Image-guided stereotactic biopsy of infiltrative, multicentric and deep-seated supratentorial cerebral gliomas

Infiltrative cerebral gliomas remain a neurosurgical challenge despite the latest achievements in neuroimaging techniques and microsurgical approaches. In this paper the authors present their experience in 85 cases of stereotactic biopsies performed for infiltrative, multicentric and deep-seated cerebral gliomas. The stereotactic and neuroimagistic tools used for these procedures included the Leksell stereotactic system and the software: Stereotactic Planning System (SPS), NTPS 8.2. The histopatological results (according to World Health Organization (WHO) classification) were: 51 cases of glioblastomas (grade IV) (60%), 7 cases of anaplastic astrocytomas (grade III) (8,2%), 13 cases of grade II diffuse astrocytomas (15,3%), 6 cases of grade I astrocytomas (7,1%), one case of grade II oligodendroglioma (1,2%), 3 cases of anaplastic oligodendrogliomas (grade III) (3,5%), one case of grade I ganglioglioma (1,2%), one case of anaplastic ganglioglioma (grade III) (1,2%), and 2 cases of anaplastic ependymomas (grade III) (2,3%). In 21 cases (24,7%) the immunohistochemistry has been performed in order to obtain an accurate histopathological result. In this series, the early postoperative mortality was 0%, with no cases of clinically significant hemorrhages after biopsy procedures. Temporary increase of neurological deficits has been noticed in 7 patients (8,2%). In conclusion, image-guided stereotactic biopsy represents now a safe and accurate diagnostic method for cerebral gliomas, which can favorably influence the therapeutic management of the patients.