Stereotactic Brainstem Biopsy in Children: A Multicentric Case Series of 88 Patients

Abstract

Introduction:
Brainstem tumors pose a significant challenge in pediatric neurosurgery. Although MRI has advanced non-invasive diagnostics, up to 20% of cases show radiologic-histologic discordance, making stereotactic biopsy an important diagnostic option. This study aimed to assess the safety, diagnostic effectiveness, and clinical significance of stereotactic brainstem biopsy in a large pediatric cohort.

Methods:
We conducted a multicentric retrospective review of 88 children with intrinsic, non-resectable brainstem lesions who underwent stereotactic biopsy (frame-based or robot-assisted). Demographic data, surgical technique, histopathological diagnosis, and complications were analyzed.

Results:
Eighty-eight pediatric patients (median age 7 years, range 1.5–17; 54% male) underwent stereotactic brainstem biopsy. The most common presenting symptom was cranial nerve dysfunction, with the pons affected in 76% of cases. Stereotactic frame-based, robot-assisted, and Talairach techniques were used in 10%, 31%, and 59% of cases, respectively. The initial diagnostic yield was 97.7%. The most common diagnoses were high-grade glioma, including diffuse midline glioma (44%), followed by low-grade glioma (41%). The overall complication rate was 9.2%, primarily transient neurological deficits. No procedure-related deaths occurred. The mean follow-up period was 32 months.

Conclusion:
Stereotactic brainstem biopsy is a safe and effective diagnostic tool in children, offering high diagnostic yield with low morbidity. Continued advances in technique and molecular analysis further enhance its clinical value.