Multiplanar MRI–CT fusion neuronavigation-guided serial stereotactic biopsy of human brain tumors: proof of a strong correlation between tumor imaging and histopathology by a new technical approach
Serial stereotactic biopsy is a diagnostic procedure, used when open biopsy or tumor bulk removal seems to be associated with a too high risk of new neurological deficits in tumors of eloquent regions or tumors of deep localizations or in anticipated high surgery related morbidity even in the older patient group. Shortcomings of this method are recognized to be the missed pathohistological information from untargeted areas in heterogeneous tumors. This study shows for the first time a collection of patients with brain tumors with their associated multiplanar MRI–CT fusion imaging during stereotaxis and the histopathological features of serial tumor biopsies along exact trajectorial sites towards the tumor center. Thirteen patients were included. Stereotactic biopsy was performed and neuronavigation was correlated to histopathological features. Reactive tissue, endothelial hyperplasia, and diffusely scattered tumor cells occur outside the contrast-enhancing tumor in glioblastomas. Within the contrast-enhancing area, endothelial hyperplasia and diffuse tumor tissue were seen as compared to endothelial proliferations and the dense tumor as well as necroses in the image-defined center. Serial stereotactic biopsy is a reliable means. Strong correlations with the imaging characteristics of the lesions could be evaluated.