Stereotactic Brainstem Biopsy Is Indicated for the Diagnosis of a Vast Array of Brainstem Pathology

Abstract

Background/Aims: A meta-analysis of thirteen studies performing stereotactic biopsy of brainstem lesions is combined with our recent series of 12 patients with brainstem lesions comparing MRI findings to biopsy histopathology to determine whether these lesions could have been diagnosed radiographically. Methods: 12 consecutive stereotactic biopsies and literature analysis were performed to analyze clinical, radiographic and histopathologic data. Results: Stereotactic biopsy of lesions in the brainstem was in 96% diagnostic. There was one mortality (3% of cases) and 4% morbidity associated with the procedure. Pathology showed that half of the adult brainstem intrinsic lesions were gliomas, 10% were metastases, and the remainder were hematomas, vascular malformations, lymphomas, demyelination, cysts, radiation necrosis, abscesses, vasculitis, infarcts, leukemia, cryptococcus, or granulomas. Conclusions: Empiric treatment of adult brainstem lesions is not prudent because there is a wide spectrum of diverse pathology in this location. Stereotactic biopsy is a safe and effective method for determining histopathology.