stereotactic brain tumor biopsy

[gd__0]

  : : You have been very helpful in past questions, here I go again....I had a craniotomy which was to do a biopsy to confirm a diagnosis, then remove core of tumor (diagnosis was low grade glioma on left temporal lobe, 4x4x6) The biopsy surprisingly came back normal so there was no removal.  An MRI done 2 months later showed no difference in mass but the radiologist doing the report claimed the biopsy missed the tumor.  A "second opinion" neurosurgeon thinks this is important to be diagnosed.  He is suggesting a stereotactic biopsy.  He believes this is a low grade glioma that will require a craniotomy to remove what is possible.  I cannot decide what to do here. I believe he may be suggesting the stereotactic biopsy because of the first craniotomy being questionable.  He does this with a local anesthetic while I sit in a chair.  I would spend one night in the hospital for precaution.  I have researched this some and all I find is the patient actually being put under.  How do you do this?  How accurate is the biopsy?  How dangerous is this? What side effects have you dealt with?  Any recommendations?  At this rate, I may lose my mind mentally before physically.  Thanks again for any input..it is very appreciated.
  : Dear GGD:
  : Sorry to hear about all your problems.  Actually, the only way to do a brain biopsy is to do it stereotactically, so what happened to you won't happen.  Is it a good idea to get a biopsy and a diagnosis.  I think the answer is yes, because if the tumor is completely removed, then the chances of the tumor changing into a malignant tumor becomes reduced.  It might reduce the chances of temporal lobe seizures.  I am assuming that the diagnosis was originally made from your symptoms and MRI scan.  Unless, the tissue is sampled and examined, your doctors will really not know for sure what the mass is.  Therefore treatment is severely restricted.  However, you have to weigh the pros and cons of surgery.  What does your neurologist say?  Gather all the opinions and sit down with those whom love you and come to a decision.  Let us know if we can help.
  : Sinerely,
  : CCF Neuro[P] MD

  I just got some information on a petscan...any opinion on this?  How does the accuracy of a petscan compare to a stereotactic biopsy?  You asked what my current neurosurgeon says-my "current" one is the doctor who did the craniotomy, insists he did not miss the tumor, and has said come back in 6 months for an MRI since the biopsy is normal (he admits this is very bizzare).  My second opinion doctor says to do the stereotactic biopsy to confirm his "diagnosis" from the MRI.  It is very difficult for me to make a decision to perform another surgery without understanding how conclusive and easy to read an MRI is.  The comment on the 2nd MRI report is:  "The biopsy tract appears to be posterior and superior to the mass."  How accurate can that statement be?  Is that something easy to determine or just an opinion?  This makes the complete difference on my decision.  Thank you again for any ideas or opinoins.  
Dear GHD:
Sorry about the confusion that you are in.  It is very easy to read a MRI, especially if the neuroradiologist read the MRI.  If the path of the surgery does not include the mass, then it is likely that the mass was missed.  If you want to verify the radiologist's reading, then have a second neuroradiologist and another neurosurgeon view the film and have them give you the verdict.  In fact, this may be a wise step, a third neurosurgeon without involvement (personal ego) in the case along with an unbiased neuroradiologist would be a conclusive diagnosis.  You didn't tell me what the pet scan showed.  Pet scan can tell you if the metabolic functioning of an area is abnormal, which a low grade glioma should demonstrate.  Again, I would assume that the reading is very accurate, it is not that difficult to see if the surgery missed the mass.  Since the radiologist is an uninvolved party, I doubt if he/she would be partial one way or another.  Get the other opinion and reading is what I would do, if it was me.  Let us know what happens.
Sincerely,
CCF Neuro[P] MD