Stereotactic biopsy of the brain mass lesions: a tertiary hospital experience

Year 2018, Volume: 45 Issue: 3, 245 - 253, 05.09.2018

Erkut Baha Bulduk Ayfer Aslan Özgür Öcal Ömer Hakan Emmez Gökhan Kurt Şükrü Aykol

https://doi.org/10.5798/dicletip.457233

Abstract

Objectives: Stereotactic
biopsy (SB) is a guided technic performed for the lesions on eloquent brain
areas. The aim of this study is revealing the diagnostic reliability and the
risk ratio of SB.

Methods:
Data of patients performed SB due to various intracranial lesions was collected
retrospectively. The study took place in Department of Neurosurgery, Gazi
University Faculty of Medicine between February 2004 and April 2014. Data
analysis performed in terms of age, gender, lesion location, histopathology,
and outcomes of surgery.

Results:
Sixty percent of patients were male (146 patients) and forty percent of them
was female (96 patients), between the ages of 11 and 84 years (mean age of 49
years) with a total number of 242. Mortality and morbidity rates were
respectively 0.4% and 3.3%. The overall diagnostic yield was 81% (196
patients), while 19% (46 patients) had nonspecific results, which did cannot
lead any further therapy. Among 36 patients of whom pathologies were confirmed
with an excisional biopsy, the diagnostic accuracy was shown in 24 patients
(67%).

Conclusions:
Beside low risk of mortality and morbidity, the high rate of non-diagnostic
results and low rate of diagnostic accuracy are the limitations of SB, which
should be improved by careful skills to obtain more specimen, sophisticated
software for planning, and intraoperative pathological examination for
guaranteeing.

Keywords

Stereotactic biopsy, Brain tumor

References

• 1. Horsley V, Clarke RH. The structure and functions of the cerebellum examined by a new method. Brain. 1908; 31: 45–124.
• 2. Schulder M. Handbook of Stereotactic and Functional Neurosurgery, 1st edn. New Jersey Medical School, USA: CRC Press, 2003: 1-608
• 3. Burger PC, Nelson JS. Stereotactic brain biopsies. Pathol Lab Med. 1997; 121: 477-80.
• 4. Krieger MD, Chandrasoma PT, Zee CS, Apuzzo ML. Role of stereotactic biopsy in the diagnosis and management of brain tumors. Seminars in surgical oncology. John Wiley & Sons, Inc. 1998; 14: 1-11.
• 5. Chandrasoma PT, Smith MM, Apuzzo ML. Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery. 1989; 24: 160-5.
• 6. Savas A. Beyin Biyopsisi – Stereotaksik Cerrahi Tekniği. Society of Turkish Neurosurgery, Basic Neurosurgery, 2nd edn: 1999, 2010.
• 7. Kim JE, Kim DG, Paek SH, Jung HW. Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta neurochirurgica. 2003; 145: 547-55.
• 8. Fritsch MJ, Leber MJ, Gossett L, Lulu BA, Hamilton AJ. Stereotactic biopsy of intracranial brain lesions. High diagnostic yield without increased complications: 65 consecutive biopsies with early postoperative CT scans. Stereotact Funct Neurosurg. 1998; 71: 36-42.
• 9. Greene GM, Hitchon PW, Schelper RL, Yuh W, Dyste GN. Diagnostic yield in CT-guided stereotactic biopsy of gliomas. J Neurosurg. 1989; 71: 494-7.
• 10. Hall WA: The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer. 1998; 82: 174955.
• 11. Hisatugo MK, Stavale JN, Bido JO, Ferraz FP. Image guided stereotactic approach of central nervous system lesions: accuracy, morbidity, mortality. Arq Neuropsiquiatr. 1999; 57: 615-20.
• 12. Rajshekhar V, Chandy MJ. Computerized tomographyguided stereotactic surgery for brainstem masses: a risk-benefit analysis in 71 patients. J Neurosurg. 1995; 82: 976-81.
• 13. Brainard JA, Prayson RA, Barnett GH. Frozen section evaluation of stereotactic brain biopsies: Diagnostic yield at the stereotactic target position in 188 cases. Arch Pathol Lab Med. 1997; 121: 481-4.
• 14. Firlik KS, Martinez AJ, Lunsford LD. Use of cytological preparations for the intraoperative diagnosis of stereotactically obtained brain biopsies: a 19-year experience and survey of neuropathologists. J Neurosurg. 1999; 91: 454-8.
• 15. Reyes MG, Homsi MF, McDonald LW, Glick RP. Imprints, smears, and frozen sections of brain tumors. Neurosurgery. 1991; 29: 575-9.
• 16. Cappabianca P, Spaziante R, Caputi F et al. Accuracy of the analysis of multiple small fragments of glial tumors obtained by stereotactic biopsy. Acta Cytol. 1991; 35: 505-11.
• 17. Feiden W, Steude U, Bise K, Gundisch O. Accuracy of stereotactic brain tumor biopsy: comparison of the histologic findings in biopsy cylinders and resected tumor tissue. Neurosurg Rev. 1991; 14: 51-6.
• 18. Jackson RJ, Fuller GN, Abi-Said D et al. Limitations of stereotactic biopsy in the initial management of gliomas. Neuro-oncol. 2001; 3: 193-200. 19. Quick-Weller J, Lescher S, Kashefiolasl S, Weise LM, Seifert V, Marquardt G. Benefit of Stereotactic Procedures in a Series of 43 Children. J Child Neurol. 2016; 31: 907-12.
• 20. Eibach S, Weise L, Setzer M, Seifert V, Senft C. Intraoperative bleeding in stereotactic biopsies and its implication on postoperative management: can we predict CT findings? Stereotact Funct Neurosurg. 2014; 92: 80-5.
• 21. Kulkarni AV, Guha A, Lozano A, Bernstein M. Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy. J Neurosurg. 1998; 89:31-5.
• 22. Scerrati M, Rossi GF. The reliability of stereotactic biopsy. Acta Neurochir Suppl. 1984; 33:201-5.
• 23. Apuzzo ML, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: Experience and perspective related to 500 procedures applied to brain masses. Neurosurgery. 1987; 20: 930-7.
• 24. Bernstein M, Parrent AG. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg. 1994; 81: 165-8. 25. Mundinger F. CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir. Suppl. 1985; 35:70-74.