Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients.
BACKGROUND
There is no consensus on the indications for stereotactic biopsy for brain stem masses in children.


OBJECTIVE
We analyzed the results of stereotactic biopsy for brain stem masses in 106 consecutive children to define current indications for this surgery.


METHODS
We performed a retrospective review of inpatient summaries, stereotactic worksheets and radiological investigations of 106 consecutive patients, under the age of 18 years, who underwent CT-guided stereotactic biopsies for brain stem lesions between 1987 and 2008. Patients were divided into two eras: era I from 1987 to 1997 and era II from 1998 to 2008.


RESULTS
91 children underwent a biopsy in era I, and 15 had the procedure in era II, this difference clearly indicating the impact of the availability of magnetic resonance imaging. There was no difference in the proportion of diffuse lesions biopsied in both eras. Astrocytoma was the most frequently diagnosed pathology in both eras accounting for nearly 90% of biopsies. Inflammatory masses were diagnosed in less than 10% of patients. There was no mortality or permanent morbidity. Mortality, on follow-up, in children with diffuse low- and high-grade astrocytoma was similar.


CONCLUSIONS
CT-guided stereotactic biopsy for brain stem masses in children is safe and is presently indicated in ruling out an inflammatory pathology of an enhancing mass of the brain stem.
Rajshekhar
Vedantam
V
Department of Neurological Sciences, Christian Medical College, Vellore, India. rajshekhar@cmcvellore.ac.in
Moorthy
Ranjith K
RK
D000293:Adolescent; D001706:Biopsy; D020295:Brain Stem Neoplasms / Q000473:pathology* / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*