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Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety

OBJECTIVE: To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS). METHODS: A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples fr...

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Autores principales: Stoecklein, Veit Michael, Kellert, Lars, Patzig, Maximilian, Küpper, Clemens, Giese, Armin, Ruf, Viktoria, Weller, Jonathan, Kreth, Friedrich-Wilhelm, Schöberl, Florian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815620/
https://www.ncbi.nlm.nih.gov/pubmed/32813052
http://dx.doi.org/10.1007/s00415-020-10157-2
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author Stoecklein, Veit Michael
Kellert, Lars
Patzig, Maximilian
Küpper, Clemens
Giese, Armin
Ruf, Viktoria
Weller, Jonathan
Kreth, Friedrich-Wilhelm
Schöberl, Florian
author_facet Stoecklein, Veit Michael
Kellert, Lars
Patzig, Maximilian
Küpper, Clemens
Giese, Armin
Ruf, Viktoria
Weller, Jonathan
Kreth, Friedrich-Wilhelm
Schöberl, Florian
author_sort Stoecklein, Veit Michael
collection PubMed
description OBJECTIVE: To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS). METHODS: A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples from the meninges and the cortex as well as from the white matter was performed in 23 patients with clinically suspected PACNS between 2010 and 2017. The relationship between biopsy yield and clinical characteristics, cerebrospinal fluid parameters, MR-imaging, time point of biopsy and exact localization of biopsy as well as number of tissue samples were examined. RESULTS: PACNS was confirmed in 7 of 23 patients (30.4%). Alternative diagnoses were identified in 7 patients (30%). A shorter time period between the onset or worsening of symptoms (p = 0.018) and ESBB significantly increased the diagnostic yield. We observed only minor and transient postoperative complications in 3 patients (13.0%). ESBB led to a direct change of the therapeutic regime in 13 of 23 patients (56.5%). Careful neuropathological analysis furthermore revealed that cortical samples were crucial in obtaining a diagnosis. CONCLUSION: ESBB is a safe approach with good feasibility, even in critically ill patients, and high diagnostic accuracy in patients with suspected PACNS changing future therapies in 13 of 23 patients (56.5%). Early biopsy after symptom onset/worsening is crucial and (sub)acute MRI-lesions should be targeted with a particular need for biopsy samples from the cortical layer.
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spelling pubmed-78156202021-01-25 Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety Stoecklein, Veit Michael Kellert, Lars Patzig, Maximilian Küpper, Clemens Giese, Armin Ruf, Viktoria Weller, Jonathan Kreth, Friedrich-Wilhelm Schöberl, Florian J Neurol Original Communication OBJECTIVE: To evaluate the diagnostic accuracy and safety of extended stereotactic brain biopsy (ESBB) in a single center cohort with suspected primary angiitis of the central nervous system (PACNS). METHODS: A standardized stereotactic biopsy targeting MRI-positive lesions and collecting samples from the meninges and the cortex as well as from the white matter was performed in 23 patients with clinically suspected PACNS between 2010 and 2017. The relationship between biopsy yield and clinical characteristics, cerebrospinal fluid parameters, MR-imaging, time point of biopsy and exact localization of biopsy as well as number of tissue samples were examined. RESULTS: PACNS was confirmed in 7 of 23 patients (30.4%). Alternative diagnoses were identified in 7 patients (30%). A shorter time period between the onset or worsening of symptoms (p = 0.018) and ESBB significantly increased the diagnostic yield. We observed only minor and transient postoperative complications in 3 patients (13.0%). ESBB led to a direct change of the therapeutic regime in 13 of 23 patients (56.5%). Careful neuropathological analysis furthermore revealed that cortical samples were crucial in obtaining a diagnosis. CONCLUSION: ESBB is a safe approach with good feasibility, even in critically ill patients, and high diagnostic accuracy in patients with suspected PACNS changing future therapies in 13 of 23 patients (56.5%). Early biopsy after symptom onset/worsening is crucial and (sub)acute MRI-lesions should be targeted with a particular need for biopsy samples from the cortical layer. Springer Berlin Heidelberg 2020-08-19 2021 /pmc/articles/PMC7815620/ /pubmed/32813052 http://dx.doi.org/10.1007/s00415-020-10157-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Communication
Stoecklein, Veit Michael
Kellert, Lars
Patzig, Maximilian
Küpper, Clemens
Giese, Armin
Ruf, Viktoria
Weller, Jonathan
Kreth, Friedrich-Wilhelm
Schöberl, Florian
Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title_full Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title_fullStr Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title_full_unstemmed Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title_short Extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
title_sort extended stereotactic brain biopsy in suspected primary central nervous system angiitis: good diagnostic accuracy and high safety
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815620/
https://www.ncbi.nlm.nih.gov/pubmed/32813052
http://dx.doi.org/10.1007/s00415-020-10157-2
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