Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Journal of Neurosurgery (Impact Factor: 3.23). 05/2001; 94(4):545-51. DOI: 10.3171/jns.2001.94.4.0545
Source: PubMed

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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    • "Similarly, Jian and colleagues found that HES was not a risk factor for post-craniotomy intracranial hematoma requiring surgery (Jian et al. 2014). The rate of reoperation for post-craniotomy intracranial hemorrhage in our cohort is similar to previously published rates (Field et al. 2001). Reoperation occurred most commonly on post-operative day 1, consistent with previous studies of post-operative hematoma evacuations (Jian et al. 2014; Kelly et al. 2011). "
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    • " is an invasive surgical procedure and in addition to health care costs and stress to patients , incurs a high risk of morbidity . Studies have shown that stereotactic brain biopsy has significant risks , with an estimated morbidity of 2 . 4 - 3 . 5% ( Favre et al . , 2002 ; Hall , 1998 ) and a death rate of 0 . 2 - 0 . 8% ( Favre et al . , 2002 ; Field et al . , 2001 ) . For tumours that evolve slowly ( e . g . pilocytic astrocytoma in children ) , repeated biopsies may not be advisable nor practical . Non - invasive methods to monitor tumour progression become necessary , so the classification accuracy of methods based on MRS data needs to be improved with the help of additional information coming "
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    • "Different clinical studies have reported the incidence of complications and the morbidity rate associated with stereotactic biopsies to be 0.7–17.2%, respectively [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12]. Different risk factors have been identified in previous studies. "
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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.
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