Safety and diagnostic yield of brain biopsy in critically-ill patients

Abstract

Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions or central nervous system infection. As an invasive procedure associated with potentially severe complications, its role in the diagnosis of neurological disease of unknown etiology remains controversial, especially in ICU patients. Brain sample can be obtain using stereotaxy or during open-brain surgery. Diagnostic yield is up to 98% in suspected brain tumors while 60-70% in neurologic diseases of unknown etiology. However, a therapeutical impact occurs in more than 75% following biopsy results. Complication rates are low, but higher in patients under mechanical ventilation. Mortality directly attributable to brain biopsy occurred in 6% patients in the only study focusing specifically in critically-ill patients. Therefore, the indication of brain biopsy needs to be carefully weighted, on the occasion of a specifically dedicated multidisciplinary meeting. A French National emergency multidisciplinary meeting under the supervision of BRAIN-TEAM has been launched on January 2022 to evaluate the indication of brain biopsy in critically-ill patients with neurological disease of unknown etiology.