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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Diagnostic value and safety of stereotactic biopsy for pediatric brainstem tumors: own experience, a systematic review and meta-analysis of 693 cases

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  • Philipp Kickingereder - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany; Abteilung für Neuroradiologie, Universität Heidelberg, Medizinisches Zentrum, Heidelberg, Germany
  • Christina A. Hamisch - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Matthias Fischer - Klinik für pädiatrische Hämatologie und Onkologie, Universitätsklinikum Köln, Germany
  • Thorsten Simon - Klinik für pädiatrische Hämatologie und Onkologie, Universitätsklinikum Köln, Germany
  • Maximilian I. Ruge - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany; Zentrum für Integrierte Onkologie, Universitäten Köln und Bonn, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.01.05

doi: 10.3205/16dgnc086, urn:nbn:de:0183-16dgnc0866

Published: June 8, 2016

© 2016 Kickingereder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Recent studies have shed light on the molecular makeup and led to the identification of potential treatment targets for diffuse intrinsic pontine gliomas, which account for the majority of pediatric brainstem tumors (pedBSTs). Therefore, stereotactic biopsy driven molecular characterization of pedBSTs may become an important prerequisite for the management of these fatal brain tumors. We conducted a systemic review and meta-analysis to precisely determine the safety and diagnostic success of stereotactic biopsy for pedBSTs.

Method: A systematic search in PubMed, EMBASE and the Web of Science yielded 944 potentially eligible abstracts. Meta-analysis was conducted on 18 studies, including our own institutional series, describing a total of 693 biopsy procedures for pedBSTs. Primary outcome measures were diagnostic success and procedure-related complications. Pooled estimates were calculated based on the Freeman-Tukey double-arcsine transformation and DerSimonian-Laird random-effect model. Heterogeneity, sensitivity, and meta-regression analyses were also conducted.

Results: The weighted average proportions across the analyzed studies were: 96.3% (95%CI: 93.3-98.2%) for a diagnostic success, 7.0% (95%CI: 4.4-10.2%) for overall morbidity, 0.7% (95%CI: 0.2-1.4%) for permanent morbidity, and 0.6% (95%CI: 0.2-1.3%) for mortality. Subgroup analysis at the study level identified no significant correlation between the outcome measures and the distribution of the chosen biopsy trajectories (transfrontal vs. transcerebellar), age, year of publication, or the number of biopsy procedures annually performed in each center.

Conclusions: Stereotactic biopsy of pedBSTs is safe and allows successful tissue sampling as a prerequisite for the molecular characterization of these tumors as a crucial first step towards more individualized treatment concepts.