Stereotactic Biopsy of Pineal Lesions.
BACKGROUND
Stereotactic biopsies are carried out to obtain tumor tissue of unknown entity from cerebral lesions. Thus, tumor tissue can be examined, resulting in correct diagnosis and treatment. These procedures go in hand with high accuracy, high diagnostic yield, and low complication rates.


OBJECTIVE
The aim of this study is to evaluate the results and complications of stereotactic biopsies carried out for lesions of the pineal region.


METHODS
We performed a retrospective analysis of our prospective database and included 14 patients who underwent stereotactic biopsy of a pineal lesion between 2006 and February 2016. The Leksell stereotactic frame was used in all patients, and entry and target points were calculated using the BrainLab stereotactic system. We evaluated histopathologic results and postoperative complications such as hydrocephalus and hemorrhage.


RESULTS
Histopathologic diagnosis was established in all patients. On postoperative computed tomography, 7 patients (50%) showed a circumscribed blood collection at the site of biopsy. Six patients (42.8%) required a cerebrospinal fluid drain preoperatively. Two patients needed external ventricular drain postoperatively (14.2%). One of these patients showed a small hemorrhage area that caused the hydrocephalus. The other patient showed only postoperative swelling. Preoperatively, 2 patients (14.2%) already had a ventriculoperitoneal (VP) shunt, whereas postoperatively, another 4 patients (28.5%) needed a VP shunt. Thus, of the 14 patients, 6 (42.8%) required a VP shunt.


CONCLUSIONS
Because of their localization, pineal lesions may result in emergence of a hydrocephalus. Stereotactic biopsies in this area may increase this effect and, thus, even VP shunts are necessary in some patients.
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany. Electronic address: johanna.quick@gmx.de.
Johanna
J
Quick-Weller
Institute for Neuroradiology, Goethe-University Frankfurt, Frankfurt, Germany.
Stephanie
S
Lescher
Edinger Institute, Institute of Neurology, Goethe-University Frankfurt, Frankfurt, Germany.
Peter
P
Baumgarten
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Nazife
N
Dinc
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Markus
M
Bruder
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Lutz
L
Weise
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Volker
V
Seifert
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Gerhard
G
Marquardt
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D016208:Databases, Factual; D004322:Drainage; D005260:Female; D018237:Germinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010870:Pineal Gland / Q000000981:diagnostic imaging / Q000473:pathology*; D010871:Pinealoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy
External ventricular drain; Hemorrhage; Hydrocephalus; Pineal lesion; Stereotactic biopsy; VP shunt