Status of stereotactic biopsy in children with brain stem masses: insights from a series of 106 patients

Abstract

BACKGROUND: There is no consensus on the indications for stereotactic biopsy for brain stem masses in children. OBJECTIVES: We analyzed the results of stereotactic biopsy for brain stem masses in 106 consecutive children to define current indications for this surgery. METHODS: We performed a retrospective review of inpatient summaries, stereotactic worksheets and radiological investigations of 106 consecutive patients, under the age of 18 years, who underwent CT-guided stereotactic biopsies for brain stem lesions between 1987 and 2008. Patients were divided into two eras: era I from 1987 to 1997 and era II from 1998 to 2008. RESULTS: 91 children underwent a biopsy in era I, and 15 had the procedure in era II, this difference clearly indicating the impact of the availability of magnetic resonance imaging. There was no difference in the proportion of diffuse lesions biopsied in both eras. Astrocytoma was the most frequently diagnosed pathology in both eras accounting for nearly 90% of biopsies. Inflammatory masses were diagnosed in less than 10% of patients. There was no mortality or permanent morbidity. Mortality, on follow-up, in children with diffuse low- and high-grade astrocytoma was similar. CONCLUSIONS: CT-guided stereotactic biopsy for brain stem masses in children is safe and is presently indicated in ruling out an inflammatory pathology of an enhancing mass of the brain stem.