STEREOTAXIC BRAIN BIOPSY IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

Objective: To evaluate prospectively the diagnostic efficacy and safet y of stereotactic brain biopsy and its impact on treatment, outcome, a nd survival in human immunodeficiency virus-infected patients with foc al brain lesions. Methods: Computed tomography-guided stereotactic bra in biopsy was performed in 26 patients, of whom 17 failed to respond t o a 2- to 3-week anti-Toxoplasma regimen. Exclusion criteria for biops y were overt acquired immunodeficiency syndrome for 2 years or longer, Karnofsky score less than 50, and severe coagulopathies. Results: A d efinitive diagnosis was obtained in 24 patients (92%), of whom 12 (46% ) had primary brain lymphoma, six (23%) had progressive multifocal leu koencephalopathy, and four (15%) had Toxoplasma encephalitis. Two thir ds of contrast-enhancing lesions on computed tomography were lymphoma and three fourths of contrast-negative lesions were leukoencephalopath y. Three patients had biopsy-related cerebral hemorrhages (morbidity, 11.5%). Median follow-up and survival for the entire group were 24 wee ks (range, 6 to 135 weeks). Twenty patients (77%) received specific th erapy and 13 (50%) responded to treatment. Of 11 patients with lymphom a undergoing irradiation treatment (whole-brain radiotherapy in seven and gamma-knife treatment in four), nine (82%) had clinical and radiol ogic response, with a median survival of 34 weeks (range, 13 to 57 wee ks). Conclusions: Stereotactic brain biopsy has high diagnostic effica cy and clinical benefit in carefully selected human immunodeficiency v irus-infected patients. The procedure should be performed essentially in patients with contrast-enhancing lesions on computed tomography who have a high frequency of treatable cerebral diseases.