Avoiding empiric therapy for brain masses in Indian patients using CT-guided stereotaxy

Empiric therapy, especially antituberculous therapy, is frequently given to Indian patients with brain masses. This report documents our experience in avoiding such therapy using CT-guided stereotaxy. Out of 101 procedures done on 99 patients with brain masses, 80 were done to obtain a histological diagnosis and 21 for therapeutic purposes. There was no mortality and 2% morbidity. A positive diagnosis was obtained in 94% (75/80) of patients undergoing a biopsy. Diagnosis of tuberculous lesions was based mainly on the presence of acid-fast bacilli in the biopsy specimen or pus. In six patients the radiological diagnosis was wrong and in one the diagnosis was not certain. Inappropriate therapy was given to three patients, on the basis of a CT or MRI scan, before a biopsy was done. It is essential that a histological diagnosis be obtained in all patients with brain masses and there is no role for empirical therapy except in isolated cases.