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Diagnostic Yield of Brain Biopsies in Children Presenting to Neurology

Department of Pediatrics, Children's Hospital of Western Ontario, University of Western Ontario, e_wassmer{at}yahoo.co.uk

Cynthia Hawkins, MD, PhD

Department of Pathology, University of Toronto, The Hospital for Sick Children, University of Toronto, Ontario

Evangeline Wassmer, MD

Department of Neurology, Birmingham Children's Hospital, United Kingdom

The role of brain biopsy is well established in patients with neoplastic lesions, with a diagnostic yield approaching 95%. The diagnostic yield of brain biopsy in adults with neurological decline varies from 20% to 43%. Only a few studies have examined the diagnostic yield of brain biopsy in children with idiopathic neurological decline. A retrospective analysis was conducted on all open and closed pediatric brain biopsies performed between January 1988 and May 2003. Biopsies were performed for diagnostic purposes in patients showing a progressively deteriorating neurologic course in whom less-invasive modalities such as neuroimaging, electroencephalography (EEG), and molecular genetic studies were either negative or inconclusive. Immunocompromised patients were included. Patients were excluded if the preoperative diagnosis was a neoplasm or if the patient was undergoing a resection as part of a work-up for intractable epilepsy. Each patient underwent numerous investigations before brain biopsy. The utility of each biopsy was analyzed. Sixty-six children had brain biopsies performed for diagnostic purposes during the study period. Patient ages ranged from 2 months to 16 years and 9 months at the time of biopsy. The diagnostic yield was 48.5% overall, with a yield of 68.8% between 1996 and 2003. Of the total, 26 (39.4%) biopsies were both diagnostic and useful. Patients most frequently presented with seizures (56.1%) and encephalopathy (33%). The most frequently diagnosed disease was vasculitis (18.2%). A total of 71.9% of patients with diagnostic biopsies improved with appropriate treatment. Brain biopsy in children had a diagnostic yield of 48.5% in our series. A specific diagnosis may help in management and outcome, especially with a diagnosis of vasculitis.

Key Words: brain biopsy • encephalitis • infection • demyelination

This version was published on March 1, 2008

Journal of Child Neurology, Vol. 23, No. 3, 253-258 (2008)
DOI: 10.1177/0883073807309254


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