title: Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review.
abstract: BACKGROUND
  Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children.
  
  
  METHODS
  The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed.
  
  
  RESULTS
  Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series.
  
  
  CONCLUSIONS
  Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Manoj
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Arivazhagan
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: D I
authors.initials: DI
authors.lastname: Bhat
authors.affiliation: Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: H R
authors.initials: HR
authors.lastname: Arvinda
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: V
authors.initials: V
authors.lastname: Santosh
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: B Indira
authors.initials: BI
authors.lastname: Devi
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Sampath
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
authors.forename: B A
authors.initials: BA
authors.lastname: Chandramouli
keywords: Age group difference; brainstem lesion; pathology; pediatric; stereotactic biopsy
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