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


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.


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.


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.


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.


Brain biopsy Benign neurological disease 



Apparent diffusion coefficient


Acquired immunodeficiency syndrome


Central nervous system


Cerebral spinal fluid


Computed tomography


Diffusion weighted imaging


Fluid-attenuated inversion recovery


Hepatitis virus B


Hepatitis C virus


Highly active anti-retroviral therapy


Human immunodeficiency virus


Magnetic resonance imaging


Progressive multifocal leukoencephalopathy


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.


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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

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