gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Stereotactic biopsy of brainstem lesions: a prospective risk-benefit estimation

Stereotaktische Biopsien von Hirnstammprozessen: eine prospektive Risiko-Nutzen-Analyse

Meeting Abstract

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  • corresponding author S. Grau - Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximillians-University, Munich
  • J. Anton - Department of Neurosurgery, Medical University Innsbruck, Austria
  • K. Bise - Centre of Neuropathology and Prion Disease, Klinikum Großhadern, Ludwig-Maximillians-University, Munich
  • J. C. Tonn - Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximillians-University, Munich
  • F. W. Kreth - Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximillians-University, Munich

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP181

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0449.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Grau et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Intra-axial tumours involving the brainstem represent a heterogenous entity. Even though tissue diagnosis still remains the gold standard for treatment decision, uncertainties continue to exist concerning risk and benefit of biopsy procedures in this highly eloquent area. The current prospective study (1999-2003) was conducted to analyze the risk and the diagnostic yield of frame based stereotactic biopsies of intraaxial brainstem lesion.

43 consecutively treated patient

(31 adults, 12 children) could be included. MR imaging was highly suspicious for a brainstem tumour in all these patients. Image fusion technique (CT, MRI) was used for multiplanar trajectory planning and biopsy procedures were performed/supervised by a stereotactic neurosurgeon. Samples were taken with small biopsy forceps (diameter: 1mm) and smear preparations of the specimens were intra-operatively examined by an attending neuropathologist. The final histopathological diagnosis was based on intra-operative smear preparations and paraffin embedded sections. Postoperative CT scan was done routinely within 24 hours past surgery, any clinical deterioration within the first week after surgery was considered as morbidity.

Results

Histopathological evaluation revealed a neoplastic disease in 31/43 patients (pilocytic astrocytoma [7], diffuse astrocytoma [11], anaplastic astrocytoma [10], glioblastoma [3], metastasis [4]). Non-neoplastic lesion was found in 8/43 patients (inflammatory lesion [2], cavernoma [1], infarction [1], gliosis [4]). Clinical follow-up corresponded with histological findings in both groups. There was no mortality or permanent morbidity. Transient morbidity occurred in 1/42 patients. No biopsy related bleeding was found on post operative CT scans. Smear and paraffin findings were concordant in 77% and discordant in 23%.

Conclusions

Stereotactic biopsy of brainstem processes is a safe, reliable and effective method when performed in experienced centres and should be done with intra-operative smear-preparations. Final diagnosis cannot be based on intra-operative pathological assessment alone.