title: Diagnostic Yield and Safety of Brain Biopsy for Suspected Primary Central Nervous System Angiitis.
abstract: The utility and safety of brain biopsy for suspected primary angiitis of the central nervous system (PACNS) are uncertain. Factors predictive of a positive biopsy have not been well described. Our aim was to evaluate the diagnostic yield and safety of brain biopsy in suspected PACNS and determine whether any prebiopsy variables are associated with a positive biopsy.
  
  
  
  This is a retrospective study of consecutive patients who underwent diagnostic brain biopsy for PACNS at a single institution. The relationship between biopsy yield and patient demographics, surgical technique, laboratory testing, neuroimaging, biopsy characteristics, and prebiopsy immunosuppressive therapy were examined.
  
  
  
  PACNS was confirmed in 9 of 79 patients (11%). Biopsy identified alternative diagnoses in 24 patients (30%), with cerebral amyloid angiopathy (8 patients), encephalitis (5 patients), demyelination (3 patients), and CNS lymphoma (3 patients) most commonly found. There was no correlation between a positive biopsy and cerebrospinal fluid results, neuroimaging, surgical technique, biopsy characteristics, or preoperative immunosuppressive therapy. Smaller biopsies (P=0.02) and closed procedures (P=0.013) were less likely to yield a diagnosis. Postoperative complications occurred in 13 patients (16%), 3 (4%) of which were serious.
  
  
  
  Brain biopsy leads to pathological confirmation of vasculitis in a minority of suspected PACNS cases but alternative diagnoses are often identified. Importantly, rare but meaningful complications may occur.
authors.affiliation: From the Department of Neurology, NYU Langone Medical Center, NY (J.T.); Department of Neurology, Yale-New Haven Hospital, CT (C.L.); Department of Neurology (B.C.), Department of Neurosurgery (M.S.), and Department of Neurology (S.M.), University of Pennsylvania, Philadelphia, PA. jose.torres2@nyumc.org.
authors.forename: Jose
authors.initials: J
authors.lastname: Torres
authors.affiliation: From the Department of Neurology, NYU Langone Medical Center, NY (J.T.); Department of Neurology, Yale-New Haven Hospital, CT (C.L.); Department of Neurology (B.C.), Department of Neurosurgery (M.S.), and Department of Neurology (S.M.), University of Pennsylvania, Philadelphia, PA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Loomis
authors.affiliation: From the Department of Neurology, NYU Langone Medical Center, NY (J.T.); Department of Neurology, Yale-New Haven Hospital, CT (C.L.); Department of Neurology (B.C.), Department of Neurosurgery (M.S.), and Department of Neurology (S.M.), University of Pennsylvania, Philadelphia, PA.
authors.forename: Brett
authors.initials: B
authors.lastname: Cucchiara
authors.affiliation: From the Department of Neurology, NYU Langone Medical Center, NY (J.T.); Department of Neurology, Yale-New Haven Hospital, CT (C.L.); Department of Neurology (B.C.), Department of Neurosurgery (M.S.), and Department of Neurology (S.M.), University of Pennsylvania, Philadelphia, PA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Smith
authors.affiliation: From the Department of Neurology, NYU Langone Medical Center, NY (J.T.); Department of Neurology, Yale-New Haven Hospital, CT (C.L.); Department of Neurology (B.C.), Department of Neurosurgery (M.S.), and Department of Neurology (S.M.), University of Pennsylvania, Philadelphia, PA.
authors.forename: Steven
authors.initials: S
authors.lastname: Messé
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D012189:Retrospective Studies; D012449:Safety; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology
keywords: PACNS; biopsy; brain; central nervous system; vasculitis