Background: Stereotactic brain biopsy is considered by many physicians to have significant morbidity and mortality rates with a high risk of sampling error resulting in misdiagnosis. The technical aspects necessary to perform the procedure safely and effectively are unfamiliar to most physicians.
Methods: After reporting his initial results with stereotactic brain biopsy, several modifications were implemented by the author to improve the morbidity, mortality, and diagnostic yield rates, including complex surgical planning with regard to patient selection, biopsy trajectory, imaging technique, target choice, and intraoperative pathologic review. The results of implementing these modifications were examined retrospectively in 134 consecutive brain biopsies.
Results: One hundred and thirty-four stereotactic brain biopsies were performed in 122 patients. Computed tomography guidance was used in 85 patients (63%) and magnetic resonance imaging was used in 49 patients (37%). Sixty-four lesions (48%) were located in the right hemisphere, 61 (45%) in the left, and 9 (7%) in the midline. The most common diagnoses included 62 malignant brain tumors (46%), 24 benign brain tumors (18%), 23 neurologic disorders (17%), and 20 infections (15%). Five biopsies (4%) did not demonstrate a pathologic process for an overall diagnostic yield of 96%. Reasons for diagnostic failure included lesion location adjacent to the ventricular system, inaccurate targeting, and the inability to penetrate the tumor. One patient sustained a neurologic deficit after the biopsy for a morbidity rate of 0.7% and one sustained a fatal hemorrhage during the biopsy of a vascular tumor for a mortality rate of 0.7%. These results are comparable to those reported in 7471 biopsies (current series included) in which the morbidity rate was 3.5%, the mortality rate was 0.7%, and the diagnostic yield was 91%.
Conclusions: Stereotactic brain biopsy is an extremely safe and effective procedure for evaluating intracranial lesions. Complex surgical planning can decrease the risk of potential complications and the use of intraoperative pathologic examination can improve the diagnostic yield for this procedure.