Open brain biopsy for nonneoplastic undiagnosed neurological conditions: diagnostic yield, clinical impact…

Cohort studyIrish journal of medical science· Jun 2026

Open brain biopsy for nonneoplastic undiagnosed neurological conditions: diagnostic yield, clinical impact, and contemporary role.

Garret P Greeneway, Ufuk Erginoglu, Umid Sulaimanov … Mustafa K Baskaya

NeuropathologyCohort studyDiagnosisQ2IF 1.9

Open brain biopsy yields a definitive diagnosis in fewer than 1 in 4 patients.

Open brain biopsy for nonneoplastic undiagnosed neurological conditions: diagnostic yield, clinical impact, and contemporary role.

Garret P Greeneway … Mustafa K Baskaya

Irish journal of medical science · Jun 2026 · Q2 in General Medicine

Background

Open cranial biopsy is reserved for patients with progressive nonneoplastic neurological conditions of unknown etiology who have failed exhaustive noninvasive evaluation, raising questions regarding its diagnostic yield, clinical utility, and risk profile.

Purpose

To characterize the diagnostic yield, treatment impact, and procedural risk of open cranial biopsy in a contemporary cohort of diagnostically refractory patients with nonneoplastic neurological conditions.

Methods

We performed a single-institution retrospective cohort study of patients undergoing open cranial biopsy for nonneoplastic undiagnosed neurological conditions (August 2016-July 2021).

Results

definitive diagnosis found in fewer than 1 in 4 patients

23.8%

Definitive yield

52.4%

Informative yield

More results

Twenty-one patients (mean age, 54.3 years; 52% male) met the inclusion criteria.

The most common diagnoses were vasculitis and cerebral amyloid angiopathy.

Three patients (14.3%; 95% CI 3.0%-36.3%) experienced fatal biopsy-attributable complications, all in patients with advanced comorbidity.

More results

No significant differences were observed between targeted and non-targeted approaches.

“

Conclusion · 1 of 2

Open cranial biopsy demonstrates limited definitive diagnostic yield but meaningful clinical impact in a subset of patients, highlighting a disconnect between histopathological diagnosis and therapeutic decision-making.

Conclusion · 2 of 2

Complication rates reflect patient severity rather than procedural risk. Careful multidisciplinary patient selection and preference for targeted biopsy when feasible are essential.

Open brain biopsy for nonneoplastic undiagnosed neurological conditions: diagnostic yield, clinical impact, and contemporary role.

Open brain biopsy for nonneoplastic undiagnosed neurological conditions: diagnostic yield, clinical impact, and contemporary role.

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