Neurobiopsy

Neurobiopsy is the medical procedure of obtaining a tissue sample from nervous system tissue for histopathologic examination. It most often refers to brain biopsy, but may also involve nerve or spinal cord tissue. The aim is to establish a definitive diagnosis when noninvasive testing fails to provide conclusive information.

Biopsy can be performed using stereotactic needle biopsy guided by computed tomography or magnetic resonance imaging, either frame-based or frameless, or as an open surgical biopsy via craniotomy. Less commonly, endoscopic approaches may be used for accessible lesions or intraventricular processes. Specimens are handled by neuropathology with histology and ancillary studies such as immunohistochemistry, microbiology culture, and molecular testing.

Indications include suspected neoplasms, infectious or inflammatory lesions, demyelinating diseases, vasculitis, or metabolic/storage diseases where tissue diagnosis would alter treatment. It is typically reserved for cases where imaging and clinical data do not yield a clear diagnosis and where the results would affect management.

Diagnostic yield varies by lesion location and technique but is generally high, often reported around 70–90%. Risks include hemorrhage, infection, and new or worsened neurological deficits; seizures can occur; anesthesia-related risks apply. The rate of complications depends on lesion depth, size, and the experience of the surgical team.

In addition to pathology, results may guide targeted therapies and clinical trials. Noninvasive imaging, CSF analysis, and serologic tests are considered when biopsy is not essential. Ethical and patient-specific considerations, including potential morbidity and likelihood of diagnostic change, influence the decision to perform neurobiopsy.