• World Neurosurg · Feb 2016

    Case Reports

    Impact of stereotactic biopsy in HIV patients.

    • Johanna Quick-Weller, Gerrit Kann, Stephanie Lescher, Lioba Imöhl, Volker Seifert, Lutz Martin Weise, Hans-Reinhard Brodt, and Gerhard Marquardt.
    • Neurosurgical Clinic, Goethe-University Frankfurt, Germany. Electronic address: johanna.quick@gmx.de.
    • World Neurosurg. 2016 Feb 1; 86: 300-5.

    ObjectiveDuring their disease a significant number of human immunodeficiency virus (HIV)-infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found are toxoplasmosis, lymphomas, or progressive multifocal leukoencephalopathy. In some patients, diagnosis is not feasible with imaging alone, requiring biopsy. The objective of this study was to evaluate the impact of stereotactic biopsy in HIV patients on adjustment of therapy.MethodsBetween January 2004 and May 2015 at our clinic, 26 HIV-infected patients underwent stereotactic biopsy. Thin-layer magnetic resonance images were obtained and fused with computed tomography scans, taken with the stereotactic frame (Leksell) mounted. Biopsy material was evaluated pathologically and microbiologically.ResultsHistologic analysis revealed B-cell lymphoma in 6 patients (23.1%) and progressive multifocal leukoencephalopathy in 2 patients (7.7%). Abscess and toxoplasmosis were found in 3 patients each (11.5% and 11.5%), and encephalitis occurred in 4 patients (15.4%). In 2 patients each (7.7%), vasculitis, metastasis, and glioblastoma were diagnosed. Further findings comprised non-Hodgkin lymphoma and Burkitt lymphoma in 1 patient each. After biopsy, treatment was significantly changed in 18 (69.2%) patients (P < 0.01). Antibiotic therapy was adjusted in 6 patients (23.1%), and chemotherapy in 3 patients (16.7%). Other changes included antibiotic/antiviral therapy to chemotherapy in 3 patients (16.7%), chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in 1 patient each. One patient with glioblastoma underwent resection, and another patient received radiation. One patient underwent palliative care.ConclusionStereotactic biopsy in HIV-infected patients results in significant changes of therapy in more than two thirds of the patients.Copyright © 2016 Elsevier Inc. All rights reserved.

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