Brain biopsy

A brain biopsy is a neurosurgical procedure in which a brain surgeon removes a small amount of brain tissue to be examined for the presence of prions (misshapen prion proteins). This procedure is done in the operating room. This invasive procedure carries risk of infection, bleeding or disruption of brain function, although it is generally a safe, well-tolerated procedure. In cases of prion disease, however, the procedure exposes the surgical team to prion infection and special precautions to prevent the spread of prions must be taken in the operating room. Currently, at our institution; all instruments used in the procedure need to be destroyed by incineration after the procedure and cannot be used on another patient. For more information, please refer your doctors to the UCSF Infection Control Website.

Because of the diagnostic usefulness of diffusion-weighted (DWI) MRI, in most cases of CJD we no longer recommend a brain biopsy. In some cases, in which the diagnosis is still uncertain even after a DWI MRI, brain biopsy may be necessary. The biopsy carries the risks of any invasive procedure, but also the tissue removed for analysis may not always show any prions, even if the person has human prion disease. Although a brain biopsy that is positive for prion disease means that the patient has prion disease, a negative brain biopsy does not rule out prion disease. A brain biopsy in a patient with CJD may be negative for a variety of reasons. In some cases, prion disease is not definitely confirmed until tissue from a brain autopsy is analyzed. Our center consults in many such cases.

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