gms | German Medical Science

Objective: Brain biopsy in pediatric patients is rarely necessary and little is known about its efficacy and risk. Nevertheless, this invasive diagnostic tool is essential for treatment planning in some conditions.

Methods: Seventy-four brain biopsies were performed in 71 children and adolescents (mean 7.9 years, range 4 months to 17 years) between 1990 and 2009: Thirty-four children (47%) had tumors in eloquent areas or multilocular tumors; 33 (46%) were suspected to have encephalitis; 4 (6%) patients had disseminated lesions in the MRI and epileptic seizures; one patient suffered from status epilepticus with a normal MRI.

Results: 90% of all biopsies were performed in cases of supratentorial lesions and 43% were stereotactically guided (18% frameless/open, 25% frame-based needle biopsy). The postoperative complications included 6% local complications (e.g. CSF fistula); 4% transient and 3% permanent new neurological deficits. One patient died from tumor bleeding two days after stereotactic biopsy of a large glioblastoma in the basal ganglia. Two patients had immediate re-biopsy because of inconclusive histopathological results; one patient had a re-biopsy after 27 months for a recurrent tumor. In summary, 75% of all biopsies provided a definite diagnosis. In 30 of 34 patients, the suspected tumor was confirmed or specified (88%), whereas suspected encephalitis could be proven in 22 of 33 patients (67%).

Conclusions: In selected pediatric patients the performance of brain biopsies is acceptably safe. Open procedures seem to be without a significantly higher risk than frame-based guided needle biopsies. In case of suspected tumor, the diagnostic yield is higher than in patients with suspected encephalitis.