Usfulness and Safety of Stereotactic Biopsy; A Case Series of 1000 Cases

Abstract

Background: There are different types of brain lesions that surgery might not be considered a good treatment option while adjuvant non-surgical treatments might be as effective in tumor control without any cyto-reductive intervention. Achieving a tumor tissue specimen is the main milestone in such cases. The aim of this study was to evaluate the usefulness and safety of stereotactic biopsy in histological diagnosis of such lesions.

Materials and Methods: The data are extracted from a prospective project undertaken during a 15 year period in a single center. The inclusion criteria were all the patients referred by different clinicians interested in having histological diagnosis of their patients in hand. Thereby the authors did not exclude any of the referred cases from the list. The exclusion criteria were; local skin infection, coagulopathies and patients not accepting the mentioned risks of surgery in the consent sheath. There were 1000 patients all operated using BRW stereotaxic frame.

Results: There were 376 females (37.6%) and 624 male (62.4%) patients. The age range varied between 4 and 94 (mean = 47.3±18.07). The lesions were mainly located in the right cerebral hemisphere in 264, in the left hemisphere in 341, around the midline in 216 and involved both hemispheres in 166 cases. The lesions were diffuse or unidentifiable in 13 cases. There were a single lesions in 826 patients, two lesions in 11 cases and multiple in 162 patients. The main location of each lesion is presented in bar charts in the manuscript. The most common histological diagnoses were different grades of Astrocytoma in almost 600 cases followed by Lymphoma, metastatic lesions and infections. Eight cases became complicated because of intracerebra/intratumoral hemorrhage and brain edema.

Conclusion: Frame based stereotactic biopsy can be a safe and useful armamentarium in the hands of neurosurgeons familiar with this type of procedure. The main indications and necessity for referring the cases for such a procedure will be discussed.