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S e eo ac ic b ain biopsy: S udy abou 100 cases and li e a u e e iew
Is ae ALMAGHRIBI *, Oyhmane LAMHAMDI, Mus apha HEMAMA, Niza e EL FATEMI and Moulay Rachid EL
MAAQILI
Depa men o Neu osu ge y, Hospi al IBN SINA-Raba , Mohammed V Uni e si y o Raba , Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2442-2445
Publica ion his o y: Recei ed on 03 Ap il 2025; e ised on 09 May 2025; accep ed on 11 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1835
Abs ac
In oduc ion: A s e eo ac ic b ain biopsy is a p ocedu e in which a small piece o an abe an b ain lesion is aken o
mic oscopic examina ion. I an uniden i ied mass is disco e ed on imaging, his p ocess may be used o p ecisely
diagnose i . In he e en ha he biopsy specimen is a umo , he ype o umo and whe he i is benign o malignan
can be iden i ied using speci ic mic oscopic pa e ns. T ea men can be guided by he in o ma ion p o ided by he
biopsy esul s. A s e eo ac ic de ice p ecisely guides he placemen o su gical ins umen s du ing he p ocedu e by
using a coo dina e-based na iga ion sys em ha is equipped wi h he pa ien 's b ain images (MRI, CT). Depending on
he lesion's loca ion, size, and su geon p e e ence, s e eo axis can be " amed" o " ameless."
Pa ien s and me hods: The objec i e o his s udy is o ca y ou a e ospec i e desc ip i e analysis o a se ies o 100
cases ollowed o b ain lesions and bene i ing om a s e eo ac ic biopsy, collec ed a he neu osu ge y depa men o
he IBN SINA hospi al in RABAT, du ing he pe iod om 2016 o 2020, in o de o implemen he con ibu ion and
impac o s e eo ac ic biopsy in he managemen o b ain lesions.
Resul s: The pa ien ages we e wi h an a e age o 53 yea s, and a p edominance o males. Clinical p esen a ions we e
domina ed by neu ological de ici s (33%), ollowed by headaches (30%) and in ac anial hype ension synd ome
(18%). Lesions we e soli a y in 79% o cases; among hem, 75% we e glial umo s, 7% me as ases, 5%
c aniopha yngiomas, and 3% ube culomas. SBB achie ed a diagnos ic success a e o 98%. One complica ion was
obse ed, bu no mo ali y was eco ded. Pos -ope a i e con ol scans e ealed only ansien and benign
pneumocephalies.
Conclusion: S e eo ac ic biopsy is no jus a echnique; i ep esen s he p omise o a u u e whe e neu osu ge y is less
in asi e, mo e a ge ed, and decidedly sa e . I ep esen s a cen al pilla o mode n neu osu ge y, a echnique ha
combines scien i ic igo and ad anced echnologies.
Keywo ds: S e eo axic Biopsy; In ac anial B ain Lesions; Glial Tumo s; LEKSELL F ame
1. In oduc ion
The b ain biopsy is an essen ial neu osu gical p ocedu e ha p o ides a his o-molecula diagnosis and guides he
managemen o b ain umo s, in he con ex o ou pa ien su ge y. This is one o he mos common c anial neu osu ge y
p ocedu es. Complica ions ollowing b ain biopsies a e a e, bu like all neu osu gical p ocedu es, hey ca y ce ain
isks, such as he occu ence o epilep ic seizu es, b ain edema o in ec ion. The mos speci ic and equen
complica ions and ad e se e ec s a e sample nega i i y (blank biopsies) equi ing a second biopsy [1], and ce eb al
hemo hage which can cause se ious consequences [2]. They ad e sely a ec he p ognosis, ex end hospi al s ays and
gene a e addi ional cos s o he heal h sys em [3]. The diagnos ic yield o b ain biopsy has also imp o ed wi h he
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2442-2445
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inc ease in he p ecision o s e eo axic echniques and imaging and he de elopmen o new in aope a i e diagnos ic
ools. In o de o ob ain a his ological diagnosis wi hou causing complica ions, new ends a e eme ging.
2. Ma e ial and me hods
This e ospec i e s udy, co e ing 100 cases o SBB conduc ed in he Neu osu ge y Depa men o A icenne Hospi al
in Raba , spans a pe iod o 55 mon hs (2016-2020). Da a we e collec ed om medical eco ds and compiled in o an
exploi a ion shee , including epidemiological, clinical, adiological, his opa hological, and ollow-up in o ma ion,
ensu ing a comp ehensi e analysis o SBB's ole in managing b ain lesions
3. Resul s
Be ween Janua y 2016 and Janua y 2020, 100 cases o SBB we e pe o med a he Neu osu ge y Depa men o ibn Sina
Hospi al in Raba , spanning a 55-mon h pe iod. Da a we e collec ed om medical eco ds and a da a shee , including
epidemiological, clinical, adiological, pa hological, and e olu iona y in o ma ion, p o iding a comp ehensi e analysis
o he implica ions o SBB in he managemen o b ain inju ies, wi h he ollowing esul s:
• Pa ien ages anged om 17 o 88 yea s, wi h a mean o 53 yea s, and a male p edominance (sex a io o 1.7).
• The mos common medical his o ies: high blood p essu e (hype ension) and diabe es, wi h espec i e a es o
22% and 31%. - Clinical p esen a ions we e domina ed by neu ological de ici s (33%), ollowed by headaches
(30%) and in ac anial hype ension synd ome (18%).
• Lesions we e single in 79% o cases; among hem, 75% we e glial umo s, 7% we e me as ases, 5% we e
c aniopha yngiomas, 4% we e la ge B-cell lymphomas, and 3% we e ube culomas.
• All pa ien s unde wen CT imaging using a LEKSELL® s e eo axic ame, and samples we e collec ed using
s aged ose es, ensu ing ep esen a i eness o he samples o ana omopa hological analysis.
• BST achie ed a diagnos ic success a e o 98%.
• One case o complica ion was obse ed, consis ing o an ex adu al hema oma equi ing immedia e su ge y.
No mo ali y was eco ded.
• Pos ope a i e ollow-up CT scans e ealed only ansien and benign pneumocephalus.
These esul s, consis en wi h he li e a u e, con i m he eliabili y and sa e y o SBB o op imal managemen o
in ac anial lesions, enabling ailo ed and speci ic he apeu ic o ien a ions o each lesion ype. Th ough ad anced
imaging, igo ous sampling me hodology, and ho ough his opa hological analysis, SBB es ablishes i sel as an essen ial
ool o he managemen o in ac anial lesions.
Figu e 1 Pa ien o ou s udy wi h pineal egion p ocess, A: B ain CT shows a p ocess in he pineal egion wi h he
onse o hyd ocephalus. B: B ain MRI shows he same umo p ocess enhanced a e gadolinium injec ion.C: ame-in-
place loca o scann, biopsy a ge chosen in a con as -enhanced a ea. D: Follow-up CT scan shows pneumocephalus a
he biopsy si e
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4. Discussion
S e eo ac ic b ain biopsy elies on ca e ul planning, equi ing p ecise a ge iden i ica ion, made possible by mode n
imaging echniques such as compu ed omog aphy (CT) and magne ic esonance imaging (MRI). These ools p o ide
p ecise spa ial coo dina es o ensu e he e ec i eness and sa e y o p ocedu es. A signi ican ad an age is ha i can be
done unde anes hesia. These echniques ha e bene i ed om p og ess in imaging and planning so wa e, which ha e
acili a ed he econs uc ion o he ajec o y and he e o e imp o ed sa e y o he p ocedu e. We a e cu en ly using
he Leksell Su gi Plan® so wa e om he ELEKTA company which has allowed us o p ope ly plan he s e eo axy
ajec o y wi h a good s udy o he s uc u es o be c ossed [4].
The indica ions o s e eo axic biopsy a e ela i ely b oad, due o i s essen ial ole in ob aining a his ological diagnosis
when a con en ional su gical app oach is un easible, whe he due o he pa ien 's condi ion o he na u e o he
suspec ed condi ion. S e eo axic biopsy hus p o es o be a aluable al e na i e, allowing o a a ge ed and less in asi e
p ocedu e. [5]
Fo umo s loca ed deep wi hin he b ain (such as hose o he halamus, midb ain, o b ains em) o in a eas known o
be a isk, he li e a u e shows ha MRI alone is o en insu icien o es ablish a de ini i e his ological diagnosis.
This is pa icula ly ue o umo s loca ed in he pos e io pa o he hi d en icle o he epiphyseal egion, whe e
only ce ain lesions show speci ic imaging indings (e.g., colloid cys s o e a omas). Apa om hese a e excep ions,
cu en neu oimaging gene ally only allows o a diagnos ic p esump ion, based on a se o clues, a he han
his ological ce ain y [6].
In many cases, s e eo ac ic b ain biopsy (SBB) p o ides a p ecise diagnosis ha decisi ely guides he apeu ic
managemen and p o ides p ognos ic in o ma ion o pa ien s. Thus, a diagnosis o ge minoma loca ed in he pineal
egion, o mo e a ely in he in undibula ecess, immedia ely leads o a chemo he apy and adio he apy p o ocol,
es ic ed o speci ic a eas. This s a egy is conside ed a e e i ying he absence o umo dissemina ion in he
ce eb ospinal luid (CSF) o along he spinal axis, bo h o which a e necessa y o limi he ex en o ea men [7]. Fo
malignan non-Hodgkin lymphomas, he diagnosis also equi es speci ic managemen , including adio he apy and
an imi o ic chemo he apy, adminis e ed sys emically and, depending on he case, in a en icula ly. The p o ocol is
adap ed acco ding o he pa ien 's age and clinical needs [8].
A diagnosis o b ain me as asis, pa icula ly when he p ima y umo si e emains unknown, equi es apid and
a ge ed he apeu ic managemen based on he p esumed na u e o he ini ial umo . F om a neu osu gical pe spec i e,
he choice be ween a di ec app oach and s e eo ac ic adiosu ge y is o en conside ed, pa icula ly when he lesion is
small and well-ci cumsc ibed.
Glial lesions pose ano he diagnos ic challenge, gi en he p e alence o low-g ade lesions, such as pilocy ic
as ocy omas, which a e common in young pa ien s. His ological con i ma ion by SBB is o en eassu ing, as al hough
hese umo s a e in ensely ascula ized and exhibi no able con as enhancemen a e gadolinium injec ion on MRI,
hey a e dis inguished by hei benign na u e. Some o hese umo s exhibi a cen al nec o ic componen and mixed
ea u es (cys ic and solid), which, on ini ial examina ions, may appea mo e de oga o y [9-10].
The diagnosis ob ained using BST can hus lead o signi ican adjus men s in he ea men plan and p ognos ic ou look.
In he p esence o benign and well-ci cumsc ibed lesions, pa icula ly in young pa ien s, comple e su gical excision is
o en p e e ed. This app oach a oids he isks associa ed wi h ex e nal beam adio he apy, e en limi ed, which can
cause neu oendoc ine and neu ocogni i e side e ec s. Al hough hese as ocy omas a e gene ally adiosensi i e,
comple e excision, guided by s e eo ac ic mapping, is ecommended when easible. I a small umo emnan is
iden i ied du ing pos ope a i e assessmen s, adiosu ge y o in e s i ial adio he apy may be p oposed o comple e he
ea men [11-12].
5. Conclusion
Following ad anced imaging, igo ous sampling me hodology and ana omo-pa hological analysis, he S e eo ac ic b ain
biopsy has es ablished i sel as an essen ial ool o he managemen o in ac anial lesions and ep esen s a cen al
pilla o mode n neu osu ge y, enabling adap ed and speci ic he apeu ic o ien a ions o each ype o lesion.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2442-2445
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Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Re e ences
[1] Chabaane M, Amelo A, Riche M, e al. E icacy o asecond b ain biopsy o in ac anial lesions a e
ini ialnega i i y. J Clin Neu ol 2020;16:659—67, h p://dx.doi.o g/10.3988/jcn.2020.16.4.659.
[2] Riche M, Amelo A, Pey e M, e al. Complica ions a e ame-based s e eo ac ic b ain biopsy: a sys ema ic e iew.
Neu osu g Re 2021;44:301—7, h p://dx.doi.o g/10.1007/s10143-019-01234-w.
[3] Riche M, Ma ijon P, Amelo A, e al. Se e i y, imeline,and managemen o complica ions a e s e eo ac ic
b ainbiopsy. J Neu osu g 2022;136:867—76, h p://dx.doi.o g/10.3171/2021.3.JNS21134.
[4] Kondziolka D, Dempsey PK, Luns o d LD, Kes le JR, Dolan EJ, Kanal E, e al. Acompa ison be ween magne ic
esonance imaging and compu ed omog aphy o s e eo ac ic coo dina e de e mina ion. Neu osu ge y.
1992;30(3):402–7.
[5] Pe agu J, Riss J, Fa na ie P, Gamba elli D, Se hian M. Colloid cys s o he hi dce eb al en icle. Compu ed x-
ay omog aphy, MRI and s e eo axic punc u e. Ap opos o 9 cases. Neu ochi u gie. 1990;36(2):122–8.
[6] Nguyen J, Decq P, Ké a el Y. S e eo axic, diagnos ic and he apeu ic app oach o b ain umo s-Technical Edi ions-
Encycl Méd Chi (Pa is, F ance). Neu ology. 1995;17:210–310.
[7] Blond S, Touze G, Reyns N, Dan as S, P u o J. Clinical applica ions o s e eo axicme hology. In 2002. p. 162–9.
[8] Hayek G, Fou nie D, Guy G. Tumo s o he pineal egion. Encycl Med Chi Ed SciMédicales Else ie SAS Pa is All
Righ s Rese ed Neu ol. 2020;9:17–380.
[9] Dempsey P, Kondziolka D, Luns o d L. S e eo ac ic diagnosis and ea men o pineal egion umo s and ascula
mal o ma ions. Ac a Neu ochi (Wien). 1992;116:14–22.
[10] Janze RC. [b]Neu opa hology[/b] and molecula pa hology o gliomas. Re Médicale Suisse [In e ne ]. 2009
[ci ed 2024 Oc 19];5(211):1501–4. A ailable om: h ps://www. e med.ch/ e ue-medicale-
suisse/2009/ e ue-medicale-suisse-211/neu opa hologie-e -pa hologie-moleculai e-des-gliomas
Oligodend oglioma - an o e iew | ScienceDi ec Topics [In e ne ]. [ci ed 2024 Oc A ailable om:
h ps://www.sciencedi ec .com/ opics/neu oscience/oligodend oglioma
[11] Blond S, Touze G, Desenclos C, Reyns N, Dubois F. S e eo ac ic applica ions in hi d en icle umo s.
Neu ochi u gie. 2000;46(3):268–80.
[12] Musolino A, Muna i C, Blond S, Be i O, Land e E, Daumas-Dupo C, e al. S e eo axic diagnosis and ea men o
colloid cys s o he 3d en icle. Ap opos o 7 cases. Neu ochi u gie. 1988;34(1):26–36.
