Diagnosis of suspected intracranial metastases. Role of direct tissue examination.

Accurate histologic diagnosis is often critical to the appropriate choice of treatment of patients suspected of harboring brain metastases. In most cases, frame based stereotactic biopsy can provide an accurate histologic diagnosis with minimal risk of morbidity. In addition, newer modalities allow for efficient coupling of stereotactic biopsy with treatment in a single session. These include frameless stereotactic systems that facilitate the combination of open biopsy and resection as well as biopsy procedures that are combined with focal interstitial or external beam irradiation. These techniques provide increasingly convenient and effective means of achieving both diagnosis and treatment of cerebral metastases.