Endoscopic Brain Biopsy: Single-Center Retrospective Experience (2012–2024)

Abstract

 Background: From Dandy's earliest endoscopic cauterization of the choroid plexus in hydrocephalus to Fukushima's first successful endoscopic brain biopsy (EB) in 1973, neuroendoscopic indications have expanded substantially.

Objective: To evaluate the effectiveness and diagnosis yield of endoscopic brain biopsy (EB)

Design, Setting and Participants: Single center retrospective series by the senior author. Between November 2012 and June 2024, 27 patients underwent intraventricular endoscopic biopsy (VEB) and 7 underwent intraparenchymal endoscopic biopsy (PEB).

Main Outcome(s) and Measure(s): Demographics, histopathology, operative times, adjunct procedures, hospital length of stay, and complications.

Results: In the VEB group, age ranged 6-70 years (mean 28) with 2:1 female: male ratio. The most common diagnoses were pilocytic astrocytoma (26%) and metastasis and ependymoma (15% each). Pathology was inconclusive in 15%. Other diagnoses included glioblastoma (11%), germinoma (7%), and meningioma, pineoblastoma, and epidermoid cyst (each 4%). In the PEB group (age 25-70 years, mean 59), glioblastoma was most frequent (71%); 14% had diffuse astrocytoma grade II and 14% were non-diagnostic. Typical operative times were 1,5-3 hours for VEB (depending on concomitant procedures_ and up to 2 hours for PEB.

Conclusions and Relevance: EB achieved an 85% diagnostic yield in this series, comparable to published yields for stereotactic biopsy (~86%). In appropriately selected intraventricular and deep lesions, EB offers tissue diagnosis with the potential to address hydrocephalus in the same session.