Brain stem lesions are pathologically heterogeneous. Pre-operative radiological diagnoses prove to be wrong in 10 to 20% of cases. It is therefore imperative to have a tissue diagnosis for appropriate therapeutic measures. We report a series of 24 patients (14 males, ten females, age range: 6–17 years) CT guided stereotactic biopsy for brain stem lesions approached via the suboccipital transcerebellar route in semi sitting position with principle used to violate only one pial plane with the biopsy probe not entering the ventral surface of the cerebellum. The inclusion and exclusion criteria with detailed material and method are discussed. Histological diagnosis was established in 23 patients (96%) with no procedure-related mortality. Our results indicate that stereotaxic approach to brain-stem lesions provides a high yield of positive histological diagnoses with a low incidence of morbidity. Awake CT-guided stereotactic biopsy via the suboccipital transcerebellar route in a semi-sitting position is a safe, reliable, and effective method for brainstem lesions that can obtain adequate tissue for histological diagnosis, thus providing each patient with the best available treatment.
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