ABSTRACT
OBJECTIVE: We sought to assess the diagnostic yield, complication rates, and therapeutic impact of open brain biopsy and serial stereotactic brain biopsy in the management of patients with nonneoplastic neurological conditions in which conventional investigations did not yield a definitive diagnosis. METHODS: A retrospective case note analysis was undertaken in consecutive patients undergoing brain biopsy at The Walton Centre for Neurology and Neurosurgery during a 15-year period. The diagnostic yield, prebiopsy diagnostic category, biopsy technique (open versus stereotactic), complication rates, and impact on clinical management were assessed. Biopsies were grouped into one of five categories: diagnostic, suggestive, nonspecific, normal, or nondiagnostic. RESULTS: Thirty-nine patients underwent biopsy. The diagnostic yield (combined diagnostic and suggestive) of targeted serial stereotactic biopsy was 64% (seven of 11 patients); in the open brain biopsy group, the diagnostic yield was 46% (13 of 28 patients). The prebiopsy diagnosis was confirmed in 100% (three of three patients) stereotactic biopsy patients and 75% (nine of 12 patients) of open biopsy patients. Two patients (7%) in the open biopsy group had short-term complications. The clinical impact was similar in both groups: nine of 28 (32%) open biopsy patients and four of 11 (36%) stereotactic biopsy patients. CONCLUSION: Despite the low clinical impact, diagnostic brain biopsy should be considered in patients with nonneoplastic undiagnosed neurological disorders. Patients with neuroimaging abnormalities should preferentially undergo targeted biopsy.
Subject(s)
Biopsy, Fine-Needle/methods , Brain Diseases/pathology , Brain Diseases/therapy , Adolescent , Adult , Aged , Brain Neoplasms/pathology , Brain Neoplasms/therapy , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificitySubject(s)
Cognition Disorders/etiology , Embolization, Therapeutic , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Activities of Daily Living , Clinical Trials as Topic , Humans , Intracranial Aneurysm/therapy , Neuropsychological Tests , Reproducibility of Results , Research Design , Treatment OutcomeABSTRACT
OBJECTIVE AND IMPORTANCE: Intracranial infections related to the various foreign materials used to secure intracranial aneurysms are extremely rare. The lack of neoendothelium formation across the necks of aneurysms, which is particularly prone to occur when the sac is incompletely packed by Guglielmi detachable coils (GDC), results in the absence of isolation of the coils from the circulation. Colonization of GDCs, which act as a foreign-body nidus after hematogenous spread from infections with bacteremia, may result in localized intracranial infection. CLINICAL PRESENTATION: A 55-year-old woman developed meningitis and a brain abscess surrounding a giant aneurysm that was treated endovascularly with GDC 3 1/2 years earlier. Four weeks before she sought care, she experienced an infective illness with proven Salmonella bacteremia. Salmonella group D was isolated from cerebrospinal fluid. INTERVENTION: The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess. CONCLUSION: This case suggests that the GDC acted as a colonized foreign body, resulting in the surrounding abscess formation after infection with Salmonella bacteremia. Alternatively, the reaction of the surrounding tissue to the GDC was the predisposing factor and acted as the nidus for the abscess formation.
