We sought to review safety and clinical utility of brainstem biopsy and resection with the aim of providing relevant data for clinicians advising patients of potential risks and benefits.
Retrospective review of consecutive cases undergoing brainstem biopsy or resection between January 2006 and March 2014 in a UK regional neurosciences centre was undertaken jointly by a neurologist and neurosurgeon.
Seventy one procedures (23 biopsies, 17 subtotal resections, 31 gross total resections) were performed in 59 patients – 23 children and 36 adults. A histological diagnosis was made on 87% biopsies and 95.8% resections. No deaths were attributed to surgery. No permanent complications occurred in those undergoing brainstem biopsy. Permanent complications were experienced by 41.2% of patients undergoing subtotal resection and 32.3% of individuals with gross total resection. MRI confidently differentiated between benign and malignant lesions but differentiating between post-radiotherapy/surgical change and tumour recurrence/progression as well as determination of tumour grade and, molecular and genomic characterisation required tissue analysis.
Our study demonstrates the remarkable safety of brainstem biopsy, and its persistent clinical utility despite advances in neuroimaging. The risks of larger resections are highlighted and it is hoped that, with improved targeting of neuro-oncological treatments, the need for these will reduce.