Computed tomography-guided intracranial biopsy and cyst aspiration.

A coordinated series of instruments has been developed for use in computed tomography (CT)-guided brain lesion biopsy and cyst aspiration: a plastic guide needle that is relatively free of CT artifacts, a ball-and-socket holding device for multidirectional sampling, and an aspiration-cutting biopsy needle that reliably produces consistent cores of tissue. Twenty-six biopsy and/or aspiration procedures have been performed on 24 patients with an overall biopsy success rate of 79%. The method is most reliable with highly malignant astrocytomas and least reliable with metastases and unusual primary tumors. There were 3 complications: 2 intratumoral hematomas and 1 death due to hemorrhage. A survey of published CT biopsy series shows an overall success rate of 85%. The rate of serious complications is 3.5% (including 3 deaths). The incidence of intratumoral hematomas that are clinically silent or associated with relatively minor clinical problems is 9%. CT-guided intracranial biopsy is more reliable than the earlier freehand methods and simpler than stereotactic techniques. It is the procedure of choice for percutaneous biopsy of superficial and deep hemispheric lesions.