Minim Invasive Neurosurg 2001; 44(4): 226-229
DOI: 10.1055/s-2001-19930
Original Article
Georg Thieme Verlag Stuttgart · New York

Stereotactic Biopsy of Brain Stem Lesions

E.  J.  Boviatsis1 , K.  Voumvourakis2 , N.  Goutas3 , K.  Kazdaglis1 , C.  Kittas3 , D.  A.  Kelekis4
  • 1Department of Neurosurgery, Medical School, University of Athens, Athens, Greece
  • 2Department of Neurology, Medical School, University of Athens, Athens, Greece
  • 3Department of Histology, Medical School, University of Athens, Athens, Greece
  • 4Department of Radiology, Medical School, University of Athens, Athens, Greece
Further Information

Publication History

Publication Date:
01 February 2002 (online)

Abstract

The successful therapy of space-occupying lesions of the brain stem, depends on precise histological diagnosis. Although the clinical management and contemporary imaging techniques (computerized tomography and magnetic resonance imaging) are now able to reveal and approach the diagnosis in these cases, only the combination of these two with the use of contemporary stereotactic systems, is able to secure the precise histological diagnosis for the patient with a good degree of safety. This study presents the first five patients in Greece with space-occupying lesions of the brain stem, in whom a stereotactic biopsy was carried out. All patients were subjected to CT-guided stereotactic biopsy, via the frontal approach in 4 patients with lesions in the superior pons and the mesencephalon and in one patient via the transcerebellar approach, for a lesion in the lateral surface of the pons. Precise histological diagnosis was possible and on the basis of a reliable choice of histological criteria the appropriate therapeutic approach was chosen, thus avoiding the old “empirical” treatment.

References

  • 1 Albright A L, Packer R J, Zimmermann R. Magnetic resonance scans should replace biopsies for the diagnosis of diffuse brain stem gliomas: a report from the Children's Cancer Group.  Neurosurgery. 1993;  33 1026-1039
  • 2 Perneczky A, Muller-Forell W, Van Lindert E. Keyhole Concept in Neurosurgery. Stuttgart: Thieme 1998
  • 3 Backlund E O, Johanson L, Sarby B. Studies on craniopharyngiomas: Treatment by stereotaxis and radiosurgery.  Acta Chir Scand. 1972;  138 749-759
  • 4 Lunsford L D. Advanced intraoperative imaging for stereotaxis: The surgical CT scanner.  Acta Neurochir (Wien). 1983;  69 297-304
  • 5 Lunsford L D, Martinez A J. Stereotactic exploration of the brain in the era of computer tomography.  Surg Neurol. 1984;  22 220-230
  • 6 Coffey R J, Lunsford L D. Stereotactic surgery for mass lesions of the midbrain and pons.  Neurosurgery. 1983;  12 298-302
  • 7 Rajshekhar V, Chandy M J. Successful stereotactic management of a large cardiogenic brain stem abscess.  Neurosurgery. 1994;  34 368-371
  • 8 Rajshekhar V, Chandy M J. CT guided stereotactic management of intracranial tuberculomas.  Br J Neurosurg. 1993;  7 619-624
  • 9 Apuzzo M LJ, Chandrasoma P T, Cohen D. et al . Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses.  Neurosurgery. 1987;  20 930-937
  • 10 Albright A L. Tumors of the pons.  Neurosurg Clin North Am. 1993;  4 529-536
  • 11 Baghai P, Vries J K, Bechtel P C. Retromastoid approach for biopsy of brain stem tumors.  Neurosurgery. 1982;  10 574-579
  • 12 Whyte T R, Colby Jr M Y, Layton Jr D D. Radiation therapy of brain stem tumors.  Radiology. 1969;  93 413-416
  • 13 Apuzzo M LK, Sabshin J K. Computed tomographic guidance stereotaxis in the management of intracranial mass lesions.  Neurosurgery. 1983;  12 277-285
  • 14 Kelly P J, Daumas-Dupont C, Kisper D B. Imaging-based stereotaxis biopsies in untreated intracranial glial neoplasms.  J Neurosurg. 1987;  66 865-874
  • 15 Ostertag C B, Mennel H D, Kiesling M. Stereotactic biopsy of brain tumors.  Surg Neurol. 1980;  14 275-283
  • 16 Abernathy C D, Camacho A, Kelly P J. Stereotaxic suboccipital transcerebellar biopsy of pontine mass lesions.  J Neurosurg. 1989;  70 195-200
  • 17 Albright A L, Guthkelch A N, Packer R J. Prognostic factors in pediatric brain-stem gliomas.  J Neurosurg. 1986;  65 751-755
  • 18 Alvisi C, Cerisoli M, Maccheroni M E. Long-term results of surgically treated brain stem gliomas.  Acta Neurochir. 1985;  76 12-17

E. J. Boviatsis, M. D. 

Department of Neurosurgery · Pireus General Hospital

3 Fanarioton Street

184 54 Nikaia

Greece

Phone: +30-1-651 8138

Fax: +30-1-645 2008

Email: eboviats@cc.uoa.gr