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

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

Deutsche Gesellschaft fŘr Neurochirurgie. SociÚtÚ Franšaise de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft fŘr Neurochirurgie e.V. (DGNC), 3Ŕmes journÚes franšaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. DŘsseldorf, K÷ln: German Medical Science; 2005. DocP181

The electronic version of this article is the complete one and can be found online at:

Published: May 4, 2005

© 2005 Grau et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




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.


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%.


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.