The role of image-directed biopsy in the diagnosis and management of brainstem lesions.
The appreciation that brainstem tumours do not comprise a homogeneous pathological group and that up to 20% of the preoperative radiological diagnoses of brainstem lesions prove at operation to be wrong, has established the need for a firm histological diagnosis prior to treatment. Current neuro-imaging modalities may have increased the diagnostic accuracy and the detection rate of intrinsic brainstem lesions, but open exploration in cases without an exophytic component is still associated with a low diagnostic yield and considerable morbidity. A series of 72 brainstem lesions approached stereotactically with CT or MRI guidance is presented. A transcortical frontal precoronal trajectory was used in 58 and a suboccipital transcerebellar route in 14. Haematoma was diagnosed preoperatively in 16 cases and therapeutic aspiration was planned. In 56 cases the diagnosis was uncertain, although intrinsic tumour was suspected. A histological diagnosis was established in 52 cases, although in the remaining four cases a tumour was excluded. Unexpected findings occurred in over 15% of the cases. There were no operative deaths and the morbidity was low. In no case was there a permanent neurological deterioration directly related to the procedure, although there was a transient deterioration in two patients and another patient required early re-aspiration of a haematoma.
Gough Cooper Department of Neurological Surgery, National Hospitals for Neurology and Neurosurgery, London, UK.
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Kratimenos
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Thomas
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle / Q000295:instrumentation*; D001927:Brain Diseases / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*