Stereotactic biopsy for brain lesions: Doing more with less

Area of Science:

• Neurosurgery
• Neuropathology
• Diagnostic Imaging

Background:

• Stereotactic biopsy (STB) is a minimally invasive diagnostic tool with high yield and low complication rates.
• Advancements in frame-based and frameless systems have improved clinical applicability.
• STB can be performed even in resource-limited settings, offering cost-effective diagnoses.

Purpose of the Study:

• To evaluate the efficacy and outcomes of STB for patients with intracranial lesions.
• To highlight the utility of performing STB under scalp block anesthesia.
• To identify risk factors affecting STB outcomes and analyze their impact on prognosis.

Main Methods:

• Retrospective analysis of 20 patients undergoing STB between January 2018 and December 2022.
• Procedures performed using the Cosman Roberts Wells® stereotactic frame.
• Pre- and post-procedure imaging (MRI, CT) used for target identification and confirmation.

Main Results:

• A definitive diagnosis was achieved in 95% of patients (19/20) on the first STB.
• Common diagnoses included glioma (55%), CNS lymphoma, tuberculosis, demyelinating disorders, and metastatic tumors.
• Most post-operative complications were transient, with one case of motor weakness deterioration.

Conclusions:

• Stereotactic biopsy is an effective method for diagnosing deep-seated or multifocal lesions in or near eloquent brain regions.
• The procedure aids in definitive diagnosis, prognosis, and guiding adjuvant therapy.
• STB is a valuable tool for managing challenging intracranial pathologies.