Brain biopsy in cryptogenic neurological disease

Abstract

Objective. Brain biopsy is standard clinical practice when CNS malignancy is suspected. Its value has not otherwise been clearly established. We reviewed the indications for, complications and outcome of diagnostic brain biopsies performed between 2003 and 2008 in a single UK centre.

Methods. Subjects were retrospectively identified using theatre log books and histopathology reports. Case records were analysed by a neurologist and neurosurgeon. Cases were excluded when the pre-operative diagnosis was clearly malignancy or infection.

Results. Of all (432) brain biopsies performed, 56 were performed in 52 patients with cryptogenic neurological disease. There were no permanent deficits or deaths. Histopathological reports were classified as definitive (45%), suggestive (20%) or non-diagnostic (36%). Brain biopsy made an immediate contribution to determination of diagnosis in 55% (31 of 56) and a confident diagnosis was eventually made in 40 of 52 patients (77%). Management was altered as a consequence of biopsy in 63%. Successful biopsy of a radiologically identified target increased the proportion of biopsies considered diagnostic to 78% (odds ratio 8.9) whereas non-targeted biopsy was non-diagnostic in 71%. Although a significant proportion of patients died or had progressive disease, this was not uniformly the case; 31% stabilised and 27% improved.

Conclusion. We present the highest reported frequency of brain biopsy for cryptogenic neurological disease. The risk associated with the procedure was low and the biopsy results impacted significantly upon diagnosis and management. We therefore propose that the procedure should no longer be considered one of last resort.

Key words:

• Brain biopsy
• diagnostic yield
• therapeutic impact

Acknowledgements

Authors gratefully acknowledge the expertise of our neuroradiology and neuropathology colleagues and the help provided by staff from their departments as well as those affiliated with the Microbiology and Audit Departments of North Bristol NHS Trust. Authors appreciate the support provided by medical secretaries and neurology consultants throughout the South West. Professor Seth Love provided very helpful comments on the manuscript. CMR thanks the Burden Neurological Institute and the National Institute of Health Research for financial support. Data from this series were presented in abstract form at annual meetings of the Society of British Neurosurgeons (2009) and Association of British Neurologists (2010).

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.