The Role of Stereotactic Frame-Based Biopsy for Brainstem Tumors in the Era of Molecular-Based Diagnosis and Treatment Decisions

Abstract

Stereotactic frame-based brain tumor biopsy (SFB) is a potent diagnostic tool considering its minimal invasiveness, though its diagnostic power and safety for brainstem lesions remain to be discussed. Here, we aimed to examine the usefulness of SFB for brainstem tumors. Twenty-two patients with brainstem tumors underwent 23 SFBs at our institution during 2002–2021. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including surgery-related complications and the diagnostic value. Seven (32%) tumors were located from the midbrain to the pons, eleven (50%) in the pons only, and four (18%) from the pons to the medulla oblongata. The target lesions were in the middle cerebellar peduncles in sixteen procedures (70%), the cerebellum in four (17%), the inferior cerebellar peduncles in two (9%), and the superior cerebellar peduncles in one (4%). A definitive diagnosis was made in 21 patients (95%) at the first SFB. The diagnoses were glioma in seventeen (77%) cases, primary central nervous system lymphoma in four (18%), and a metastatic brain tumor in one (5%). The postoperative complications (cranial nerve palsy in three [13%] cases, ataxia in one [4%]) were all transient. SFB for brainstem tumors yields a high diagnostic rate with a low risk of morbidity.

Development and external validation of dual online tools for prognostic assessment in elderly patients with high-grade glioma: a comprehensive study using SEER and Chinese cohorts

“…This study demonstrates poor prognosis for gliomas located in the cerebellum and brainstem, consistent with previous studies (28,29), maybe attributable to surgical challenges, disruption of critical functional regions, heightened tumor invasiveness, increased postoperative complications, and reduced efficacy of adjuvant therapies. The cerebellum and brainstem comprise critical functional hubs, conferring substantial surgical risks that often preclude total tumor resection.…”

Stereotactic frame-based biopsy of infratentorial lesions via the suboccipital-transcerebellar approach with the Zamorano-Duchovny stereotactic system—a retrospective analysis of 79 consecutive cases

“…Overall, 5.1% showed transient deficits, and 3.8% permanent deficits, respectively. Compared to other published literature, our complication rate is within the typical range [ 8 , 10 , 15 , 16 , 23 ]. Undoubtedly, the complication rate for brainstem/cerebellar biopsies is higher than at supratentorial target points.…”

A prospective study of outcome of CT-Scan-Guided stereotactic biopsy for brain pathology.

“…10 In the past even the biopsy of brain stem was not possible but in recent years the biopsy of brain stem can be with minimal side effects with a high diagnostic rate and low morbidity. 11,12 The success of obtaining positive brain biopsy was 95.2% in the following study, with the complication rate of 3.6%. stereotactic brain biopsy was considered safe method in diagnosing lesions specially deeply located lesions.…”