajectory adjustment due to an unintended, minor deviation in the burr hole entry point, demonstrating the benefit of an MRI-guided approach. Langerhans cell histiocytosis was diagnosed after biopsy, and the lesion regressed after cladribine treatment. Technical nuances of the case are reviewed in the context of the available literature.

Keywords: Langerhans cell histiocytosis; MRI-guided biopsy; Suprasellar.

Publication types

Case Reports
Review

MeSH terms

Adult
Brain Diseases / diagnostic imaging*
Female
Histiocytosis, Langerhans-Cell / diagnostic imaging*
Humans
Image-Guided Biopsy / methods*
Magnetic Resonance Imaging / methods*
Neuroimaging / methods*