Institutional members access full text with Ovid®

Diagnostic Value and Safety of Stereotactic Biopsy for Brainstem Tumors: A Systematic Review and Meta-analysis of 1480 Cases

Kickingereder, Philipp MD*; Willeit, Peter MD‡,§; Simon, Thorsten MD; Ruge, Maximilian I. MD*

doi: 10.1227/NEU.0b013e31828bf445
Review: Editor's Choice
Editor's Choice
Press Release

BACKGROUND: The feasibility and safety of stereotactic biopsy for brainstem tumors (BSTs) are controversial. Although magnetic resonance imaging (MRI) has been reported as the preferred diagnostic tool, histopathological analysis is frequently necessary to establish a definitive diagnosis. Recent advances in molecular characterization of brainstem gliomas—accounting for the majority of BSTs—have revealed several potential targets for molecular-based therapies. Hence, a molecular stereotactic biopsy that combines histopathological diagnosis with molecular-genetic analysis will become increasingly important for patients with BSTs.

OBJECTIVE: We conducted a systemic review and meta-analysis to determine the risks and benefits of stereotactic biopsy for BSTs.

METHODS: A systematic search in PubMed, Embase, and the Web of Science yielded 3766 potentially eligible abstracts. Meta-analysis was conducted on 38 studies describing 1480 biopsy procedures for BSTs. Primary outcome measures were diagnostic success and procedure-related complications. Data were analyzed according to standard meta-analytic techniques.

RESULTS: The weighted average proportions across the analyzed studies were: 96.2% (95% confidence interval [CI]: 94.5%-97.6%) for diagnostic success, 7.8% (95% CI: 5.6%-10.2%) for overall morbidity, 1.7% (95% CI: 0.9%-2.7%) for permanent morbidity, and 0.9% (95% CI: 0.5%-1.4%) for mortality. Meta-regression revealed a significant correlation between diagnostic success rates and the number of biopsy procedures performed annually in each center (P = .011). Other factors did not affect the outcome measures.

CONCLUSION: Stereotactic biopsy of BSTs is safe. It allows exact histopathological diagnosis as a prerequisite for adequate treatment and opens new perspectives for the molecular characterization of these tumors as a crucial first step toward more individualized treatment concepts.

ABBREVIATIONS: BST, brainstem tumor

CI, confidence interval

D-BSG, diffuse brainstem glioma

HGG, high-grade glioma

LGG, low-grade gliomas

TC, transcerebellar

TF, transfrontal

*Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany;

Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom;

§Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; and

Department of Pediatric Hematology and Oncology, University Hospital of Cologne, Cologne, Germany

Correspondence: Maximilian I. Ruge, MD, Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received September 16, 2012

Accepted January 29, 2013

Copyright © by the Congress of Neurological Surgeons