The Role of Percutaneous CT-Guided Biopsy in the Management of Central Skull Base Pathology: A Case Series

Objective: Report our consecutive series of CT-guided skull base biopsies with an emphasis on patient selection, safe approach and diagnostic accuracy.

Methods: Evaluated patients who underwent skull base CT-guided fine needle aspirations and core biopsies from January 1, 2015, to September 1, 2021. Safety was assessed by clinical follow-up and diagnostic accuracy by surgical confirmation, predicted treatment response or clinical follow-up.

Results: Eighteen patients (age: 6–84, 5 females and 13 males) had an average follow-up of 4.9 months including three patients who succumbed to their disease within 2 months of biopsy. The most common location biopsied was the clivus in eight patients (44.4%), followed by the sphenoid wing and the pterygopalatine fossa in four patients respectively (22.2%). Seven patients (38.9%) received a diagnosis of carcinoma, two patients (11.1%) with reactive lymphoid tissue, two patients (11.1%) with osteomyelitis, and the remainder with diagnoses of lymphoma, multiple myeloma, chondrosarcoma and Langerhans’ cell histiocytosis. Four biopsies (22.2%) were nondiagnostic. Lesion location did not impact diagnostic accuracy. There were no major morbidities from the procedures noted. One patient (5.6%) developed V2 hypoesthesia which improved on follow-up. No evidence of seeding was noted along the biopsy tracts. In the four patients with a nondiagnostic biopsy one patient underwent biopsy of a liver lesion and was found to have carcinoma, one patient underwent open resection and was found to have a capillary hemangioma, one patient was lost to follow-up and one is awaiting patient decision. Due to a diagnosis of chondrosarcoma, one patient underwent open resection after biopsy. The remaining patients with diagnostic biopsies were referred to the appropriate specialists in oncology, radiation oncology, infectious disease, or were monitored with surveillance imaging.

Conclusion: CT-guided biopsy can provide a safe, minimally invasive means of obtaining pathology samples for histologic diagnosis that can optimize treatment plans for complex central skull base pathology. This may represent an underutilized technique in the management of skull base pathology and warrants additional large-scale, multi-institutional study to further hone patient selection and improve diagnostic accuracy.

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Artikel online veröffentlicht:
15. Februar 2022