An Audit on the Use of Brain Biopsies for Non-neoplastic Brain Diseases

Introduction: In cases where a brain tumour is suspected, brain biopsies are the gold standard method for confirming the diagnosis. Brain biopsies are not frequently performed in non-neoplastic diseases as they tend to be regarded as an investigation of last resort. The role of brain biopsies, and their impact on subsequent clinical care, in non-neoplastic brain disorders is not well-defined. Methods: This is a retrospective analysis of brain biopsies for non-neoplastic brain diseases performed at a single tertiary neuroscience centre over a ten-year period, from 2008 to 2018. Cases were identified from neuropathology reports. The charts were reviewed where pre-operative clinical information and investigation results were documented and post-biopsy clinical outcome as well as management changes were also recorded. Data analysis was performed using the frequencies tool and Fisher-exact test via SPSS software. Results: Twenty cases were identified from pathology reports. 60% of biopsies (n = 12) were pathologically diagnostic. In those who had clinical management following biopsy recorded, clinical management was altered in 84% (n = 16) of patients. Of those with clinical outcome recorded: 62% (n = 8) had a documented clinical improvement; 15% (n = 2) returning to pre-disease baseline while 46% (n = 6) of patients improved without returning to pre-disease baseline. Complications occurred in 5% of patients (n = 1), a lower respiratory tract infection. Discussion: In comparison with previous papers, the diagnostic yield of biopsies in this study is high. This could be attributable to extensive investigations, particularly neuroimaging resulting in targeted biopsies. Clinical improvements were seen in higher rates compared to previous research and complication rates were low. Conclusion: This study shows that brain biopsies are useful in the investigation of non-neoplastic neurological disease and can have a high diagnostic yield. Clinical outcome was, for the majority, positive with a significant proportion of the patients improving. Complications were rare and did not have an adverse effect on patient outcomes. Our findings support the inclusion of brain biopsies as part of the diagnostic algorithm for non-neoplastic neurological conditions of unknown aetiology.