Article
Safety and diagnostic accuracy of stereotactic brain biopsy for suspected primary angiitis of the central nervous system
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Authors
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Veit Stöcklein
- Klinikum der Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Lars Kellert
- Klinikum der Universität München, Neurologische Klinik und Poliklinik, München, Deutschland
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Maximilian Patzig
- Klinikum der Universität München, Abteilung für Neuroradiologie, München, Deutschland
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Clemens Küpper
- Klinikum der Universität München, Neurologische Klinik und Poliklinik, München, Deutschland
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Armin Giese
- Klinikum der Ludwig-Maximilians-Universität, Zentrum für Neuropathologie und Prionforschung, München, Deutschland
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Friedrich-Wilhelm Kreth
- Klinikum der Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Florian Schöberl
- Klinikum der Universität München, Neurologische Klinik und Poliklinik, München, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Primary angiitis of the central nervous system (PACNS) represents a rare neurological disorder, potentially leading to severe morbidity. Diagnosis of PACNS is challenging: conventional tests (i.e. MRI, CSF and catheter angiography) lack both specificity and sensitivity. The diagnostic benefit of biopsy is also questioned. Uncertainties to identify appropriate target volumes allowing histopathological assessment of vascular structures is one of the major drawbacks of this technique. We have extended our biopsy sampling technique targeting both lesions as defined by MRI and cortical strata in the vicinity of the chosen track. Here, we present the diagnostic accuracy and the risk profile of extended frame-based stereotactic biopsy technique (ESBT) in a consecutive series of patients with suspected PACNS.
Methods: ESBT was applied in all patients. Imaging included the localized contrast enhanced CT and additionally enhanced T1 and T2 weighted MRI sequences and a MRI angiography, which were automatically fused with the CT data. MRI-positive lesions were targeted if present. Small tissue samples (1mm3) were collected in 1mm steps along the biopsy track from the brain surface towards the lesion. Additional multiple cortical samples were obtained close to the trajectory. ESBT was conducted using a 1 cm burr hole.
Results: Between 2010-2017, 23 Patients with suspected PACNS underwent ESBT. PACNS was found in 7/23 patients (30%). The diagnosis was based on samples taken from the lesion-related area in 3 patients and on samples collected from both cortical and perilesional areas in 4 patients. 7 patients exhibited different diagnoses including cerebral amyloid angiopathy (N=3), encephalitis (N=2), intravascular primary B cell lymphoma (N=1), and acute demyelination (N=1). These different diagnoses were predominantly made considering samples taken from both strata (5/7 patients). No diagnosis could be made in 9/23 cases (39%). The overall diagnostic accuracy was 61%. Transient morbidity was 8.7% including a wound infection (N=1) and postoperative delirium without evidence of bleeding or edema (N=1).
Conclusion: We present the first series of patients with suspected PACNS undergoing exclusively ESBT for diagnostic tissue sampling. The diagnostic accuracy was comparable or even better than what has been previously reported. The complication rate of the stereotactic approach was lower. Taken together, these data favor ESBT for surgically diagnosing PACNS.
