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Roles and outcomes of stereotactic biopsy for adult patients with brainstem lesion

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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.

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References

  1. Ranjan A, Rajshekhar V, Joseph T et al (1993) Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience. J Neurosurg 79:839–844. https://doi.org/10.3171/jns.1993.79.6.0839

    Article  CAS  PubMed  Google Scholar 

  2. Hall WA (1998) The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:1749–1755

    Article  CAS  PubMed  Google Scholar 

  3. Ferreira MP, Ferreira NP, Pereira Filho AA et al (2006) Stereotactic computed tomography–guided brain biopsy: diagnostic yield based on a series of 170 patients. Surg Neurol 65:S27–S32. https://doi.org/10.1016/j.surneu.2005.11.036

    Article  Google Scholar 

  4. Mathon B, Amelot A, Mokhtari K, Bielle F (2019) Increasing the diagnostic yield of stereotactic brain biopsy using intraoperative histological smear. Clin Neurol Neurosurg 186:105544. https://doi.org/10.1016/j.clineuro.2019.105544

    Article  PubMed  Google Scholar 

  5. Noronha C, Figueiredo G, Pinheiro C et al (2019) Brain biopsy in suspected non-neoplastic neurological disease. Acta Neurochir (Wien) 161:1139–1147. https://doi.org/10.1007/s00701-019-03910-8

    Article  Google Scholar 

  6. Mathon B, Le Joncour A, Bielle F et al (2020) Neurological diseases of unknown etiology: Brain-biopsy diagnostic yields and safety. Eur J Intern Med 80:78–85. https://doi.org/10.1016/j.ejim.2020.05.029

    Article  PubMed  Google Scholar 

  7. Riche M, Amelot A, Peyre M et al (2021) Complications after frame-based stereotactic brain biopsy: a systematic review. Neurosurg Rev 44:301–307. https://doi.org/10.1007/s10143-019-01234-w

    Article  PubMed  Google Scholar 

  8. Grimm SA, Chamberlain MC (2013) Brainstem glioma: a review. Curr Neurol Neurosci Rep 13:346. https://doi.org/10.1007/s11910-013-0346-3

    Article  CAS  PubMed  Google Scholar 

  9. Pérez-Gómez JL, Rodríguez-Alvarez CA, Marhx-Bracho A, Rueda-Franco F (2010) Stereotactic biopsy for brainstem tumors in pediatric patients. Childs Nerv Syst 26:29–34. https://doi.org/10.1007/s00381-009-1000-x

    Article  PubMed  Google Scholar 

  10. Puget S, Beccaria K, Blauwblomme T et al (2015) Biopsy in a series of 130 pediatric diffuse intrinsic Pontine gliomas. Childs Nerv Syst 31:1773–1780. https://doi.org/10.1007/s00381-015-2832-1

    Article  PubMed  Google Scholar 

  11. Pfaff E, El Damaty A, Balasubramanian GP et al (2019) Brainstem biopsy in pediatric diffuse intrinsic pontine glioma in the era of precision medicine: the INFORM study experience. Eur J Cancer 114:27–35. https://doi.org/10.1016/j.ejca.2019.03.019

    Article  PubMed  Google Scholar 

  12. Morais BA, Solla DJF, Matushita H et al (2020) Pediatric intrinsic brainstem lesions: clinical, imaging, histological characterization, and predictors of survival. Childs Nerv Syst 36:933–939. https://doi.org/10.1007/s00381-019-04453-0

    Article  PubMed  Google Scholar 

  13. Ostrom QT, Cioffi G, Gittleman H et al (2019) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the united states in 2012–2016. Neuro Oncol 21:v1–v100. https://doi.org/10.1093/neuonc/noz150

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gleason CA, Wise BL, Feinstein B (1978) Stereotactic localization (with computerized tomographic scanning), biopsy, and radiofrequency treatment of deep brain lesions. Neurosurgery 2:217–222. https://doi.org/10.1227/00006123-197805000-00006

    Article  CAS  PubMed  Google Scholar 

  15. Cheng G, Yu X, Zhao H et al (2020) Complications of stereotactic biopsy of lesions in the sellar region, pineal gland, and brainstem: A retrospective, single-center study. Medicine (Baltimore) 99:e18572. https://doi.org/10.1097/MD.0000000000018572

    Article  Google Scholar 

  16. Riche M, Marijon P, Amelot A et al (2022) Severity, timeline, and management of complications after stereotactic brain biopsy. J Neurosurg 136:867–876. https://doi.org/10.3171/2021.3.JNS21134

    Article  PubMed  Google Scholar 

  17. Mathon B, Favreau M, Degos V et al (2022) Brain biopsy for neurological diseases of unknown etiology in critically Ill patients: feasibility, safety, and diagnostic yield. Crit Care Med. https://doi.org/10.1097/CCM.0000000000005439

    Article  PubMed  Google Scholar 

  18. Quick-Weller J, Lescher S, Bruder M et al (2016) Stereotactic biopsy of brainstem lesions: 21 years experiences of a single center. J Neurooncol 129:243–250. https://doi.org/10.1007/s11060-016-2166-1

    Article  PubMed  Google Scholar 

  19. Chen S-Y, Chen C-H, Sun M-H et al (2011) Stereotactic biopsy for brainstem lesion: comparison of approaches and reports of 10 cases. J Chin Med Assoc 74:110–114. https://doi.org/10.1016/j.jcma.2011.01.024

    Article  PubMed  Google Scholar 

  20. Dellaretti M, Touzet G, Reyns N et al (2012) Correlation between magnetic resonance imaging findings and histological diagnosis of intrinsic brainstem lesions in adults. Neuro Oncol 14:381–385. https://doi.org/10.1093/neuonc/nor215

    Article  PubMed  PubMed Central  Google Scholar 

  21. Manoj N, Arivazhagan A, Bhat DI et al (2014) Stereotactic biopsy of brainstem lesions: techniques, efficacy, safety, and disease variation between adults and children: a single institutional series and review. J Neurosci Rural Pract 5:32–39. https://doi.org/10.4103/0976-3147.127869

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Furtak J, Śledzińska P, Bebyn MG et al (2021) Infratentorial stereotactic biopsy of brainstem and cerebellar lesions. Brain Sci 11:1432. https://doi.org/10.3390/brainsci11111432

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Jaradat A, Nowacki A, Fichtner J et al (2021) Stereotactic biopsies of brainstem lesions: which approach? Acta Neurochir (Wien) 163:1957–1964. https://doi.org/10.1007/s00701-021-04733-2

    Article  Google Scholar 

  24. Guillamo JS, Monjour A, Taillandier L et al (2001) Brainstem gliomas in adults: prognostic factors and classification. Brain 124:2528–2539. https://doi.org/10.1093/brain/124.12.2528

    Article  CAS  PubMed  Google Scholar 

  25. Gonçalves-Ferreira AJ, Herculano-Carvalho M, Pimentel J (2003) Stereotactic biopsies of focal brainstem lesions. Surg Neurol. https://doi.org/10.1016/s0090-3019(03)00379-3

    Article  PubMed  Google Scholar 

  26. Boviatsis EJ, Kouyialis AT, Stranjalis G et al (2003) CT-guided stereotactic biopsies of brain stem lesions: personal experience and literature review. Neurol Sci 24:97–102. https://doi.org/10.1007/s10072-003-0093-3

    Article  CAS  PubMed  Google Scholar 

  27. Shad A, Green A, Bojanic S, Aziz T (2005) Awake stereotactic biopsy of brain stem lesions: technique and results. Acta Neurochir. https://doi.org/10.1007/s00701-004-0420-3

    Article  PubMed  Google Scholar 

  28. Samadani U, Stein S, Moonis G et al (2006) Stereotactic biopsy of brain stem masses: decision analysis and literature review. Surg Neurol. https://doi.org/10.1016/j.surneu.2006.05.056

    Article  PubMed  Google Scholar 

  29. Kesari S, Kim RS, Markos V et al (2008) Prognostic factors in adult brainstem gliomas: a multicenter, retrospective analysis of 101 cases. J Neurooncol 88:175–183. https://doi.org/10.1007/s11060-008-9545-1

    Article  CAS  PubMed  Google Scholar 

  30. Sanai N, Wachhorst SP, Gupta NM, McDermott MW (2008) Transcerebellar stereotactic biopsy for lesions of the brainstem and peduncles under local anesthesia. Neurosurgery. https://doi.org/10.1227/01.NEU.0000324731.68843.74

    Article  PubMed  Google Scholar 

  31. Rachinger W, Grau S, Holtmannspötter M et al (2009) Serial stereotactic biopsy of brainstem lesions in adults improves diagnostic accuracy compared with MRI only. J Neurol Neurosurg Psychiatry 80:1134–1139. https://doi.org/10.1136/jnnp.2009.174250

    Article  CAS  PubMed  Google Scholar 

  32. Haegelen C, Touzet G, Reyns N et al (2010) Stereotactic robot-guided biopsies of brain stem lesions: Experience with 15 cases. Neurochirurgie 56:363–367. https://doi.org/10.1016/j.neuchi.2010.05.006

    Article  CAS  PubMed  Google Scholar 

  33. Kickingereder P, Willeit P, Simon T, Ruge MI (2013) Diagnostic value and safety of stereotactic biopsy for brainstem tumors: a systematic review and meta-analysis of 1480 cases. Neurosurgery 72(6):873–881. https://doi.org/10.1227/NEU.0b013e31828bf445

    Article  PubMed  Google Scholar 

  34. He L, He D, Qi Y et al (2021) Stereotactic biopsy for brainstem lesions: a meta-analysis with noncomparative binary data. Cancer Control 28:10732748211059858. https://doi.org/10.1177/10732748211059858

    Article  PubMed  PubMed Central  Google Scholar 

  35. Duran-Peña A, Ducray F, Ramirez C et al (2022) Adult brainstem glioma differential diagnoses: an MRI-based approach in a series of 68 patients. J Neurol. https://doi.org/10.1007/s00415-022-11070-6

    Article  PubMed  Google Scholar 

  36. Pafundi DH, Laack NN, Youland RS et al (2013) Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study. Neuro Oncol 15:1058–1067. https://doi.org/10.1093/neuonc/not002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Verger A, Kas A, Darcourt J, Guedj E (2022) PET Imaging in neuro-oncology: an update and overview of a rapidly growing area. Cancers (Basel) 14:1103. https://doi.org/10.3390/cancers14051103

    Article  CAS  Google Scholar 

  38. Hirano Y, Shinya Y, Aono T et al (2022) The role of stereotactic frame-based biopsy for brainstem tumors in the era of molecular-based diagnosis and treatment decisions. Curr Oncol 29:4558–4565. https://doi.org/10.3390/curroncol29070360

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mathon B, Marijon P, Riche M et al (2022) Outpatient stereotactic brain biopsies. Neurosurg Rev 45:661–671. https://doi.org/10.1007/s10143-021-01593-3

    Article  PubMed  Google Scholar 

  40. Mathon B, Malaizé H, Amelot A, PSL BRAIN-BIOPSY STUDY GROUP (2022) Stereotactic biopsies of brainstem lesions: dilemma on the best trajectory. Acta Neurochir (Wien) 164:745–746. https://doi.org/10.1007/s00701-021-04924-x

    Article  Google Scholar 

  41. Catapano G, Sgulò FG, Seneca V et al (2019) Fluorescein-assisted stereotactic needle biopsy of brain tumors: a single-center experience and systematic review. Neurosurg Rev 42:309–318. https://doi.org/10.1007/s10143-018-0947-z

    Article  PubMed  Google Scholar 

  42. Chabaane M, Amelot A, Riche M et al (2020) Efficacy of a second brain biopsy for intracranial lesions after initial negativity. J Clin Neurol 16:659–667. https://doi.org/10.3988/jcn.2020.16.4.659

    Article  PubMed  PubMed Central  Google Scholar 

  43. Quick-Weller J, Konczalla J, Duetzmann S et al (2017) General anesthesia versus local anesthesia in stereotactic biopsies of brain lesions: a prospective randomized study. World Neurosurg 97:16–20. https://doi.org/10.1016/j.wneu.2016.09.064

    Article  PubMed  Google Scholar 

  44. Quick-Weller J, Tritt S, Behmanesh B et al (2017) Biopsies of pediatric brainstem lesions display low morbidity but strong impact on further treatment decisions. J Clin Neurosci 44:254–259. https://doi.org/10.1016/j.jocn.2017.06.028

    Article  PubMed  Google Scholar 

  45. Feng J, Hao S, Pan C et al (2015) The H3.3 K27M mutation results in a poorer prognosis in brainstem gliomas than thalamic gliomas in adults. Hum Pathol 46:1626–1632. https://doi.org/10.1016/j.humpath.2015.07.002

    Article  CAS  PubMed  Google Scholar 

  46. Liu C-J, Lin S-Y, Yang C-F et al (2020) A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma. Cancer Med 9:2134–2145. https://doi.org/10.1002/cam4.2872

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Laigle-Donadey F, Loiseau H, au nom du groupe GLITRAD du réseau TUCERA de l’ANOCEF (2017) [The GLITRAD (Adult Brainstem Gliomas) network: A national multidisciplinary group dedicated to brainstem gliomas in adults]. Bull Cancer 104:593–595. https://doi.org/10.1016/j.bulcan.2017.03.007

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, la Pitié–Salpêtrière University Hospital, 47–83, Boulevard de L’Hôpital, 75651, Paris Cedex 13, France

    Henri Malaizé, Maximilien Riche, Pauline Marijon, Alexandre Carpentier & Bertrand Mathon

  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

    Florence Laigle-Donadey, Ahmed Idbaih, Khê Hoang-Xuan & Mehdi Touat

  3. Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France

    Karima Mokhtari, Franck Bielle, Suzanne Tran & Lucia Nichelli

  4. Department of Pediatric Neurosurgery, University of Paris Cité, APHP, Necker - Enfants Malades Hospital, 75015, Paris, France

    Kevin Beccaria

  5. Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France

    Karima Mokhtari, Franck Bielle, Suzanne Tran & Bertrand Mathon

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  1. Henri Malaizé
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the PSL BRAIN-BIOPSY STUDY GROUP

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All authors had access to the data and a role in writing the manuscript.

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Correspondence to Bertrand Mathon.

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The database is registered within a protected and anonymized File (N°2214386 – CNIL). The need for patient informed consent was waived by the IRB of Sorbonne University. The article was prepared according to the STROBE guidelines

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Malaizé, H., Laigle-Donadey, F., Riche, M. et al. Roles and outcomes of stereotactic biopsy for adult patients with brainstem lesion. J Neurooncol 160, 159–170 (2022). https://doi.org/10.1007/s11060-022-04129-x

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