Clinical impact and safety of brain biopsy in unexplained central nervous system disorders: a real-world cohort study

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY

Annals of Clinical and Translational Neurology Pub Date : 2025-02-21 DOI:10.1002/acn3.70000

Robin W. van Steenhoven, Saan Salih, Juna M. de Vries, Ide Smets, Rob M. Verdijk, Mayke Gardeniers, Jeroen Kerstens, Juliette Brenner, Yvette S. Crijnen, Marjolein Geurts, Jacoline E. C. Bromberg, Corine H. GeurtsvanKessel, Peter A. E. Sillevis Smitt, Rutger K. Balvers, Maarten J. Titulaer

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引用次数: 0

Abstract

Objective

A substantial part of central nervous system (CNS) disorders remains unexplained, despite various new and minimally invasive diagnostic techniques. Within this rapidly developing diagnostic field, the precise role of brain biopsy is unknown. We aimed to study the clinical impact and safety of brain biopsies in unexplained CNS disorders.

Methods

In this retrospective cohort study, we included all adult patients who were referred for a diagnostic work-up to our academic center with neuro-inflammatory, neuro-oncological, and neuro-infectious expertise and underwent a brain biopsy between January 2010 and December 2023. Typical cases of CNS neoplasms and infections were not analyzed. Brain biopsies were evaluated with respect to diagnostic and therapeutic impact and complication risk.

Results

Brain biopsy was performed in 587 patients. Ninety-four patients with a CNS disorder of unknown cause, with 107 biopsies, were analyzed (44% female, median age 58 years). Postoperative diagnoses included brain tumors/lymphomas (37/94, 39%), inflammatory disorders (11/94, 12%), infections (8/94, 9%), autoimmune encephalitis (8/94, 9%), and primary angiitis of the CNS (4/94, 4%). Diagnostic yield of brain biopsy was 62%, increasing up to 72% after repeat biopsies, as 10 additional patients were diagnosed with a brain tumor. In 77% of patients, brain biopsy changed the treatment strategy. Symptomatic intracranial hemorrhage occurred in 4 of 107 brain biopsies (4%).

Interpretation

In a selected population of patients with unexplained CNS disorders, clinical impact of brain biopsies is high, while being relatively safe. A multidisciplinary team approach is fundamental in establishing optimal indication for brain biopsy and subsequent treatment decisions.

Abstract Image

查看原文本刊更多论文

脑活检在不明原因中枢神经系统疾病中的临床影响和安全性：一项真实世界的队列研究。

目的：尽管有各种新的微创诊断技术，但大部分中枢神经系统（CNS）疾病仍未得到解释。在这个快速发展的诊断领域，脑活检的确切作用尚不清楚。我们的目的是研究脑活检在不明原因的中枢神经系统疾病中的临床影响和安全性。方法：在这项回顾性队列研究中，我们纳入了所有在2010年1月至2023年12月期间转诊到我们的学术中心接受神经炎症、神经肿瘤和神经感染专业知识诊断的成年患者，并接受了脑活检。未分析中枢神经系统肿瘤及感染的典型病例。评估脑活检在诊断和治疗方面的影响以及并发症的风险。结果：587例患者行脑活检。我们分析了94例原因不明的中枢神经系统疾病患者，107例活检（44%为女性，中位年龄58岁）。术后诊断包括脑肿瘤/淋巴瘤（37/ 94,39 %）、炎症性疾病（11/ 94,12 %）、感染（8/ 94,9 %）、自身免疫性脑炎（8/ 94,9 %）和中枢神经系统原发性脉管炎（4/ 94,4 %）。脑活检的诊断率为62%，在重复活检后增加到72%，因为另外10例患者被诊断为脑肿瘤。在77%的患者中，脑活检改变了治疗策略。107例脑活检中有4例（4%）出现症状性颅内出血。解释：在一组有不明原因中枢神经系统疾病的患者中，脑活检的临床影响很高，但相对安全。多学科团队方法是建立脑活检和后续治疗决策的最佳适应症的基础。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.