Brain biopsy

In the brain biopsy for the diagnosis even more obscure brain lesions, a sample of the brain is removed in order to investigate this further. Especially in increasingly symptomatic lesions that spread in the imaging, brain biopsy has an important place. Thanks to new methods such as stereotactic, neuronavigation, multimodal image fusion, MRI and PET - diagnostics procedures today are very accurate, and have become a major contribution to diagnosis.

Often, the diagnosis of primary brain tumors, a biopsy is done, especially if resection is contraindicated ( eg, location of the tumor, age). The exact diagnosis is nevertheless of great importance in order to plan further therapy.

Clinical Application

By brain biopsy not only been unclear brain lesions can be examined more closely. In imaging today not only the structural morphology of CT and MRI, but also the metabolism can be examined by means of PET. Magnetic resonance spectroscopy helps in differentiating inflammation / Entmarkungen and tumors. If the clinical course progresses rapidly and therefore the course of observation is out of the question and if the patient can be biopsied and wants stereotactic tissue sampling can be done.

Indications of brain biopsies are:

• Clarification of brain tumors,
• Diagnosis of a primary CNS lymphoma ( gold standard ) and
• Diagnosis of inflammatory lesions.

Technology and process

In preparation must include a thorough imaging carried out to clarify the location of the lesion. Then, under local anesthesia or under general anesthesia, a stereotactic frame with screws attached to the skull. Then with the frame, take additional imaging techniques (CCT with contrast medium ) under stereotactic conditions. From these images, a surgical planning is performed by a computer system can be fused in variety of imaging techniques used.

It is carried out a detailed Zielpunkt-/Trajektplanung to achieve with the needle not only the lesion, but also to damage as little as possible to healthy brain tissue. During surgery, the patient is fixed to the frame to the operating table, the scalp is disinfected and sterilized covered. Then, a small skin incision, and a hole is drilled through the skull bone. Subsequently, the hollow needle is advanced through the aiming arm to Läsionsbeginn. Depending on the lesion takes you a bioptate or more biopsies. By intraoperative rapid diagnosis, the accuracy can be further increased, because then in the wrong position further biopsies may still be taken.

Swell

• Rössler K: State of the Art - brain biopsy. J Neurol Neurochir Psychiatr 2005; 6 (3) :11 -5

• Pathology
• Neurosurgery