title: The role of biopsy in the management of patients with presumed diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline.
abstract: OBJECTIVE
  What is the optimal role of biopsy in the initial management of presumptive low-grade glioma in adults?
  
  
  METHODS
  Adult patients with imaging suggestive of a low-grade glioma.
  
  
  CONCLUSIONS
  
  
  
  METHODS
  Stereotactic biopsy is recommended when definitive surgical resection is limited by lesions that are deep-seated, not resectable, and/or located within eloquent cortex, or in patients unable to undergo craniotomy due to medical co-morbidities to obtain the critical tissue diagnosis needed for targeted treatment planning for patients with low-grade gliomas.
  
  
  OBJECTIVE
  What is the best technique for brain biopsy?
  
  
  METHODS
  Adult patients with imaging suggestive of a low-grade glioma.
  
  
  CONCLUSIONS
  
  
  
  METHODS
  Frameless and frame-based stereotactic brain biopsy for low-grade gliomas are recommended based on clinical circumstances as they provide similar diagnostic yield, diagnostic accuracy, morbidity, and mortality. It is recommended the surgeon consider advanced imaging techniques (e.g., perfusion, spectroscopy, metabolic studies) to target specific regions of interest to potentially improve diagnostic accuracy.
authors.affiliation: Rebound Orthopedics and Neurosurgery, 200 NE Mother Joseph Place, Suite 210, Vancouver, WA, 98664, USA. brian.ragel@gmail.com.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Ragel
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Ryken
authors.affiliation: Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Kalkanis
authors.affiliation: Department of Neurosurgery, Seton Brain and Spine Institute, Austin, TX, USA.
authors.forename: Mateo
authors.initials: M
authors.lastname: Ziu
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cahill
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Olson
mesh_terms: D006801:Humans; D001706:Biopsy / Q000379:methods; D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D019468:Disease Management; D019317:Evidence-Based Medicine; D005910:Glioma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods
keywords: Biopsy; Guidelines; Low-grade glioma; Stereotactic biopsy