Brain biopsy

A Brain biopsy, also Brain puncture called, is a medical examination method in which a piece of the brain is removed for further examination. The examination of the removed tissue can provide information about the type of brain lesions and, for example, confirm whether a brain tumor is present.

What is the brain biopsy?

When diagnosing diseases of the brain, a brain biopsy, the underlying tissue sample of which is taken through a hole drilled in the skull wall, enables a reliable diagnosis of the disease present. The goal of a brain biopsy is to distinguish brain lesions.

These occur, for example, in the form of bleeding, infections, cerebral vasculitis (blood vessel inflammation), but also as tumors. Even if doctors cannot determine what type of brain lesion is present from the course of the disease, a brain biopsy is advisable. Because with this tissue examination, the result is quickly available, which speeds up the diagnosis - and thus also the appropriate therapy. A brain biopsy, for example, shows whether a benign tumor is present that does not require further treatment, or if a malignant tumor has to be removed immediately with chemotherapy.

Function, effect & goals

A common method for obtaining a tissue sample from the brain is a stereotactic biopsy. In preparation for the brain biopsy, the doctor fixes a helmet on the patient's head. The imaging procedures prior to anesthesia, e.g. Through an MRI scan, the surgeon is already informed at which point in the brain there are abnormalities. He now wears the coordinators on his helmet, who show him where to take the tissue sample.

At the appropriate point, the surgeon then drills through the skull wall and takes a tissue sample through a needle. The area concerned is disinfected beforehand to avoid infection of the wound and prepared by making an incision about four centimeters wide. Since the hair only needs to be shaved selectively, the biopsy is not noticeable in the hairstyle. The hole through the skull wall is about 7 mm deep and less than one centimeter in diameter. The puncture can also be repeated at several points in order to precisely examine the different areas of a brain lesion. The aim of the puncture is to damage the brain tissue as little as possible. Due to the imaging means available today, which are available to the surgeon even during the operation, this can also be achieved.

The operation takes about two hours, with about half of the time being spent on finding the right drilling site. At the points where a tissue sample was taken, the surgeon leaves a titanium ball that is visible in subsequent MRI examinations and can confirm that the puncture took place in the right place. During the procedure, a neuropathologist is present in the operating room who immediately examines the removed tissue sample - this is done, for example, by coloring the tissue sample and then examining it under the microscope.

The use of cytological diagnostics (relating to the cells) allows the neuropathologist to confirm the suspicion of a tumor or to eliminate it based on the cell activity in the tissue sample. The suspicion of cerebral vasculitis, i.e. inflammation of the vessels in the brain, can also be clarified quickly and very reliably with the help of a biopsy. If the results of the neuropathological examination so require, additional tissue samples are taken.

Otherwise, the neuropathologist declares the operation to be over and prepares the report, which the doctor then discusses with the patient with regard to the next treatment steps. After the procedure, the patient remains in the hospital for a few days for observation. The doctor can also check the healing process on an outpatient basis.

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Risks, side effects & dangers

A brain biopsy is an invasive procedure, and so there are risks associated with it. There may be bleeding in the puncture canal. In order to reduce the risks here, a coagulation finding is made before the operation. A brain biopsy is only advisable if there are no bleeding disorders. Because bleeding in the brain carries the risk of permanent paralysis or speech disorders in the patient.

In extreme cases, it can lead to a fatal bleeding complication - but the risk of this is extremely low at 0.2 percent. The location of any brain lesions and the age of the patient also influence the decision for or against a brain biopsy. After the brain puncture, an infection of the wound can rarely occur, which in the worst case can spread to the meninges or brain. To avoid this, compliance with the highest hygienic standards during surgery and wound care is mandatory. In addition, swelling of the brain tissue can occur after the puncture, and brain water can also leak out.

Furthermore, the complications that can occur in the course of anesthesia, such as disorders of the cardiovascular system, must also be taken into account during a brain biopsy. Overall, however, the brain puncture is considered an examination method that has a low complication rate and can provide valuable information for the treatment of the underlying disease. Before the patient decides, for example, on chemotherapy, which itself entails high health risks, the brain biopsy provides definitive certainty as to whether a tumor or another brain lesion - which requires a different treatment - is actually present. In 98 percent of brain biopsies, a clear diagnosis can be made after tissue examination.