gms | German Medical Science

Objective: Neoplasms of the central nervous system accounting for up to 25% of primary pediatric tumors. Despite the advances in neuroimaging, histopathological diagnosis remains the gold standard for sufficient treatment in most cerebral tumors. Stereotactic biopsy in adults is established as a safe and effective procedure. Spare data are published so far concerning stereotactic biopsy in children. We report on children undergoing stereotactic biopsy in two neurosurgical centres over the last 30 years.

Method: A retrospective study was conducted on stereotactic procedures, performed in children between 1982 and 2010 in two major neurosurgical centres in Germany. The data from medical records were analyzed concerning descriptive statistics, stereotactic systems used and surgical technique, results of biopsy and complications.

Results: Between 1982 and 2010 31 stereotactic procedures were performed in both centres in 28 children aged 1 to 16 years. In 26 children biopsy of a cerebral mass lesions were the primary purpose of surgery, in the others biopsy of different lesions or diagnostic puncture of cysts were the intention for the procedures. In two children biopsy of gliomas were performed twice, to rule out, respectively confirm a secondary malignant transformation over time. In a third child recurrent puncture of a hypothalamic cyst for decompression was performed twice after initial diagnostic puncture. Stereotactic biopsy revealed sufficient diagnosis in all cases, except for one child with unspecific diffuse signal changes on MRI (FLAIR and T2 weighted images) within the vermis. Intended decompression of cyst fluid was successful in all procedures. Postoperative imaging (MRI or CT) was performed in 20 of all procedures, showing in four cases haemorrhages within the tumor, without clinical relevance. In one of two patients younger then two years of age, the post operative MRI revealed a small impression fracture of the occ. bone, due to the pin from the stereotactic frame. Postoperative complication occurred in one patient as wound infection, which healed under conservative treatment.

Conclusions: Stereotactic biopsy is a safe and effective diagnostic procedure in children older than two years. In infants, stereotactic procedures are possible, but care has to been taken for a sufficient stability of the cranium to avoid calvarian fractures due to the stereotactic frame.