Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy
ABSTRACT Stereotactic brain biopsy has played an integral role in the diagnosis and management of brain lesions. At most centers, imaging studies following biopsy are rarely performed. The authors prospectively determined the acute hemorrhage rate after stereotactic biopsy by performing immediate postbiopsy intraoperative computerized tomography (CT) scanning. They then analyzed factors that may influence the risk of hemorrhage and the diagnostic accuracy rate.
Five hundred consecutive patients undergoing stereotactic brain biopsy underwent immediate postbiopsy intraoperative CT scanning. Before surgery, routine preoperative coagulation studies were performed in all patients. All medical charts, laboratory results, preoperative imaging studies, and postoperative imaging studies were reviewed. In 40 patients (8%) hemorrhage was detected using immediate postbiopsy intraoperative CT scanning. Neurological deficits developed in six patients (1.2%) and one patient (0.2%) died. Symptomatic delayed neurological deficits developed in two patients (0.4%), despite the fact that the initial postbiopsy CT scans in these cases did not show acute hemorrhage. Both patients had large intracerebral hemorrhages that were confirmed at the time of repeated imaging. The results of a multivariate logistic regression analysis of the risk of postbiopsy hemorrhage of any size showed a significant correlation only with the degree to which the platelet count was below 150,000/mm3 (p = 0.006). The results of a multivariate analysis of a hemorrhage measuring greater than 5 mm in diameter also showed a correlation between the risk of hemorrhage and a lesion location in the pineal region (p = 0.0086). The rate at which a nondiagnostic biopsy specimen was obtained increased as the number of biopsy samples increased (p = 0.0073) and in accordance with younger patient age (p = 0.026).
Stereotactic brain biopsy was associated with a low likelihood of postbiopsy hemorrhage. The risk of hemorrhage increased steadily as the platelet count fell below 150,000/mm3. The authors found a small but definable risk of delayed hemorrhage, despite unremarkable findings on an immediate postbiopsy head CT scan. This risk justifies an overnight hospital observation stay for all patients after having undergone stereotactic brain biopsy.
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ABSTRACT: In this paper we present our experience of representing the knowledge behind HealthAgents, a distributed decision support system for brain tumour diagnosis. Our initial motivation came from the distributed nature of the information involved in the system and has been enriched by clinicians' requirements and data access restrictions. We present in detail the steps we have taken towards building our ontology starting from knowledge acquisition to data access and reasoning. We motivate our representational choices and show our results using domain examples employed by clinical partners in HealthAgents.
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ABSTRACT: Stereotactic biopsy is a widely used surgical technique for the histological diagnosis of intracranial lesions. Potential risks of this procedure, such as hemorrhage, seizure, and infection have been established, and different risk factors have been characterized. However, these risks have been addressed by only few studies conducted in Asian countries. The study group is comprised of 299 consecutive stereotactic biopsy procedures by 11 neurosurgeons between 2004 and 2007. The pre-operative medical conditions, methods of biopsy and postoperative complications were analyzed. The overall diagnostic yield was 90.64%. Complications were observed in 7.36% of the cases, with symptomatic hemorrhages occurring in 4.35% of the cases, and the overall mortality rate in this study population was 1.34%. Patients with liver cirrhosis were at a higher risk of hemorrhage. Other clinical, radiological, or histological variables were not associated with an increased risk of complications. Stereotactic brain biopsy is a safe and reliable way to obtain a histological diagnosis. Based on our recent clinical experiences, the data suggests that more attention should be paid to liver cirrhotic patients, since the chance on hemorrhage is significantly larger.Clinical neurology and neurosurgery 09/2009; 111(10):835-9. DOI:10.1016/j.clineuro.2009.08.013 · 1.25 Impact Factor
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ABSTRACT: A variety of surgical approaches to the posterior third ventricle and pineal region exist. The choice of approach is influenced by the exact location of the lesion, its expected pathologic findings, and the comfort level of the operating surgeon with the approach that is being considered. For most pineal region masses that are situated in the midline below the deep venous system, we favor the supracerebellar-infratentorial approach in the sitting position. For pineal region lesions that displace the deep venous system inferiorly or have significant lateral extension, we prefer the occipital-transtentorial approach in the three-quarter prone or sitting position. For lesions that are truly in the posterior third ventricle without extension posterior to the splenium, we prefer the interhemispheric-transcallosal approach in the lateral position.Neurosurgery Clinics of North America 11/2003; 14(4):527-45. DOI:10.1016/S1042-3680(03)00061-5 · 1.54 Impact Factor