Brain biopsy

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Brain biopsy

Brain biopsy under stereotaxy.

ICD-9-CM 01.11-01.14

LOINC 66109-0

Brain biopsy is the removal of a small piece of brain tissue for the diagnosis of
abnormalities of the brain. It is used to diagnose tumors, infection, inflammation,
and other brain disorders. By examining the tissue sample under a microscope,
the biopsy sample provides information about the appropriate diagnosis and
treatment.

Contents

 1Indications
 2Procedure
 3Preparation
 4Aftercare
 5Risks
 6Interpretation
 7References

Indications[edit]
Given the potential risks surrounding the procedure, cerebral biopsy is indicated
only if other diagnostic approaches (e.g. magnetic resonance imaging) have
been insufficient in showing the cause of symptoms, and if it is felt that the
benefits of histological diagnosis will influence the treatment plan.
If the person has a brain tumor, biopsy is 95% sensitive. The procedure can also
be valuable in people who are immunocompromised and who have evidence of
brain lesions that could be caused by opportunistic infections. In other groups,
particularly those with unexplained neurological disease, a diagnosis is reached
by performing a biopsy in half the cases where it is done, and it has helpful
practical effect in 30% of people. If primary angiitis of the central nervous
system (PACNS) is suspected, brain biopsy is most likely to positively influence
the treatment plan.[1]

Procedure[edit]

Simplistic representation of a stereotactic brain biopsy

Procedures are categorized into stereotactic, needle, and open. [2] Stereotactic is

the least invasive and open is the most invasive. [2]
When an abnormality of the brain is suspected, stereotactic (probing in three
dimensions) brain needle biopsy is performed and guided precisely by a
computer system to avoid serious complications. A small hole is drilled into the
skull, and a needle is inserted into the brain tissue guided by computer-assisted
imaging techniques (CT or MRI scans). Historically, the patient's head was held
in a rigid frame to direct the probe into the brain; however, since the early 1990s,
it has been possible to perform these biopsies without the frame. Since the frame
was attached to the skull with screws, this advancement is less invasive and
better tolerated by the patient. The doctor (pathologist) prepares the sample for
analysis and studies it further under a microscope.

Preparation[edit]
A CT or MRI brain scan is done to find the position where the biopsy will be
performed. Prior to the biopsy, the patient is placed under general anesthesia.

Aftercare[edit]
The patient is monitored in the recovery room for several hours following the
biopsy. Neurological assessments are performed once the patient is fully awake
and if left without deficit, most patients can be discharged the day after surgery.

Risks[edit]
The procedure is invasive and includes risks associated with anesthesia and
surgery. Brain injury may occur due to removal of brain tissue. The resulting scar
left on the brain has the potential to trigger seizures.
If brain biopsy is performed for a possible tumor (which contain more blood
vessels), the risk of death is 1% and a risk of complications 12%. For
unexplained neurological disease, there is no risk of death and a complication
rate of 9%; complications were more common in PACNS. [1]

Interpretation[edit]
Various brain abnormalities can be diagnosed by microscopic analysis of the
tissue sample. The pathologist (a physician trained in how disease affects the
body's tissues) looks for abnormal growth, changes in cell membranes, and/or
abnormal collections of cells. In Alzheimer's disease, the cortex of the brain
contains abnormal collections of plaques. If infection is suspected, the infectious
organism can be cultured from the tissue and identified. Classification of tumors
is also possible after biopsy.

References[edit]
1. ^ Jump up to:a b Bai, Harrison Xiao; Zou, Yingjie; Lee, Ashley M.; Lancaster, Eric; Yang, Li
(August 2015). "Diagnostic Value and Safety of Brain Biopsy in Patients With Cryptogenic
Neurological Disease".  Neurosurgery. 77 (2): 283–
295.  doi:10.1227/NEU.0000000000000756. PMID 25856111.
2. ^ Jump up to:a b "Brain Biopsy | Definition and Patient Education". Healthline. Retrieved  2018-
12-02.
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Tests and procedures involving the central nervous system

Neurosurgery

Craniotomy

ll Decompressive craniectomy

Cranioplasty

Thalamotomy
thalamus and globus
Thalamic stimulator
pallidus
Pallidotomy

Cerebral shunt

Ventriculostomy
ventricular system
Suboccipital puncture

Intracranial pressure monitoring

Psychosurgery 
Lobotomy
n Bilateral cingulotomy

cerebrum Multiple subpial transection

Hemispherectomy

Corpus callosotomy
Anterior temporal lobectomy

pituitary gland 
Hypophysectomy

Other hippocampus 
Amygdalohippocampectomy

Brain biopsy

es Meningeal biopsy

al Spinal decompression

al Discectomy
 Intervertebral disc annuloplasty

Cordotomy

Rhizotomy

Neuroimaging

Head CT

Cerebral angiography

Pneumoencephalography

Echoencephalography/Transcranial Doppler

ng Brain MRI

Brain PET

Magnetoencephalography

Myelography

Wada test

Microneurography

Electroencephalography

Lumbar puncture 
ic
CSF tap test

Polysomnography

Glasgow Coma Scale

Mini–Mental State Examination

es
National Institutes of Health Stroke Scale

CHADS2 score
Categories: 
 Neurosurgical procedures