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Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review.

Al's Comment:

 This reinforces the idea that biopsy of brainstem tumors is not as dangerous as we used to think. It is becoming more common and  as this study reveals, can have a major impact in outcome. Almost 10% of the time, it turned out to be a TB infection instead of brain tumor(this is India - I would assume a much lower rate here in the USA).  On the other hand, it shows that studies of brainstem tumors done without a biopsy have to be interpreted carefully - as you are never quite sure that it was a tumor to begin with - and if it is a tumor, which grade


Posted on: 04/18/2014

J Neurosci Rural Pract. 2014 Jan;5(1):32-9. doi: 10.4103/0976-3147.127869.
Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review.
Manoj N1, Arivazhagan A1, Bhat DI1, Arvinda HR 2, Mahadevan A3, Santosh V3, Devi BI1, Sampath S1, Chandramouli BA1.
Author information: 
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
2Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
3Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
 
Abstract
BACKGROUND: 
Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children.
 
MATERIALS AND METHODS: 
The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed.
 
RESULTS: 
Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series.
 
CONCLUSION: 
Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
 
 PMID: 24741247 [PubMed] 
 

 


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