Brain Biopsy – Treatment, Effect & Risks

Brain Biopsy

brain biopsy , also known as a brain puncture , is a medical examination in which a piece of the brain is removed for further examination. Examination of the removed tissue can provide information about the nature of the 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 at hand. The goal of a brain biopsy is to distinguish brain lesions.

These occur, for example, in the form of bleeding , infections , cerebral vasculitis (vascular inflammation), but also as tumors . Even if the doctors cannot determine what type of brain lesion is present from the course of the disease, a brain biopsy is appropriate. Because the result of this tissue examination is quickly available, which accelerates the diagnosis – and thus also the appropriate therapy. A brain biopsy, for example, shows whether the tumor is benign and requires no further treatment, or whether a malignant tumor must be treated immediately with chemotherapy .

Function, effect & goals

A common technique for removing a tissue sample from the brain is stereotactic biopsy. In preparation for the brain biopsy, the doctor fixes a helmet on the patient’s head. The imaging procedures that precede the anesthesia , for example an MRT examination, already tell the surgeon where the abnormalities are in the brain. He now puts the coordinators on his helmet, who show him where to take the tissue sample. 

The surgeon then drills through the skull wall at the appropriate point and takes a tissue sample through a needle. Beforehand, the affected area is disinfected to avoid infection of the wound and prepared with a skin incision about four centimeters wide. There the haironly have to be shaved selectively, the biopsy is not noticeable in the hairstyle. The burr hole through the skull wall is about 7 mm deep and less than 1 cm in diameter. The puncture can also be repeated in several places in order to be able to precisely examine the different areas of a brain lesion. During the puncture, as little brain tissue as possible should be damaged. This is also feasible due to the imaging means available today, which the surgeon can even use during the operation.

The operation will take approximately two hours, with approximately half of the time spent locating the appropriate drill site. In those places where a tissue sample was taken, the surgeon leaves a titanium bead that is visible in later MRI scans 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 tissue sample taken – this is done, for example, by staining the tissue sample and then examining it under a microscope.

Recourse to cytological (cell-related) diagnostics allows the neuropathologist to confirm or eliminate the suspicion of a tumor based on the cell activity in the tissue sample. The suspicion of cerebral vasculitis, i.e. an 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 require it, additional tissue samples are taken.

Otherwise, the neuropathologist declares the operation over and prepares the findings report, which the doctor then discusses with the patient regarding the next treatment steps. After the procedure, the patient remains in the hospital for a few days for observation. The doctor can also carry out the follow-up check of the healing on an outpatient basis.

Risks, side effects & dangers

A brain biopsy is an invasive procedure, and as such it comes with risks. Bleeding can occur in the puncture canal. In order to reduce the risks here, a coagulation test is performed before the operation. A brain biopsy is only appropriate if there are no blood clotting disorders . Because bleeding in the brain carries the risk of permanent paralysis or speech disorders occurring in the patient. 

In extreme cases, there is a fatal bleeding complication – 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, infection of the wound can occur in the rarest of cases, which in the worst case can also spread to the meninges or brain. In order to avoid this, compliance with the highest hygienic standards during the operation and wound care is mandatory. In addition, swelling of the brain tissue can occur after the puncture, and brain fluid 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 in a brain biopsy. Overall, however, 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. For example, before the patient opts for chemotherapy, which itself entails high health risks, the brain biopsy provides definitive certainty as to whether a tumor or another brain lesion – which requires different treatment – is actually present. In 98 percent of brain biopsies, a clear diagnosis can be made after tissue analysis.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.