Summary
A neurological complication occurs in 40–60% of HIV infected patients during the course of the disease. In 10–20% the neurological complication is the first manifestation of the HIV infection. A reliable neuropathological diagnosis is a prerequisite for a specifically selected treatment. While modern computer-assisted imaging techniques, such as computed tomography or magnetic resonance imaging, do possess a high sensitivity, they do not as a rule permit an unambiguous diagnosis.
Between October 1989 and July 1994 we biopsied 38 HIV infected patients stereotactically. The indication for the biopsy was determined by having radiologically detectable lesions with no regression tendency in patients under antitoxoplasmosis therapy. In 89% an unambiguous diagnosis wa made based on the biopsy; 11 % of the biopsies were not diagnostic. For the most part, toxoplasmosis (31%) and progressive multifocal leucoencephalopathy (29%) were involved. 18% of the patients suffered from a non-Hodgkin lymphoma. The foci were primarily frontal (47%), parietal (21%) or localised in the basal ganglia area (11%). The result of the biopsy led to a change in treatment for 52% of the patients. Morbidity and mortality of the operation were 0%.
The results or our research series are similar to other groups. It was shown that stereotactic brain biopsy is a safe and effective method for establishing a sound basis for treating the frequently life-threatening cerebral complications of AIDS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Budka H, Costanzi G, Cristina S, Lechi A, Parravicini C, Trabattoni R, Vago L (1987) Brain pathology induced by infection with the human immunodeficiency virus (HIV)-a histological, immunocytochemical, and electron microscopical study of 100 autopsy cases. Acta Neuropathol 75: 185–198
Rosenblum ML, Levy RM, Bredesen DE (1988) Neurosurgical implications of the acquired immunodeficiency syndrome (AIDS). Clin Neurosurg 34: 419–445
Berger J, Moskowitz L, Fischl M, Kelley R (1987) Neurological disease as the presenting manifestation of the acquired immunodeficiency syndrome. South Med J 80: 683–686
Budka H (ed) (1990) Neuropathology of AIDS. In: Chopra JSet al (eds) Proc XlVth World Congr Neurol, Advances in neurology. Internat Congr Series 883. Elsevier, Amsterdam, pp 193–202
Dietrich B, Alesch F (1989) Specificity of CT diagnosis assessed by stereotaxic brain biopsy. A retrospective analysis of 180 cases. In: IMN (ed) Imaging of brain metabolism, spine and cord, interventional neuroradiology. Springer, Berlin Heidelberg New York Tokyo
Alesch F, Pappaterra J, Trattnig S, Koos W (1995) The role of stereotactic biopsy in radiosurgery. Acta Neurochir (Wien) [Suppl] 63: 20–24
Ciricillo SF, Rosenblum ML (1990) Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 73: 720–724
Friedman WA, Sceats DJ, Nestok BR, Ballinger WE (1989) The incidence of unexpected pathological findings in an image-guided biopsy series: a review of 100 consecutive cases. Neurosurgery 25: 180–184
Apuzzo MU, Chandrasoma PT, Cohen D, Zee C-H, Zeelman V (1987) Computed imaging stereotaxy: experiences and perspective relative to 500 procedures applied to brain masses. Neurosurgery 20: 930–937
Ostertag CB, Mennel HD, Kiessling M (1980) Stereotactic biopsy of brain tumors. Surg Neurol 14: 275–283
Alesch F, Kitz K, Koos W, Ostertag C (1991) Diagnostic potential of stereotactic biopsy of midline lesions. Acta Neurochir (Wien) 53: 33–36
CDC (1987) Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 36: 1–15S
Olsen W, Longo F, Mills C, Norman D (1988) White matter disease in AIDS: findings at MR imaging. Radiology 169: 445–448
Handwerker M, Krahe T, Klinker H, Schindler R (1992) MR-tomographische Volumetrie der Liquorräume bei HIV-asso-ziierter Hirnatrophie. Fortschr Röntgenstr 157: 466–470
Bornstein R, Nasrallah H, Para M, Whitacre C, Rosenberger P, Fass R, Rice R (1992) Neuropsychological performance in asymptomatic HIV infection. J Neuropsychiat 4(4): 386–394
Levy RM, Bredesen DE, Rosenblum ML (1985) Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62: 475–495
Cuadrado L, Guerrero A, Asenjo J, Martin F, Palau E, Urra D (1988) Cerebral mucormycosis in two cases of acquired immunodeficiency syndrome. Arch Neurol 45: 109–111
Karahalios D, Brait R, Dal Canto MC, Levy RM (1992) Progressive multifocal leukoencephalopathy in patients with HIV infection: lack of impact of early diagnosis by stereotactic brain biopsy. J Acqu Immune Defic Syndr 5(10): 1030–1038
Pell M, Thomas D, Whittle I (1991) Stereotactic biopsy of cerebral lesions in patients with AIDS. Br J Neurosurg 5: 585–589
Anson J, Glick R, Reyes M (1992) Diagnostic accuracy of AIDS-related CNS lesions. Surg Neurol 37: 432–440
Levy RM, Russell E, Yungbluth M, Hidvegi DF, Brody BA, Dal Canto MC (1992) The efficacy of image-guided brain biopsy in neurologically symptomatic acquired immunodeficiency syndrome patients. Neurosurgery 30: 186–189
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Alesch, F., Armbruster, C. & Budka, H. Diagnostic value of stereotactic biopsy of cerebral lesions in patients with AIDS. Acta neurochir 134, 214–219 (1995). https://doi.org/10.1007/BF01417692
Issue Date:
DOI: https://doi.org/10.1007/BF01417692