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CC BY 4.0 · J Neurol Surg Rep 2022; 83(04): e123-e128
DOI: 10.1055/s-0042-1758696
Case Report

A Case Series of Stereotactic Biopsy of Brainstem Lesions through the Transfrontal Approach

Oscar Andrés Escobar-Vidarte
1   Department of Neurosurgery, University del Valle, Cali, Valle del Cauca, Colombia
2   Department of Neurosurgery, University Hospital del Valle, Cali, Valle del Cauca, Colombia
3   Department of Neurosurgery, Castellana Clinic, Cali, Valle del Cauca, Colombia
4   Department of Neurosurgery, Latin American Institute of Neurology and the Nervous System, Bogota, Colombia
,
Dylan Paul Griswold
5   Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
6   School of Medicine, Stanford Medical School, Stanford, California, United States
,
Javier Orozco-Mera
1   Department of Neurosurgery, University del Valle, Cali, Valle del Cauca, Colombia
2   Department of Neurosurgery, University Hospital del Valle, Cali, Valle del Cauca, Colombia
,
Juan Felipe Mier-Garcia
1   Department of Neurosurgery, University del Valle, Cali, Valle del Cauca, Colombia
2   Department of Neurosurgery, University Hospital del Valle, Cali, Valle del Cauca, Colombia
,
Fernando Peralta Pizza
7   Department of Neurosurgery, University Hospital Tomas Uribe Uribe of Tuluá, Tuluá, Valle del Cauca Colombia
› Author Affiliations Funding Dylan Paul Griswold was supported by the Bill and Melinda Gates Foundation (Gates Cambridge Grant: OPP1144).
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Abstract

Background and Importance Brainstem lesions may be unresectable or unapproachable. Regardless, the histopathological diagnosis is fundamental to determine the most appropriate treatment. We present our experience with transfrontal stereotactic biopsy technique for brainstem lesions as a safe and effective surgical route even when contralateral transhemispheric approach is required for preservation of eloquent tissue.

Clinical Presentation Twenty-five patients underwent surgery by transfrontal approach. Medical records were reviewed for establishing the number of patients who had postoperative histopathological diagnosis and postoperative complications. Twenty-four patients (18 adults and 7 children) had histopathological diagnosis. There were 18 astrocytomas documented, of which 12 were high grade and 6 low grade. The other diagnoses included viral encephalitis, post–renal transplant lymphoproliferative disorder, nonspecific chronic inflammation, Langerhans cell histiocytosis, and two metastases. No case was hindered by cerebrospinal fluid loss or ventricular entry. Complications included a case of mesencephalic hemorrhage with upper limb monoparesis and a case of a partially compromised third cranial nerve in another patient without associated bleeding.

Conclusion Stereotactic biopsy of brainstem lesions by transfrontal ipsilateral or transfrontal transhemispheric contralateral approaches is a safe and effective surgical approach in achieving a histopathological diagnosis in both pediatric and adult populations.

Key Words

brainstem biopsy - stereotactic surgery - transfrontal approach - brain tumor


Publication History

Received: 17 April 2021

Accepted: 24 June 2022

Article published online:
25 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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