Neuropathological diagnosis with stereotactic biopsies : possibilities, difficulties and requirements

The present paper is based on stereotactic biopsies (SB) of 870 patients during the last 20 years. Approximately 700 patients suffered with brain tumour. Dementias and various diseases such as vasculopathies, leucoencephalopathies and inflammatory lesions were diagnosed in the other cases. Three groups of problems can be diagnosed with SB: 1) deeply located brain lesions; 2) early stages of lesions and diffuse or multiple lesions detected with imaging techniques; 3) some progressive dementing or degenerative diseases. Multiple (generally 4 to 6) SB should be taken in the vicinity and various parts of the lesion; they should be numbered, described separately and located exactly on an image of the brain. Handling the SB with care and the quality of the processing are important. Previous contact between neurosurgeon and neuropathologist can improve the accuracy of the diagnosis, which is reliable in the majority of cases, without producing undesirable brain damage.