Diagnostic yield and safety of cerebellar and brainstem parenchymal biopsy

W. Oliver Tobin, Fredric B. Meyer, B Mark Keegan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective We aimed to determine the diagnostic yield and safety of posterior fossa parenchymal biopsy. Methods One-hundred-thirty-six patients who underwent 137 posterior fossa (brainstem or cerebellar) parenchymal biopsies at Mayo Clinic (Rochester, Minnesota, USA) between 1996 and 2009 were identified by chart review. Case histories; radiologic, surgical, and pathologic reports; and safety outcomes were assessed. Results Posterior fossa parenchymal biopsies were performed on 78 male and 58 female patients of median age 47 years (interquartile range 28-61). Preoperative clinical diagnosis in the majority of cases was of a malignant neoplasm. Glial neoplasm (51%) was the most common finding followed by lymphoma (7%) and neurosarcoidosis (7%). Normal tissue or nonspecific changes were observed in 28 cases (20%). Three deaths occurred: 2 at the time of biopsy (1%) and 1 due to underlying disease. All deaths occurred in patients who had a cerebellar biopsy. Transient neurologic deficits occurred in 15 patients (11%): worsening of presenting symptoms (4), cardiac arrhythmia (3), vertigo (2), diplopia (2), ataxia (3), seizure (1), decreased consciousness (1), and limb numbness (3). Sustained neurologic deficits occurred in 3 patients: fourth nerve palsy (1), hemiparesis (1), and facial numbness (1). Conclusions The diagnostic yield of posterior fossa parenchymal biopsy in Mayo Clinic patients with diverse pathologies was 80%. The complication rate was 11% with the majority being transient, but 2 deaths were attributed to biopsy. Evaluation of the diagnostic yield and complication rate at individual neurosurgical centers is needed to determine generalizability of these results.

Original languageEnglish (US)
Pages (from-to)1973-1976
Number of pages4
JournalWorld Neurosurgery
Volume84
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Brain Stem
Biopsy
Safety
Hypesthesia
Neurologic Manifestations
Trochlear Nerve Diseases
Diplopia
Vertigo
Paresis
Ataxia
Consciousness
Neuroglia
Cardiac Arrhythmias
Lymphoma
Neoplasms
Seizures
Extremities
Pathology

Keywords

  • Biopsy
  • Inflammatory changes
  • Neoplasm
  • Posterior fossa
  • Sarcoid
  • Spinal cord

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Diagnostic yield and safety of cerebellar and brainstem parenchymal biopsy. / Tobin, W. Oliver; Meyer, Fredric B.; Keegan, B Mark.

In: World Neurosurgery, Vol. 84, No. 6, 01.12.2015, p. 1973-1976.

Research output: Contribution to journalArticle

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abstract = "Objective We aimed to determine the diagnostic yield and safety of posterior fossa parenchymal biopsy. Methods One-hundred-thirty-six patients who underwent 137 posterior fossa (brainstem or cerebellar) parenchymal biopsies at Mayo Clinic (Rochester, Minnesota, USA) between 1996 and 2009 were identified by chart review. Case histories; radiologic, surgical, and pathologic reports; and safety outcomes were assessed. Results Posterior fossa parenchymal biopsies were performed on 78 male and 58 female patients of median age 47 years (interquartile range 28-61). Preoperative clinical diagnosis in the majority of cases was of a malignant neoplasm. Glial neoplasm (51{\%}) was the most common finding followed by lymphoma (7{\%}) and neurosarcoidosis (7{\%}). Normal tissue or nonspecific changes were observed in 28 cases (20{\%}). Three deaths occurred: 2 at the time of biopsy (1{\%}) and 1 due to underlying disease. All deaths occurred in patients who had a cerebellar biopsy. Transient neurologic deficits occurred in 15 patients (11{\%}): worsening of presenting symptoms (4), cardiac arrhythmia (3), vertigo (2), diplopia (2), ataxia (3), seizure (1), decreased consciousness (1), and limb numbness (3). Sustained neurologic deficits occurred in 3 patients: fourth nerve palsy (1), hemiparesis (1), and facial numbness (1). Conclusions The diagnostic yield of posterior fossa parenchymal biopsy in Mayo Clinic patients with diverse pathologies was 80{\%}. The complication rate was 11{\%} with the majority being transient, but 2 deaths were attributed to biopsy. Evaluation of the diagnostic yield and complication rate at individual neurosurgical centers is needed to determine generalizability of these results.",
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AB - Objective We aimed to determine the diagnostic yield and safety of posterior fossa parenchymal biopsy. Methods One-hundred-thirty-six patients who underwent 137 posterior fossa (brainstem or cerebellar) parenchymal biopsies at Mayo Clinic (Rochester, Minnesota, USA) between 1996 and 2009 were identified by chart review. Case histories; radiologic, surgical, and pathologic reports; and safety outcomes were assessed. Results Posterior fossa parenchymal biopsies were performed on 78 male and 58 female patients of median age 47 years (interquartile range 28-61). Preoperative clinical diagnosis in the majority of cases was of a malignant neoplasm. Glial neoplasm (51%) was the most common finding followed by lymphoma (7%) and neurosarcoidosis (7%). Normal tissue or nonspecific changes were observed in 28 cases (20%). Three deaths occurred: 2 at the time of biopsy (1%) and 1 due to underlying disease. All deaths occurred in patients who had a cerebellar biopsy. Transient neurologic deficits occurred in 15 patients (11%): worsening of presenting symptoms (4), cardiac arrhythmia (3), vertigo (2), diplopia (2), ataxia (3), seizure (1), decreased consciousness (1), and limb numbness (3). Sustained neurologic deficits occurred in 3 patients: fourth nerve palsy (1), hemiparesis (1), and facial numbness (1). Conclusions The diagnostic yield of posterior fossa parenchymal biopsy in Mayo Clinic patients with diverse pathologies was 80%. The complication rate was 11% with the majority being transient, but 2 deaths were attributed to biopsy. Evaluation of the diagnostic yield and complication rate at individual neurosurgical centers is needed to determine generalizability of these results.

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