Abstract】Objective: This study was designed to discuss the methodological development of image-guided stereotactic brain tissue biopsy based on the summary of previous cases of stereotactic brain tissue biopsy and to clarify its significance in the diagnosis of neurological diseases. Methods: We retrospectively analyzed the medical records of 1187 stereotactic brain tissue biopsies from December 1987 to January 2009, including 607 CT-guided biopsies and 580 MRI-guided biopsies, including 67 hydrogen proton magnetic resonance spectroscopy (1H-MRS)-guided brain biopsies and 2 PET-CT functional imaging-guided brain biopsies. There were 726 cases of frame-guided biopsies and 461 cases of CAS-type frameless stereotactic robot-guided biopsies. RESULTS: Among all cases, 694 cases (58.5%) were male and 493 cases (41.5%) were female; age ranged from 1 to 85 years, with an average of 39.7 years; various oncological pathological diagnoses were obtained in 983 cases (82.81%), including 813 cases of tumors of neuroepithelial origin (82.70% of all tumors) and 64 cases of metastatic tumors (6.51%); including (4 cases of leukemic intracerebral invasion), 43 cases of primary lymphoma (4.37%), 40 cases of germ cell tumors (4.06%; including 14 cases of basal ganglia thalamic germ), 13 cases of benign and malignant meningiomas (1.32%), 5 cases of melanoma (0.5%), and 5 cases of other miscellaneous tumors; 173 cases (14.57%) were diagnosed with non-neoplastic lesions including: multiple sclerosis (3.87% of all biopsies); 34 cases of neurodegenerative diseases (2.86%, including CJD, mitochondrial encephalomyopathy, metabolic encephalopathy, etc.); 44 cases of specific or non-specific inflammatory lesions (3.71%, including abscesses, tuberculomas, syphilitic granulomas, vasculitis, etc.); 11 cases of parasites; 20 cases of congenital cysts; 11 cases of radiation necrosis; 2 cases of cerebral infarcts; and 5 cases of miscellaneous tumors. cases; 2 cases of cerebral infarction; 5 cases of malformed blood vessels; 31 cases (2.61%) who could not be clearly diagnosed histopathologically; the total positive biopsy diagnosis rate reached 97.39%. There were 3 cases of directly related deaths due to biopsy hemorrhage, which were biopsies of lesions in the pineal and saddle areas (0.25%), 20 cases of small hematomas with no neurological deficits (hematoma volume <10 ml) due to a small amount of blood leakage from the target site, and 9 cases of large hematomas requiring surgical management (tube placement and open hematoma removal). The positive biopsy rate also reached 98% in 67 cases of "single voxel and multi voxel mass spectrometry MRS" guided stereotactic intracerebral lesion biopsies, which indirectly quantified the metabolic and biochemical environment of the lesion tissue by measuring the hydrogen proton spectral changes in the region of interest. The biopsy target selection and range definition were guided by the metabolic characteristics of different regions of interest to determine the internal composition and boundaries of the lesion, which greatly improved the purposefulness and positive rate of biopsy. Conclusion: Advanced imaging technology-guided stereotactic brain biopsy is a safe, reliable, and minimally invasive diagnostic aid for intracerebral diseases, and the recent development of biochemical imaging and functional imaging technologies such as MRS and PET-CT has given a new content to stereotactic-guided biopsy technology. Wang Yaming, Department of Neurosurgery, Naval General Hospital