Brain biopsy

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In a brain biopsy , a sample of the brain is taken to diagnose brain lesions that are still unclear so that they can be examined further. A brain biopsy is particularly important for increasingly symptomatic lesions that are also spreading in imaging . Thanks to new methods such as stereotaxic , neuronavigation , multimodal image fusion , MRT and PET diagnostics, the procedures are now very accurate and contribute significantly to diagnostics.

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

Clinical application

The brain biopsy not only enables previously unclear brain lesions to be examined more closely. In imaging today, not only the structural morphology can be examined using CT and MRT, but also the metabolism using PET. Magnetic resonance spectroscopy helps to differentiate inflammation / demyelinating and tumors. If the clinical course is progressing rapidly, which is why follow-up monitoring is out of the question and if the patient can and wants to be biopted, stereotactic tissue samples can be taken.

Indications for brain biopsies are:

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

Technology and process

In preparation, detailed imaging must be carried out to pinpoint the location of the lesion. Then, under local or general anesthesia, a stereotactic frame is attached to the skull with screws. Then further imaging procedures (CCT with contrast agent) are carried out with the frame under stereotactic conditions. From these images, a computer system is used to carry out surgery planning, in which the most diverse imaging methods used can be merged.

A precise target / trajectory planning is carried out in order not only to reach the lesion with the needle, but also to damage healthy brain tissue as little as possible. During the operation, the patient is fixed with the frame on the operating table , the scalp is disinfected and covered with a sterile cover. A small skin incision is then made and a hole is drilled through the skull bone. The hollow needle is then advanced to the start of the lesion using the aiming arm. Depending on the lesion, one or more biopsies are taken. Intraoperative rapid diagnostics can increase the accuracy even more, because further biopsies can then be taken if the position is incorrect.

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