Limitations of stereotactic biopsy in the initial management of gliomas1,2

Stereotactic biopsy is often performed for diagnostic pur-poses before treating patients whose imaging studies highly suggest glioma. Indications cited for biopsy include diagnosis and/or the “inoperability ” of the tumor. This study questions the routine use of stereotactic biopsy in the initial management of gliomas. At The University of Texas M. D. Anderson Cancer Center, we retrospectively reviewed a consecutive series of 81 patients whose imag-ing studies suggested glioma and who underwent stereo-tactic biopsy followed by craniotomy/resection (within 60 days) between 1993 and 1998. All relevant clinical and imaging information was reviewed, including computer-ized volumetric analysis of the tumors based on pre- and postoperative MRI. Stereotactic biopsy was performed at institutions other than M. D. Anderson in 78 (96%) o