**9.1 Infectious**

*Current Cancer Treatment*

in small (<1 cm3

**8.1 Open biopsy**

accurate diagnosis.

combined.

**8.2 Stereotactic biopsy**

**8.3 Endoscopic biopsy**

**8. Histologic confirmation of diagnosis**

Histopathologic diagnosis of brain tumours is necessary for decision making regarding appropriate management. Stereotactic biopsy has emerged as a comparatively safe method of histological diagnosis and has significantly reduced the risks associated with brain biopsy [16]. Tissue sampling can be obtained either with

Greater than 90% diagnostic yield, while it may be significantly lower (60–70%)

It can be frame based and frameless. The frame-based method is focused on the fixation of the stereotactic frame on the patient's head, whereupon the localizer is attached to the frame with many N-shaped posts. Under stereotactic circumstances, neuroimaging (CT, MRI, positron emission tomography [PET], etc.) is carried out and radiological information is transmitted to the specialized computer platform. The localizer posts are used as space coordinate references. For optimizing the target location and defining the ideal trajectory for biopsy, multiple pictures are

The frameless biopsies are generally technically easier and require less prepara-

It is recommended for intra- and periventricular tumors and can be done with or

without frameless stereotactic guidance. The advantages of this technique are

4. cerebrospinal fluid (CSF) samples can be taken for tumor marker analysis

Exception may be produced in chosen patients such as patients with known active systemic cancer and numerous lesions radiographically associated with brain metastases, patients with classic clinical and MRI results of brain stem glioma or optic nerve meningioma, HIV-positive patients with CT or MRI results consistent with primary CNS lymphoma and positive Epstein-Barr virus polymerase chain

reaction in the CSF, or patients with secretory germ-cell tumors [19].

In case obstructive hydrocephalus, third ventriculostomy can be simultaneously

2.vascular structures can be seen during tissue sampling

3.more pathological specimens can be taken.

tory efforts in comparison to frame-based ones [18].

1.direct visualization of the lesion

It is performed as an open technique by intraoperative neuronavigation. Typically, it is asserted for surface brain lesion, where hemostasis is critically vital or a surgical resection depending on frozen section histopathology is arranged. Although morbidity and mortality of open biopsy is more as compared to stereotactic biopsy but neoplastic tissue yield is better and it influences the likelihood of an

stereotactic, open, or endoscopic procedures and, overall, provides.

) and/or heterogeneous lesions [17].

**154**

done [10].

Abscess-fever, acutely ill, ±systemic infection, ct findings show cyst cavity with smooth thin walls and restricted diffusion within cavity.

Cerebritis-fever, acutely ill, ±systemic infection, mri findings show diffuse T2 change, no mass meningitis-diffuse enhancement of meninges on T1-weighted imaging.
