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Neurosurgery. 2008 Sep;63(3):460-6; discussion 466-8. doi: 10.1227/01.NEU.0000324731.68843.74.

Transcerebellar stereotactic biopsy for lesions of the brainstem and peduncles under local anesthesia.

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  • 1Department of Neurological Surgery, University of California San Francisco, San Francisco, California CA 94143-0112, USA.

Abstract

OBJECTIVE:

For certain brainstem lesions, a diagnostic biopsy is required for treatment planning. We reviewed the indications, safety, and diagnostic effectiveness of a transcerebellar stereotactic biopsy using local anesthesia and sedation.

METHODS:

We retrospectively reviewed hospital records for all adult patients with symptomatic lesions of the pons and/or cerebellar peduncle who underwent an awake transcerebellar stereotactic biopsy at our institution over a 7-year period. Our technique features several modifications from the standard method and was performed under local anesthesia with patients in the semi-sitting position.

RESULTS:

Our rate of diagnostic success (92%) was comparable to those in other published reports. However, only 5 (42%) of 12 biopsy-derived diagnoses were consistent with those predicted from preoperative magnetic resonance imaging. There were no deaths, and the only neurological complication was a cranial nerve palsy. Diagnoses in the 13 cases included infiltrative glioma (), metastases (), lymphoma (), encephalitis (), and reactive astrogliosis ().

CONCLUSION:

Tissue diagnosis of lesions in the brainstem and cerebellar peduncles continues to be a significant challenge, with the potential for major morbidity. With appropriate patient selection, however, awake transcerebellar biopsy is a safe and effective procedure that can change clinical management and provide important prognostic information.

PMID:
18812957
[PubMed - indexed for MEDLINE]
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