Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Abstract

Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill patients with neurologic diseases of unknown etiology. We also aimed to compare these endpoints to those of non-ICU patients who underwent a brain biopsy in the same clinical context. DESIGN: Monocenter, retrospective, observational cohort study. SETTING:A French tertiary center. PATIENTS:All adult patients with neurologic diseases of unknown etiology under mechanical ventilation undergoing in-ICU brain biopsy between January 2008 and October 2020 were compared with a cohort of non-ICU patients. INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Among the 2,207 brain-biopsied patients during the study period, 234 biopsies were performed for neurologic diseases of unknown etiology, including 29 who were mechanically ventilated and 205 who were not ICU patients. Specific histological diagnosis and final diagnosis rates were 62.1% and 75.9%, respectively, leading to therapeutic management modification in 62.1% of cases. Meningitis on prebiopsy cerebrospinal fluid analysis was the sole predictor of obtaining a final diagnosis (2.3 [1.4-3.8]; p = 0.02). ICU patients who experienced therapeutic management modification after the biopsy had longer survival (p = 0.03). The grade 1 to 4 (mild to severe) complication rates were: 24.1%, 3.5%, 0%, and 6.9%, respectively. Biopsyrelated mortality was significantly higher in ICU patients compared with non-ICU patients (6.9% vs 0%; p = 0.02). Hematological malignancy was associated with biopsy-related mortality (1.5 [1.01-2.6]; p = 0.04). CONCLUSIONS:Brain biopsy in critically ill patients with neurologic disease of unknown etiology is associated with high diagnostic yield, therapeutic modifications and postbiopsy survival advantage. Safety profile seems acceptable in most patients. The benefit/risk ratio of brain biopsy in this population should be carefully weighted.

Méningites et encéphalites graves : prise en charge initiale en réanimation

“…En effet, devant une encéphalite d'étiologie indéterminée, la biopsie cérébrale a pu être associée à un rendement diagnostique élevé, à des modifications thérapeutiques et à un avantage en termes de survie après la biopsie. Ceci doit donc en faire discuter le rapport bénéfice/risque [26]. Le recours à la biopsie cérébrale est cependant rarement nécessaire et nécessite, outre l'absence de contre-indications, l'existence de lésions cérébrales accessibles.…”

Comparison of Navigated and Frame-Based Stereotactic Biopsy—A Single-Center Cohort Study

“…Brain biopsy (BB) has become one of the most important surgical procedures in the management of patients with suspected brain neoplastic lesions. It is also one of the most frequently performed procedures in neurosurgical centers [ 1 ]. BBs are used to obtain tissue for histological and genetic examination.…”