Stereotactic biopsy for intracranial lesions using the Leksell system: usefulness of rapid intraoperative diagnosis

Objective: Performing stereotactic biopsy using the Leksell system, we discuss its advantages and disadvantages and analyze our intraoperative histopathological and cytological diagnostic success rates. Methods: We present a series of 47 patients subjected to stereotactic biopsies for a wide variety of brain lesions. The anatomical locations, diagnostic yield, morbidity and mortality rates, and the concordance rates between final histopathological diagnoses, intraoperative histological diagnoses, and intraoperative cytological diagnoses were analyzed. Results: The final histopathological diagnoses were made in 41 of 47 patients (diagnostic yield, 87.2%). Complications occurred in 2 of 47 patients (4.25%). The mortality rate was 2.1% (1 patient). The concordance rate between final histopathological diagnosis and intraoperative cytological diagnosis was 70.7% (29/41), and the concordance rate between final histopathological diagnosis and intraoperative histological diagnosis was 60.9% (25/41). In 4 of 41 cases, cytology yielded a better quality specimen than did histology for the correct diagnosis. Conclusions: Stereotactic biopsy using the Leksell system is less invasive and, therefore, useful for deciding adjuvant therapy after the surgical diagnoses of tumors. Using both intraoperative histological diagnosis and intraoperative cytological diagnosis concurrently can compensate for the limitations of each individual method and contributes greatly to the accuracy of the final diagnosis.