STEREOTACTIC BRAIN BIOPSY: A REVIEW OF 15 CASES WITH OUTCOMES
Objectives: Despite improvements in the imaging techniques which aid pre-operative diagnosis, starting specific treatment requires confirmation by histopathological examination (HPE). However dilemma arises in deep seated lesions, lesions in eloquent areas, and lesion in a patient with a poor performance score for palliation/adjuvant therapy. The aim of this study is to determine the diagnostic accuracy and benefits of stereotactic biopsy (STB) in cases of clinical dilemma plus its effect on post-operative stay, morbidity and mortality, and overall management of patients.
Methods: In this study, a prospective analysis of 15 patients who underwent STB in our hospital from September 2019 to July 2020 was made. The histopathological data derived from the STB, its clinical benefits, and post-operative hospital stay were analyzed.
Results: In terms of histopathology, glial tumor (66.7%) was the most common lesion. The success of obtaining positive STB samples in our study was 100%. Average post-operative stay was 3 days. The clinical benefits were immense as seen in the varied presentations and clinical dilemma with which the patients presented and a how a safely sourced tissue for histopathological diagnosis by STB greatly altered the treatment of the patient.
Conclusion: STB is a multifaceted tool in clinical practice. It can be used in diagnostic and therapeutic situations. Furthermore, in recurrent high-grade cases, it aids in providing HPE diagnosis for a more logical adjuvant treatment than one that follows an assumed diagnosis based on image findings/undergo a high-risk interventional procedure to get a specimen. It is a relatively safe procedure.
2. Spiegel EA, Wycis HT, Marks M, Lee AJ. Stereotaxic apparatus for operations on the human brain. Science 1947;106:349-50.
3. Vettikkadan AR, Jith A, Krishnaveni K, Kumar RS. Study of utilization pattern and drug interactions of antiepileptic drugs in a private hospital. Asian J Pharm Clin Res 2014;7:164-6.
4. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: Prognosis, extent of resection, and survival. J Neurosurg 2001;95:190-8.
5. Wood JR, Green SB, Shapiro WR. The prognostic importance of tumor size in malignant gliomas: A computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 1988;6:338-43.
6. Bouvier G, Couillard P, Leger SL, Lesage J, Rotent F, Beique RA, et al. Stereotactic biopsy of cerebral space-occupying lesions. Appl Neurophysiol 1983;46:227-30.
7. Abernathey CD, Camacho A, Kelly PJ. Stereotaxic suboccipital transcerebellar biopsy of pontine mass lesions. J Neurosurg 1989;70:195-200.
8. Apuzzo ML, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: Experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 1987;20:930-7.
9. Apuzzo ML, Sabshin JK. Computed tomographic guidance stereotaxis in the management of intracranial mass lesions. Neurosurgery 1983;12:277-85.
10. Thomas DG, Anderson RE, Du Boulay GH. CT-guided stereotactic neurosurgery: Experience in 24 cases with a new stereotactic system. J Neurol Neurosurg Psychiatry 1984;47:9-16.
11. Yamada K, Goto S, Kochi M, Ushio Y. Stereotactic biopsy for multifocal, diffuse, and deep-seated brain tumors using leksell’s system. J Clin Neurosci 2004;11:263-7.
12. Yamasaki T, Moritake K, Takaya M, Kagawa T, Nagai H, Akiyama Y, et al. Intraoperative use of doppler ultrasound and endoscopic monitoring in the stereotactic biopsy of malignant brain tumors. Technical note. J Neurosurg 1994;80:570-4.
13. Bander ED, Jones SH, Pisapia D, Magge R, Fine H, Schwartz TH, et al. Tubular brain tumor biopsy improves diagnostic yield for subcortical lesions. J Neurooncol 2019;141:121-9.
14. Dammers R, Schouten JW, Haitsma IK, Vincent AJ, Kros JM, Dirven CM. Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir (Wien) 2010;152:1915-21.
15. Frati A, Pichierri A, Bastianello S, Raco A, Santoro A, Esposito V, et al. Frameless stereotactic cerebral biopsy: Our experience in 296 cases. Stereotact Funct Neurosurg 2011;89:234-45.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.