title: Safety and diagnostic accuracy of neuroendoscopic biopsies: an international multicenter study.
abstract: OBJECTIVE
  Analysis of the safety and morbidity of neuroendoscopic biopsies (NEBs), as well as the reliability in obtaining an accurate diagnosis, has until now been based on studies with relatively small sample sizes. Through the cooperative efforts of several international medical centers, authors of the present study collected data on a large number of patients to obtain better insight into this issue. When possible, they compared pathology obtained through an NEB with the "gold-standard" pathology obtained in open surgery.
  
  
  METHODS
  Thirteen randomly chosen medical centers in 9 countries collected data for patients who had undergone NEB, which were then analyzed for universal complications, bleeding, navigation technique, pathology, mismatch between biopsy results and final diagnosis, and a number of other potentially influential factors.
  
  
  RESULTS
  Data for 293 patients were analyzed. Sixty percent of the patients were male, and patient ages ranged from 0.1 to 78.7 years (median age 20.4 years). The most common tumor locations were pineal (33.1%), thalamic (16.7%), tectal (13%), and hypothalamic (4.4%). Fifty percent of the tumors were larger than 20 mm, 36% were between 10 and 20 mm, and 14% were smaller than 10 mm. Intraoperative bleeding was seen in 275 patients (94%). The amount of blood was noted as mild in 75%, moderate in 13%, and severe in 6%. Infection occurred in 8 patients (3%). Death occurred in 1 patient (0.3%), which was caused by severe intraoperative bleeding. Biopsies were informative in 265 patients (90.4%). Seventy-eight patients (26.6%) had open surgery following the NEB. For these patients, the pathology results from the NEB were compared with those from the open surgery that followed. In 14 cases (17.9%) there was disagreement on the pathology. Of these cases, a meaningful mismatch, in which the erroneous NEB pathology could have led to an inappropriate management decision, occurred in 9 cases (11.5%). Most of these meaningful mismatches were lesions diagnosed as low-grade or pilocytic astrocytoma on the NEB and later proved to be high-grade astrocytoma (4 cases) and 1 case each of meningioma, cavernoma, primitive neuroectodermal tumor, neurocysticercosis, and pineocytoma.
  
  
  CONCLUSIONS
  In experienced hands, NEBs can be performed with low morbidity and mortality, providing meaningful pathological data for the majority of patients with a wide range of tumor types, locations, and presentations. These biopsies also offer other advantages, such as the ability to perform concomitant endoscopic third ventriculostomy and septum pellucidotomy. However, due caution must be maintained, since pathology obtained from an NEB, as with stereotactic biopsies, may be subject to sampling errors, especially when the results seem to indicate a low-grade glial tumor.
authors.affiliation: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. sconsts@netvision.net.il
authors.forename: Shlomi
authors.initials: S
authors.lastname: Constantini
authors.forename: Aaron
authors.initials: A
authors.lastname: Mohanty
authors.forename: Samuel
authors.initials: S
authors.lastname: Zymberg
authors.forename: Sergio
authors.initials: S
authors.lastname: Cavalheiro
authors.forename: Conor
authors.initials: C
authors.lastname: Mallucci
authors.forename: Dieter
authors.initials: D
authors.lastname: Hellwig
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ersahin
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mori
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mascari
authors.forename: José Aloysio Costa
authors.initials: JA
authors.lastname: Val
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Spyros
authors.initials: S
authors.lastname: Sgouros
authors.forename: Shizuo
authors.initials: S
authors.lastname: Oi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020542:Third Ventricle; D014696:Ventriculostomy