title: Computerized tomography and magnetic resonance guided stereotactic brain biopsy in nonimmunocompromised and AIDS patients.
abstract: BACKGROUND
  The utility of stereotactic brain biopsy (SBB) in AIDS patients still remains controversial. The authors investigated SBB-related diagnostic accuracy, complications, and postoperative sequelae in nonimmunocompromised (NIC) patients and AIDS patients. The role of bioptic yield in treatment planning was also studied in AIDS patients.
  
  
  METHODS
  From 1990-95, 200 computerized tomography (CT) or magnetic resonance imaging (MRI)-guided SBBs were performed in our Department; 172 bioptic procedures were performed in NIC patients (169), and 28 SBBs in AIDS patients (27). The statistical significance was evaluated using the Fisher exact t-test.
  
  
  RESULTS
  SBB accuracy was very high in both NIC (94.8%) and AIDS (92.9%) patients. Statistical analysis indicated nonsignificant (NS) differences between the two study groups (P > 0.05). Diagnostic yield resulted higher in contrast-enhancing (CE) brain lesions (98.6% in NIC and 95.0% in AIDS patients; P > 0.05; NS), than in non-CE lesions (74.1% in NIC and 87.5% in AIDS patients; P > 0.05; NS). The overall complication rate was similar in both groups (17.2% in NIC and 14.8% in AIDS patients, P > 0.05, NS). The most frequent complication was hemorrhage, with statistically negligible differences between the two study groups (P > 0.05). The frequency of complications involving minor/major morbidity or mortality was very low in NIC (5.9%, 0.6%, and 2.4%, respectively), and in AIDS (3.7%, 7.4%, and 0.0%, respectively) patients. Regarding the therapeutic impact of bioptic diagnosis for neuro-AIDS patients, the preoperative treatment attitude was modified in 23/27 cases (85.2%), and the empiric anti-toxoplasmosis regimen was changed or withdrawn in 17/21 patients (81.0%).
  
  
  CONCLUSIONS
  Our experience demonstrated SBB to be an accurate, manageable, and reasonably safe diagnostic tool in both NIC and AIDS patients. These results suggest also that timely SBB indication in selected AIDS patients, reaching an early diagnosis, may on one side prevent unnecessary and potentially toxic empiric therapeutic regimens, and on the other address the appropriate treatment, thereby improving length and quality of life in such patients.
authors.affiliation: Department of Neurosurgery, University Hospital, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nicolato
authors.forename: M
authors.initials: M
authors.lastname: Gerosa
authors.forename: E
authors.initials: E
authors.lastname: Piovan
authors.forename: C
authors.initials: C
authors.lastname: Ghimenton
authors.forename: R
authors.initials: R
authors.lastname: Luzzati
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.forename: A
authors.initials: A
authors.lastname: Bricolo
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000821:virology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed