Stereotactic brain biopsy in human immunodeficiency virus-infected patients.
OBJECTIVE
To evaluate prospectively the diagnostic efficacy and safety of stereotactic brain biopsy and its impact on treatment, outcome, and survival in human immunodeficiency virus-infected patients with focal brain lesions.


METHODS
Computed tomography-guided stereotactic brain biopsy was performed in 26 patients, of whom 17 failed to respond to a 2- to 3-week anti- Toxoplasma regimen. Exclusion criteria for biopsy were overt acquired immunodeficiency syndrome for 2 years or longer, Karnofsky score less than 50, and severe coagulopathies.


RESULTS
A definitive diagnosis was obtained in 24 patients (92%), of whom 12 (46%) had primary brain lymphoma, six (23%) had progressive multifocal leukoencephalopathy, and four (15%) had Toxoplasma encephalitis. Two thirds of contrast-enhancing lesions on computed tomography were lymphoma and three fourths of contrast-negative lesions were leukoencephalopathy. Three patients had biopsy-related cerebral hemorrhages (morbidity, 11.5%). Median follow-up and survival for the entire group were 24 weeks (range, 6 to 135 weeks). Twenty patients (77%) received specific therapy and 13 (50%) responded to treatment. Of 11 patients with lymphoma undergoing irradiation treatment (whole-brain radiotherapy in seven and gamma-knife treatment in four), nine (82%) had clinical and radiologic response, with a median survival of 34 weeks (range, 13 to 57 weeks).


CONCLUSIONS
Stereotactic brain biopsy has high diagnostic efficacy and clinical benefit in carefully selected human immunodeficiency virus-infected patients. The procedure should be performed essentially in patients with contrast-enhancing lesions on computed tomography who have a high frequency of treatable cerebral diseases.
Luzzati
R
R
Institute of Immunology and Infectious Diseases, University of Verona, Italy.
Ferrari
S
S
Nicolato
A
A
Piovan
E
E
Malena
M
M
Merighi
M
M
Morbin
M
M
Gerosa
M
M
Rizzuto
N
N
Concia
E
E
D000328:Adult; D001707:Biopsy, Needle; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000821:virology*; D001927:Brain Diseases / Q000401:mortality / Q000473:pathology* / Q000628:therapy / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015497:HIV-1; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013238:Stereotaxic Techniques / Q000295:instrumentation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome