title: Stereotactic biopsy for brainstem tumors: comparison of transcerebellar with transfrontal approach.
abstract: BACKGROUND
  An important aspect of evaluating patients submitted to stereotactic biopsy of the brainstem is the trajectory used. The literature describes two principal approaches: the suboccipital transcerebellar and the transfrontal; however, no studies exist comparing these two techniques.
  
  
  OBJECTIVE
  The purpose of this study was to compare diagnosis success rates and complications between the suboccipital transcerebellar and transfrontal trajectories.
  
  
  METHODS
  The study evaluated 142 patients submitted to stereotactic biopsy. The patients presented brainstem tumors in the following areas: pons (n = 31), midbrain (n = 36), medulla (n = 2), pons-medulla (n = 30), pons-midbrain (n = 33), and midbrain-pons-medulla (n = 10). On 123 patients, the transfrontal approach was used, and on 19 the suboccipital transcerebellar approach.
  
  
  RESULTS
  Comparing success rates between the two approaches, it was observed that in the group of patients submitted to the transfrontal approach, 95.1% (117 cases) were successful, while in those submitted to the suboccipital transcerebellar approach, 84.2% (16 cases) were successful. Despite a higher success rate among patients in the first group, the difference was not statistically significant. Regarding complications, in patients who were biopsied via the transfrontal trajectory, the morbidity rate was 9.8% (12 cases), while in patients submitted to the suboccipital transcerebellar approach, the morbidity rate was 5.3% (1 case) and the mortality rate 5.3% (1 case).
  
  
  CONCLUSIONS
  This study verified a higher diagnosis rate in patients submitted to the transfrontal approach than in those submitted to the suboccipital transcerebellar approach (95.1 vs. 84.2%); however, the difference was not statistically significant. Regarding complications, the rate was similar in both groups of patients.
authors.affiliation: Department of Neurosurgery, Hospital Roger Salengro, Lille, France. mdellaretti@mac.com
authors.forename: Marcos
authors.initials: M
authors.lastname: Dellaretti
authors.forename: Nicolas
authors.initials: N
authors.lastname: Reyns
authors.forename: Gustavo
authors.initials: G
authors.lastname: Touzet
authors.forename: François
authors.initials: F
authors.lastname: Dubois
authors.forename: Sebastião
authors.initials: S
authors.lastname: Gusmão
authors.forename: Júlio Leonardo Barbosa
authors.initials: JL
authors.lastname: Pereira
authors.forename: Serge
authors.initials: S
authors.lastname: Blond
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D001933:Brain Stem / Q000473:pathology*; D020295:Brain Stem Neoplasms / Q000473:pathology*; D002525:Cerebellar Cortex; D005260:Female; D006801:Humans; D008297:Male; D013238:Stereotaxic Techniques