Henri Malaizé1, Florence Laigle-Donadey2, Maximilien Riche1, Pauline Marijon1, Karima Mokhtari3,4, Franck Bielle3,4, Suzanne Tran3,4, Lucia Nichelli3, Kevin Beccaria5, Ahmed Idbaih2, Khê Hoang-Xuan2, Mehdi Touat2, Alexandre Carpentier1, Bertrand Mathon6,7. 1. Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France. 2. Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France. 3. Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France. 4. Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France. 5. Department of Pediatric Neurosurgery, University of Paris Cité, APHP, Necker - Enfants Malades Hospital, 75015, Paris, France. 6. Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France. bertrand.mathon@aphp.fr. 7. Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France. bertrand.mathon@aphp.fr.
Abstract
PURPOSE: This study aimed to assess the benefit-risk ratio by determining diagnostic yield and safety of brainstem biopsies in adult patients. The secondary objectives were (i) to compare brainstem biopsy safety and postbiopsy patients' outcomes and survival with those of patients biopsied for a brain or cerebellar lesion, and (ii) to assess the impact of brainstem biopsy on final diagnosis and further therapeutic management. METHODS: Among 1784 stereotactic biopsies performed in adult patients at a tertiary center between April 2009 and October 2020, we retrospectively examined 50 consecutive brainstem biopsies. We compared variables regarding diagnostic yield, safety and post-biopsy outcomes between brainstem biopsy patients and brain/cerebellum biopsy patients. RESULTS: Brainstem biopsy led to a diagnosis in 86% of patients (94.6% in patients with suspected tumor). Lesion contrast enhancement on imaging was the sole predictor of obtaining a diagnosis. Rates of symptomatic complications and mortality were significantly higher in brainstem biopsy patients compared to brain/cerebellum biopsy patients (20% vs 0%; p < 0.001 and 6% vs 0%; p = 0.01, respectively). Transfrontal trajectory and prebiopsy swallowing disorders were predictors of brainstem biopsy-related symptomatic complications. Brainstem biopsy findings led to diagnostic change in 22% of patients. CONCLUSIONS: Stereotactic biopsy in adult patients with brainstem lesion has a high diagnostic yield. Although stereotactic brainstem biopsy is associated with more functional and fatal complications than biopsies targeting the brain/cerebellum, its safety profile appears acceptable. Thus, the benefit-risk ratio of stereotactic biopsy in patients with brainstem lesion is favorable but should nevertheless be carefully weighted on a case-by-case basis.
PURPOSE: This study aimed to assess the benefit-risk ratio by determining diagnostic yield and safety of brainstem biopsies in adult patients. The secondary objectives were (i) to compare brainstem biopsy safety and postbiopsy patients' outcomes and survival with those of patients biopsied for a brain or cerebellar lesion, and (ii) to assess the impact of brainstem biopsy on final diagnosis and further therapeutic management. METHODS: Among 1784 stereotactic biopsies performed in adult patients at a tertiary center between April 2009 and October 2020, we retrospectively examined 50 consecutive brainstem biopsies. We compared variables regarding diagnostic yield, safety and post-biopsy outcomes between brainstem biopsy patients and brain/cerebellum biopsy patients. RESULTS: Brainstem biopsy led to a diagnosis in 86% of patients (94.6% in patients with suspected tumor). Lesion contrast enhancement on imaging was the sole predictor of obtaining a diagnosis. Rates of symptomatic complications and mortality were significantly higher in brainstem biopsy patients compared to brain/cerebellum biopsy patients (20% vs 0%; p < 0.001 and 6% vs 0%; p = 0.01, respectively). Transfrontal trajectory and prebiopsy swallowing disorders were predictors of brainstem biopsy-related symptomatic complications. Brainstem biopsy findings led to diagnostic change in 22% of patients. CONCLUSIONS: Stereotactic biopsy in adult patients with brainstem lesion has a high diagnostic yield. Although stereotactic brainstem biopsy is associated with more functional and fatal complications than biopsies targeting the brain/cerebellum, its safety profile appears acceptable. Thus, the benefit-risk ratio of stereotactic biopsy in patients with brainstem lesion is favorable but should nevertheless be carefully weighted on a case-by-case basis.
Authors: Elke Pfaff; Ahmed El Damaty; Gnana Prakash Balasubramanian; Mirjam Blattner-Johnson; Barbara C Worst; Sebastian Stark; Hendrik Witt; Kristian W Pajtler; Cornelis M van Tilburg; Ruth Witt; Till Milde; Martin Jakobs; Petra Fiesel; Michael C Frühwald; Pablo Hernáiz Driever; Ulrich W Thomale; Martin U Schuhmann; Markus Metzler; Konrad Bochennek; Thorsten Simon; Matthias Dürken; Michael Karremann; Stephanie Knirsch; Martin Ebinger; André O von Bueren; Torsten Pietsch; Christel Herold-Mende; David E Reuss; Karl Kiening; Peter Lichter; Angelika Eggert; Christof M Kramm; Stefan M Pfister; David T W Jones; Heidi Bächli; Olaf Witt Journal: Eur J Cancer Date: 2019-04-22 Impact factor: 9.162
Authors: Stephanie Puget; Kevin Beccaria; Thomas Blauwblomme; Thomas Roujeau; Syril James; Jacques Grill; Michel Zerah; Pascale Varlet; Christian Sainte-Rose Journal: Childs Nerv Syst Date: 2015-09-09 Impact factor: 1.475
Authors: José L Pérez-Gómez; Carlos A Rodríguez-Alvarez; Alfonso Marhx-Bracho; Fernando Rueda-Franco Journal: Childs Nerv Syst Date: 2009-09-26 Impact factor: 1.475