Stereotactic Biopsy in Brain Lesions.

Kim, Jeong Eun; Kim, Dong Gyu

Original Article

Journal of Korean Neurosurgical Society 1997;26(8): 1050-1058.

Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea.

ABSTRACT

The authors present a retrospective analysis of 100 consecutive patients who between February 1993 and June 1996 underwent computed tomography(CT)-guided stereotactic biopsy using the Riechert-Mundinger system. The patients were aged between ten and 70(mean 41) years and the male-to-female ratio was 58 : 42. All were suffering from intracranial lesion(s) which had not been correctly diagnosed by CT and/or magnetic resonance(MR) imaging. Among these 100 patients, 102 stereotactic biopsy procedures were carried out ; in two cases, the procedure was repeated, due to initial failure. Diagnostic yield was 92%(94 procedures) and the accuracy by image was 100%. After biopsy, eleven glioma cases underwent craniotomy ; in ten of these(92%), the diagnosis was the same on craniotomy and on biopsy. The exception had on biopsy been diagnosed as anaplastic astrocytoma, but on craniotomy was diagnosed as anaplastic oligoastrocytoma. The treatment plan for 27 of 85 patients(31%) was changed after biopsy. The mortality rate was 1%(one case) ; after biopsy, a patient with brain abscess and impending herniation died due to progressive brain edema. The morbidity rate was 7%(seven cases) ; one patient showed transient symptoms of increased intracranial pressure, five showed transient weakness, and one, transient speech disturbance. In conclusion, our system for CT-guided stereotactic biopsy is highly diagnostic, accurate, effective for treatment planning, and in diagnosing brain lesions, does not damage tissue. The possible causes and the solutions for non-specific diagnoses are also discussed.

Key Words: Stereotactic biopsy; Computed tomography; Diagnostic yield; Accuracy; Treatment; ComplicatioX