title: Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience.
abstract: OBJECTIVE
  Pineal tumours account for 1% to 4% of brain tumours in adults and for around 10% in children. Except in a few cases where germ cell markers are elevated, accurate histological samples are mandatory to initiate the treatment. Open surgery still has a high morbidity and is often needless. Biopsies can either be obtained by endoscopic or stereotactic procedures.
  
  
  METHODS
  Following an extensive review of the literature (PubMed 1970-2013; keywords pineal tumour, biopsy; English and French), 33 studies were analysed and relevant data compared regarding the type of procedure, diagnosis rate, cerebrospinal fluid diversion type and rate, perioperative mortality, morbidity.
  
  
  RESULTS
  Endoscopic and stereotactic biopsies showed a diagnosis rate of 81.1% (20%-100%) and 93.7% (82%-100%), respectively. Endoscopic biopsies involved 21.0% of minor and 2.0% of major complications whereas stereotactic biopsies involved 6.4% of minor and 1.6% of major complications. The most frequently reported complication was haemorrhage for both endoscopic and stereotactic procedures, accounting for 4.8% and 4.3%, respectively. Mortality rate was low for both endoscopic and stereotactic procedures, equal to 0.4% and 1.3%, respectively. Local experience of stereotactic biopsies was also reported and corroborated the previous data.
  
  
  CONCLUSIONS
  The difference between both procedures is not statistically significant (p>0.05) across large series (≥20patients). Nevertheless, tissue diagnosis appears less accurate with endoscopic procedures than with stereotactic procedures (81.1% versus 93.7%, weighted mean across all series). In our opinion, the neuroendoscopic approach is the best tool for managing hydrocephalus, whereas stereotactic biopsies remain the best way to obtain a tissue diagnosis with accuracy and low morbidity.
authors.affiliation: Service de neurochirurgie, CHRU de Lille, 59037 Lille, France; Service de neurochirurgie, CHU de Caen, 14000 Caen, France. Electronic address: balossier-a@chu-caen.fr.
authors.forename: A
authors.initials: A
authors.lastname: Balossier
authors.affiliation: Service de neurochirurgie, CHRU de Lille, 59037 Lille, France. Electronic address: serge.blond@chru-lille.fr.
authors.forename: S
authors.initials: S
authors.lastname: Blond
authors.affiliation: Service de neurochirurgie, CHRU de Lille, 59037 Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Touzet
authors.affiliation: Service de neurochirurgie, CHU d'Amiens, 80000 Amiens, France.
authors.forename: M
authors.initials: M
authors.lastname: Lefranc
authors.affiliation: Service de neurochirurgie, CHRU de Lille, 59037 Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: de Saint-Denis
authors.affiliation: Laboratoire d'anatomo-pathologie, CHRU de Lille, 59037 Lille, France.
authors.forename: C-A
authors.initials: CA
authors.lastname: Maurage
authors.affiliation: Service de neurochirurgie, CHRU de Lille, 59037 Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Reyns
mesh_terms: D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D010870:Pineal Gland / Q000473:pathology*; D010871:Pinealoma / Q000175:diagnosis* / Q000473:pathology*; D013238:Stereotaxic Techniques
keywords: Biopsie endoscopique; Biopsie stéréotaxique; Complication; Diagnosis accuracy; Endoscopic biopsy; Minimally invasive neurosurgery; Neurochirurgie mini-invasive; Pineal tumour; Précision diagnostique; Stereotactic biopsy; Tumeur de la région pinéale