Article
Feasibility, safety and diagnostic yield of stereotactic biopsy in lesions of supra- and infratentoriell midline structures in 511 procedures
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Authors
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Christina A. Hamisch
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Stephanie Kellermann
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Vanessa Hafkemeyer
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Daniel Rueß
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Stefan J. Grau
- Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
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Maximilian I. Ruge
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany; Zentrum für Integrierte Onkologie, Universitäten Köln und Bonn, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: To establish a definite diagnosis histological, immunological and molecular evaluation of tissue remains despite improvement of modern imaging the gold standard for unclear lesions/tumors in the brain. Stereotactically guided biopsy serves to obtain tissue, especialley in areas not accessible for microsurgical resection. Here we evaluate feasibility, safety, and diagnostic yield of stereotactic biopsy in lesions located in midline structures of the brain.
Method: We conducted a single centre retrospective analysis of all patients who received stereotactic biopsy (SB) for lesions localized in midline structures (corpus callosum, basal ganglia, pineal region, sella, thalamus and brainstem) and evaluated feasibility, procedural complications (mortality, transient and permanent morbidity), diagnostic success and performed a risk-analysis of factors influencing these parameters. For statistical analysis, Student t test and Mann-Whitney rank sum test were used.
Results: Four hundred and eighty-nine patients receiving 511 stereotactic biopsy procedures (median age: 48.5 years, range 1-82; median Karnofsky Score (KPS): 80, range 50-100) in the period of January 1996 and June 2015 were identified. In all cases SB was feasible. Lesions were localized in corpus callosum: 29.5%, basal ganglia 17.0%, pineal region 11.5%, sella 7.8%, thalamus 4.3%, brainstem 28.8%, others: 1.1%). Procedure-related mortality was 0% and permanent morbidity was 0.4%. Transient morbidity was 9.6% (all symptoms resolved completely within 10 days). Histological diagnosis was obtained in 98.4%. Tumors were found in 84.3%: low-grade gliomas 16.2%, high-grade gliomas 40.3% and other tumors 27.8%. None neoplastic lesions encompassed infectious- and degenerative disease in 14.1%. SB for brainstem lesions were significantly associated with transient complications (p<0.001).
Conclusions: SB in midline structures can be performed safely, with a high diagnostic yield and very low risk for permanent deficit independent of patient´s age, KPS and localization of the lesion. Under the aspect of providing tissue for advanced histo-pathological, immunological and molecular information in this high risk and mostly inoperable localizations to tailor treatment, stereotactic biopsy remains gold standard.
