Safety and efficacy of brainstem biopsy in children and young adults

• Published in: Journal of neurosurgery. Pediatrics Vol. 26; no. 5; p. 552
• Main Authors: Hersh, David S, Kumar, Rahul, Moore, Kenneth A, Smith, Luke G F, Tinkle, Christopher L, Chiang, Jason, Patay, Zoltan, Gajjar, Amar, Choudhri, Asim F, Lee-Diaz, Jorge A, Vaughn, Brandy, Klimo, Paul
• Format: Journal Article
• Language: English
• Published: United States 01.11.2020
• Subjects: biopsy; brainstem; stereotactic; intraoperative MRI; oncology
• ISSN: 1933-0715
• DOI: 10.3171/2020.4.peds2092

Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection. All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected. A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis. Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.