Article
Retrospective comparison of stereotactic biopsies, navigation-guided needle biopsies and open craniotomy biopsies for the diagnosis of cerebral lesions
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Authors
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Witold H. Polanski
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät ‘Carl Gustav Carus’ der Technischen Universität Dresden
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Georgina Kusnick
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät ‘Carl Gustav Carus’ der Technischen Universität Dresden
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Klaus D. Martin
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät ‘Carl Gustav Carus’ der Technischen Universität Dresden
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät ‘Carl Gustav Carus’ der Technischen Universität Dresden
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Stephan B. Sobottka
- Klinik und Poliklinik für Neurochirurgie, Medizinische Fakultät ‘Carl Gustav Carus’ der Technischen Universität Dresden
| Published: | May 13, 2014 |
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Outline
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Objective: In patients with cerebral lesions or tumors, a biopsy is required to determine the histological diagnosis in order to make the decision whether a specific therapy is needed or not. Three possible biopsy techniques can lead to the necessary diagnosis: the stereotactic biopsy, the navigation-guided needle biopsy and the open craniotomy biopsy. Depending to the pros and cons of the biopsy technique, the most suitable type of surgery was chosen for the individual patient. In this study, we compared the three biopsy procedures regarding the histological results, the complications and the clinical condition of the patient.
Method: From 2007 to 2010, 203 patients with brain lesions underwent tissue biopsies including 124 stereotactic biopsies, 18 navigation-guided needle biopsies and 61 open craniotomy biopsies. Retrospectively, tumor localization, pre- and postoperative Karnofsky index, operation time, complication rate, suspected and final histological diagnosis and clinical course of the patients were evaluated.
Results: The Karnofsky index of patients, who underwent stereotactic biopsies did not alter in any of the patients. In contrast, after navigation-guided biopsies and open biopsies the Karnofsky index decreased in 3 patients (16%) and in 15 patients (24.5%), respectively. Complications occurred in 7% after stereotactic and in 11% after navigation-guided needle biopsies and in 13% after open craniotomy. 11% of the stereotactic biopsies revealed no histological diagnosis although the target area had been reached in 100% of cases, while 15% of the open biopsies led to no diagnosis. Following navigation-guided biopsy, there was no case without a histologic diagnosis. Mean operation time of stereotactic biopsies, navigation-guided needle biopsies and open biopsies were 55, 76 and 126 minutes, respectively.
Conclusions: Based on our study, stereotactic biopsies may be the preferred operative biopsy technique, since it shows a low complication rate coupled with a high diagnostic efficiency and a short operation time. Navigation-guided needle biopsy offers a good alternative with the highest diagnostic efficiency but higher complication rates. Open craniotomy biopsies should only be used for the diagnosis of meningeal, cortical and ventricular lesions, since it shows the highest complication rate without any advantage regarding the accuracy of the histological diagnosis.
