Advertisement

Acta Neurochirurgica

, Volume 161, Issue 6, pp 1139–1147 | Cite as

Brain biopsy in suspected non-neoplastic neurological disease

  • Carolina NoronhaEmail author
  • Gonçalo Figueiredo
  • Célia Pinheiro
  • Ernesto Carvalho
  • Alfredo Calheiros
  • Manuel Melo Pires
  • Ricardo Taipa
Original Article - Neurosurgery general
Part of the following topical collections:
  1. Neurosurgery general

Abstract

Brain biopsy has a well-established role in the diagnosis of CNS neoplasia. Nevertheless, despite being essential for the diagnosis of some benign neurological diseases, little consensus exists regarding its indications for disease diagnosis and patient orientation. Our aim was to assess brain biopsy diagnostic yield in patients with neurological deterioration of unknown etiology, to identify the clinical characteristics associated with an increased likelihood of achieving a diagnostic biopsy as well as the characteristics linked to a particular diagnosis.

Methods

A retrospective analysis of 62 consecutive brain biopsies performed at a single tertiary care center between January 2004 and December 2015 for suspected non-neoplastic neurological disease was performed. The clinical presentation, imaging, and laboratory results were collected and compared between diagnostic groups.

Results

Sixty-eight percent of the biopsies led to a definitive diagnosis. The most common histological diagnosis was central nervous system lymphoma (eight cases), followed by astrocytoma, demyelinating disease, and progressive multifocal leukoencephalopathy (four cases each). No clinical characteristics were found to predict a diagnostic biopsy or to correlate with a specific diagnosis. Importantly, a distinct diagnosis from the initially suspected was achieved in 52% of cases and biopsy findings led to a change of therapeutic orientation in 78% of the cases.

Conclusions

Our results suggest that brain biopsies have a significant impact on patient management and should be considered early in selected cases in which less invasive testing was unable to reach a definitive diagnosis.

Keywords

Brain biopsy Benign neurological disease 

Abbreviations

ADC

Apparent diffusion coefficient

AIDS

Acquired immunodeficiency syndrome

CNS

Central nervous system

CSF

Cerebral spinal fluid

CT

Computed tomography

DWI

Diffusion weighted imaging

FLAIR

Fluid-attenuated inversion recovery

HBV

Hepatitis virus B

HCV

Hepatitis C virus

HAART

Highly active anti-retroviral therapy

HIV

Human immunodeficiency virus

MRI

Magnetic resonance imaging

PML

Progressive multifocal leukoencephalopathy

Notes

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

References

  1. 1.
    Alesch F, Armbruster C, Budka H (1995) Diagnostic value of stereotactic biopsy of cerebral lesions in patients with AIDS. Acta Neurochir 134(3–4):214–219CrossRefGoogle Scholar
  2. 2.
    Antinori A, Ammassari A, De Luca A et al (1997) Diagnosis of AIDS-related focal brain lesions: a decision-making analysis based on clinical and neuroradiologic characteristics combined with polymerase chain reaction assays in CSF. Neurology 48(3):687–694CrossRefGoogle Scholar
  3. 3.
    Antinori A, Luca AD, Cingolani A, Fortini M, Tartaglione T, Larocca LM, Zannoni G, Grillo R, Iacoangeli M, Scerrati M (1997) Diagnosis of AIDS-related focal brain lesions. Neurology 48(3):687–694Google Scholar
  4. 4.
    Bai HX, Zou Y, Lee AM, Lancaster E, Yang L (2015) Diagnostic value and safety of brain biopsy in patients with cryptogenic neurological disease. Neurosurgery 77(2):283–295CrossRefGoogle Scholar
  5. 5.
    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(3):235–239CrossRefGoogle Scholar
  6. 6.
    Clifford (1999) Focal brain lesions in people with HIV. Curr Treat Options Neurol 1(2):167–172CrossRefGoogle Scholar
  7. 7.
    Gilkes CE, Love S, Hardie RJ, Edwards RJ, Scolding NJ, Rice CM (2012) Brain biopsy in benign neurological disease. J Neurol 259(5):995–1000CrossRefGoogle Scholar
  8. 8.
    Hall WA (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82(9):1749–1755CrossRefGoogle Scholar
  9. 9.
    Holloway RG, Mushlin AI (1996) Intracranial mass lesions in acquired immunodeficiency syndrome: using decision analysis to determine the effectiveness of stereotactic brain biopsy. Neurology 46(4):1010–1015CrossRefGoogle Scholar
  10. 10.
    Jackson RJ, Fuller GN, Abi-Said D, Lang FF, Gokaslan ZL, Shi WM, Wildrick DM, Sawaya R (2001) Limitations of stereotactic biopsy in the initial management of gliomas. Neuro-Oncology 3(3):193–200CrossRefGoogle Scholar
  11. 11.
    Javedan SP, Tamargo RJ (1997) Diagnostic yield of brain biopsy in neurodegenerative disorders. Neurosurgery 41(4):823–8-30CrossRefGoogle Scholar
  12. 12.
    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(1):72–75CrossRefGoogle Scholar
  13. 13.
    Kim JE, Kim DG, Paek SH, Jung H-W (2003) Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir 145(7):547–555CrossRefGoogle Scholar
  14. 14.
    Kobayashi M, Shimizu Y, Uchiyama S, Shibata N (2014) Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 261(1):1902–1910CrossRefGoogle Scholar
  15. 15.
    Lucchinetti C, Brück W, Parisi J, Scheithauer B, Rodriguez M, Lassmann H (2000) Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 47(6):707–717CrossRefGoogle Scholar
  16. 16.
    Luft BJ, Chua A (2000) Central nervous system toxoplasmosis in HIV pathogenesis, diagnosis, and therapy. Curr Infect Dis Rep 2(4):358–362CrossRefGoogle Scholar
  17. 17.
    Magaki S, Gardner T, Khanlou N, Yong WH, Salamon N, Vinters HV (2015) Brain biopsy in neurologic decline of unknown etiology. Hum Pathol 46(4):499–506CrossRefGoogle Scholar
  18. 18.
    Najjar S, Pearlman DM, Hirsch S et al (2014) Brain biopsy findings link major depressive disorder to neuroinflammation, oxidative stress, and neurovascular dysfunction: a case report. Biol Psychiatry.  https://doi.org/10.1016/j.biopsych.2013.07.041
  19. 19.
    Pulhorn H, Quigley DG, Bosma JJD, Kirollos R, Du Plessis DG, Jenkinson MD (2008) Impact of brain biopsy on the management of patients with nonneoplastic undiagnosed neurological disorders. Neurosurgery 62(4):833–837CrossRefGoogle Scholar
  20. 20.
    Salvarani C, Brown RD, Calamia KT, Christianson TJH, Weigand SD, Miller DV, Giannini C, Meschia JF, Huston J, Hunder GG (2007) Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 62(5):442–451CrossRefGoogle Scholar
  21. 21.
    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(3):327–341CrossRefGoogle Scholar
  22. 22.
    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(5):419–424CrossRefGoogle Scholar
  23. 23.
    Venneti S, Robinson JL, Roy S, White MT, Baccon J, Xie SX, Trojanowski JQ (2011) Simulated brain biopsy for diagnosing neurodegeneration using autopsy-confirmed cases. Acta Neuropathol 122(6):737–745CrossRefGoogle Scholar
  24. 24.
    Warren JD, Schott JM, Fox NC et al (2005) Brain biopsy in dementia. Brain 128(9):2016–2025CrossRefGoogle Scholar
  25. 25.
    Zibly Z, Levy I, Litchevski V, Nass D, Hofmann C, Barham J, Graves CA, Spiegelmann R, Hadani M, Cohen ZR (2014) Brain biopsy in AIDS patients: diagnostic yield and treatment applications. AIDS Res Ther 11:4CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neurosurgery DepartmentHospital Santo Antonio, Centro Hospitalar e Universitario do PortoPortoPortugal
  2. 2.i3s Institute for Research and Innovation in HealthUniversidade do PortoPortoPortugal
  3. 3.Neuropathology Unit, Hospital de Santo AntonioCentro Hospitalar e Universitario do PortoPortoPortugal

Personalised recommendations