Brain Biopsy in Pediatric Medicine
Brain Biopsy in Pediatric Medicine
Key Points
- Gold standard for definitive diagnosis of brain lesions
- Required for molecular and genetic characterization of tumors
- Essential for treatment planning and prognosis assessment
- Success rates: 90-95% diagnostic yield when properly executed
Introduction
Pediatric brain biopsy is a crucial neurosurgical procedure for obtaining brain tissue samples for histopathological examination. The procedure requires meticulous planning, precise execution, and specialized pediatric considerations due to the developing brain's vulnerability and anatomical variations in children.
Pre-Operative Considerations
- Detailed neuroimaging (MRI with contrast, functional MRI if indicated)
- Coagulation profile assessment
- Anesthetic risk evaluation
- Informed consent discussion with guardians
- Surgical planning with neuronavigation
Surgical Techniques
1. Stereotactic Biopsy
- Frame-based stereotactic system
- Higher accuracy (±1mm)
- Better suited for deep-seated lesions
- Requires longer setup time
- Frameless stereotactic system
- More flexible for pediatric patients
- Real-time navigation capability
- Accuracy ±2mm
2. Open Biopsy
- Craniotomy approach
- Better for superficial lesions
- Larger tissue samples possible
- Direct visualization of abnormal tissue
3. Endoscopic Biopsy
- Minimally invasive option
- Ideal for intraventricular lesions
- Combined with stereotactic guidance
Clinical Indications
Primary Indications
- Suspected neoplasms
- Primary brain tumors
- Metastatic lesions
- Infiltrative processes
- Inflammatory conditions
- Demyelinating diseases
- Autoimmune encephalitis
- Inflammatory pseudotumors
- Infectious processes
- Cerebral abscess
- Opportunistic infections
- Parasitic infections
Contraindications
- Absolute
- Severe coagulopathy
- High intracranial pressure
- Lesions in extremely eloquent areas
- Relative
- Thrombocytopenia
- Severe hydrocephalus
- Multiple small lesions
Complications & Management
Immediate Complications
- Hemorrhage (2-3% risk)
- Intraparenchymal
- Subdural
- Management: immediate CT, possible surgical evacuation
- Neurological deficits (1-2%)
- Temporary or permanent
- Related to trajectory
- Management: steroids, rehabilitation
Delayed Complications
- Infection (0.5-1%)
- Meningitis
- Cerebritis
- Management: antibiotics, wound care
- CSF leak
- Through biopsy tract
- Management: bed rest, possible surgical repair
