Abstract
Brain biopsy is well established in clinical practice when there is suspicion of CNS malignancy. However, there is little consensus regarding the indications for brain biopsy in non-malignant neurological disease. This is due in no small part to limitations in the available literature pertaining to diagnostic brain biopsies. The published evidence largely comprises small, retrospective, single-centre analyses performed over long time periods, including non-homogeneous patient groups with considerable variation in reported outcomes. Here we present pragmatic guidance for those clinicians considering diagnostic brain biopsy in a patient with non-neoplastic neurological disease and highlight practice points with the aim of maximising the probability of gaining clinically useful information from the procedure.
References
Hall WA (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:1749–1755
Kim JE, Kim DG, Paek SH, Jung HW (2003) Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment Acta Neurochir(Wien) 145:547–554
Tilgner J, Herr M, Ostertag C, Volk B (2005) Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis–influence of clinical factors. Neurosurgery 56:257–265
Nielsen CJ, Gjerris F, Pedersen H, Jensen FK, Wagn P (1994) Brain biopsy in AIDS diagnostic value and consequence. Acta Neurochir (Wien) 127:99–102
Antinori A, Ammassari A, Luzzati R, Castagna A, Maserati R, Rizzardini G, Ridolfo A, Fasan M, Vaccher E, Landonio G, Scerrati M, Rocca A, Butti G, Nicolato A, Lazzarin A, Tirelli U (2000) Role of brain biopsy in the management of focal brain lesions in HIV-infected patients Gruppo Italiano Cooperativo AIDS and Tumori. Neurology 54:993–997
Hornef MW, Iten A, Maeder P, Villemure JG, Regli L (1999) Brain biopsy in patients with acquired immunodeficiency syndrome: diagnostic value, clinical performance, and survival time. Arch Intern Med 159:2590–2596
Vidal JE, Dauar RF, de Oliveira AC ((2008)) Utility of brain biopsy in patients with acquired immunodeficiency syndrome before and after introduction of highly active antiretroviral therapy. Neurosurgery 63:E1209 author reply E1209
Whittle IR, Leen C (1998) Brain biopsy in AIDS patients: what are the indications? Br J Neurosurg 12:301–304
Schott JM, Reiniger L, Thom M, Holton JL, Grieve J, Brandner S, Warren JD, Revesz T (2010) Brain biopsy in dementia: clinical indications and diagnostic approach. Acta Neuropathol 120:327–341
Warren JD, Schott JM, Fox NC, Thom M, Revesz T, Holton JL, Scaravilli F, Thomas DG, Plant GT, Rudge P, Rossor MN (2005) Brain biopsy in dementia. Brain 128:2016–2025
Josephson SA, Papanastassiou AM, Berger MS, Barbaro NM, McDermott MW, Hilton JF, Miller BL, Geschwind MD (2007) The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia. J Neurosurg 106:72–75
Elbers J, Halliday W, Hawkins C, Hutchinson C, Benseler SM (2010) Brain biopsy in children with primary small-vessel central nervous system vasculitis. Ann Neurol 68:602–610
Alrawi A, Trobe JD, Blaivas M, Musch DC (1999) Brain biopsy in primary angiitis of the central nervous system. Neurology 53:858–860
Alreshaid AA, Powers WJ (2003) Prognosis of patients with suspected primary CNS angiitis and negative brain biopsy. Neurology 61:831–833
Heinemann U, Krasnianski A, Meissner B, Kallenberg K, Kretzschmar HA, Schulz-Schaeffer W, Zerr I (2008) Brain biopsy in patients with suspected Creutzfeldt-Jakob disease. J Neurosurg 109:735–741
Mahadevan A, Shankar SK, Yasha TC, Santosh V, Sarkar C, Desai AP, Satishchandra P (2002) Brain biopsy in Creutzfeldt-Jakob disease: evolution of pathological changes by prion protein immunohistochemistry. Neuropathol Appl Neurobiol 28:314–324
Burns JD, Cadigan RO, Russell JA (2009) Evaluation of brain biopsy in the diagnosis of severe neurologic disease of unknown etiology. Clin Neurol Neurosurg 111:235–239
Pulhorn H, Quigley DG, Bosma JJ, Kirollos R, du Plessis DG, Jenkinson MD (2008) Impact of brain biopsy on the management of patients with nonneoplastic undiagnosed neurological disorders. Neurosurgery 62:833–837
Schuette AJ, Taub JS, Hadjipanayis CG, Olson JJ (2010) Open biopsy in patients with acute progressive neurologic decline and absence of mass lesion. Neurology 75:419–424
Venkateswaran S, Hawkins C, Wassmer E (2008) Diagnostic yield of brain biopsies in children presenting to neurology. J Child Neurol 23:253–258
Wong SH, Jenkinson MD, Faragher B, Thomas S, Crooks D, Solomon T (2010) Brain biopsy in the management of neurology patients. Eur Neurol 64:42–45
Rice CM, Gilkes CE, Teare E, Hardie RJ, Scolding NJ, Edwards RJ (2011) Brain biopsy in cryptogenic neurological disease. Br J Neurosurg 25:614–620
Burns JD, Cadigan RO, Russell JA (2009) Evaluation of brain biopsy in the diagnosis of severe neurologic disease of unknown etiology. Clin Neurol Neurosurg 111:235–239
Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJ, Vincent AJ (2008) Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 150:23–29
Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD (2006) Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 104:233–237
Acknowledgments
CMR gratefully acknowledges the support of the National Institute for Health Research and The Burden Neurological Institute.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gilkes, C.E., Love, S., Hardie, R.J. et al. Brain biopsy in benign neurological disease. J Neurol 259, 995–1000 (2012). https://doi.org/10.1007/s00415-012-6455-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-012-6455-0