Hemorrhage after Stereotactic Biopsy from Intra-Axial Brain Lesions: Incidence and Avoidance

Abstract

Background With the introduction of stereotactic surgery in humans by Spiegel and Wycis in 1947 and the great advances in neuroimaging, image-guided stereotactic brain biopsy is the mainstay for diagnosis of intrinsic deep-seated brain lesions. Stereotactic biopsy is usually safe, and the reported rate of complications is minimal, with mortality being reported in less than 1% and significant morbidity occurring in less than 5%. The complication most often encountered after stereotactic biopsy is hemorrhage.

Patients and Methods A total of 150 patients (84 male and 66 female) with the mean age of 52.8 years having intra-axial brain lesions were included in the study. Image-guided (114 computed tomography [CT] and 36 magnetic resonance imaging [MRI]) stereotactic biopsy were performed by a specialized stereotactic neurosurgeon. Routine preoperative coagulation studies were performed in all patients. A workstation with multiplanar trajectory planning software was used. Serial biopsies were done with Sedan-type side cutting needle. Any detectable bleeding was analyzed by CT within 4 hours after procedure. All medical charts, laboratory results, preoperative imaging studies, and postoperative imaging studies were reviewed.

Results A conclusive histopathological diagnosis was achieved in 147 patients (98%). In 7 patients (4.7%), hemorrhage was detected in post-biopsy CT scan (3.3% asymptomatic and 1.4% symptomatic). Hemorrhage occurred in patients with highly malignant tumors. There was no mortality.

Conclusion Using multiplanar image-guided trajectory planning and a small biopsy needle decreases the incidence of post-biopsy hemorrhage. Neurologically intact patients with no hemorrhage in post-biopsy CT scan could safely be discharged home at the same operative day.

Keywords

stereotactic biopsy - intra-axial brain lesions - complications - hemorrhage

• References

• 1 Ostertag CB, Mennel HD, Kiessling M. Stereotactic biopsy of brain tumors. Surg Neurol 1980; 14 (4) 275-283
• 2 Tilgner J, Herr M, Ostertag C, Volk B. Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis—influence of clinical factors. Neurosurgery 2005; 56 (2) 257-265 , discussion 257–265
• 3 Aker FV, Hakan T, Karadereler S, Erkan M. Accuracy and diagnostic yield of stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimens. Neuropathology 2005; 25 (3) 207-213
• 4 Ferreira MP, Ferreira NP, , Pereira Filho Ade A , Pereira Filho Gde A, Franciscatto AC. Stereotactic computed tomography-guided brain biopsy: diagnostic yield based on a series of 170 patients. Surg Neurol 2006; 65 (Suppl. 01) S1:27-S1:32
• 5 Grossman R, Sadetzki S, Spiegelmann R, Ram Z. Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir (Wien) 2005; 147 (6) 627-631 , discussion 631
• 6 Bernstein M, Parrent AG. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 1994; 81 (2) 165-168
• 7 Hall WA. The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 1998; 82 (9) 1749-1755
• 8 Chen JCT, Apuzzo MLJ. Stereotactic brain biopsy for tissue diagnosis. In: Batjer HH, Loftus CM, , eds. Textbook of Neurological Surgery: Principles and Practice. Philadelphia: Lippincott Williams & Wilkins; 2003: 2659-2667
• 9 Apuzzo ML, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 1987; 20 (6) 930-937
• 10 Field M, Witham TF, Flickinger JC, Kondziolka D, Lunsford LD. Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg 2001; 94 (4) 545-551
• 11 Lunsford LD, Martinez AJ. Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 1984; 22 (3) 222-230
• 12 Voges J, Schröder R, Treuer H , et al. CT-guided and computer assisted stereotactic biopsy. Technique, results, indications. Acta Neurochir (Wien) 1993; 125 (1–4) 142-149
• 13 Yu X, Liu Z, Tian Z , et al. CT-guided stereotactic biopsy of deep brain lesions: report of 310 cases. Chin Med J (Engl) 1998; 111 (4) 361-363
• 14 Sawin PD, Hitchon PW, Follett KA, Torner JC. Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases. Surg Neurol 1998; 49 (6) 640-649
• 15 Kulkarni AV, Guha A, Lozano A, Bernstein M. Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy. J Neurosurg 1998; 89 (1) 31-35
• 16 Kreth FW, Muacevic A, Medele R, Bise K, Meyer T, Reulen HJ. The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours—a prospective study. Acta Neurochir (Wien) 2001; 143 (6) 539-545 , discussion 545–546
• 17 Kelly PJ. Tumor Stereotaxis. Philadelphia: WB Saunders; 1991
• 18 Hertel F, Feiden W, Bettag M. The value of micro-Doppler in stereotactic brain biopsy. Minim Invasive Neurosurg 2005; 48 (3) 165-168
• 19 Levin AB. Experience in the first 100 patients undergoing computerized tomography-guided stereotactic procedures utilizing the Brown-Roberts-Wells guidance system. Appl Neurophysiol 1985; 48 (1-6) 45-49
• 20 Niizuma H, Otsuki T, Yonemitsu T, Kitahara M, Katakura R, Suzuki J. Experiences with CT-guided stereotaxic biopsies in 121 cases. Acta Neurochir Suppl (Wien) 1988; 42: 157-160
• 21 Smith JS, Quiñones-Hinojosa A, Barbaro NM, McDermott MW. Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol 2005; 73 (2) 173-179
• 22 Heper AO, Erden E, Savas A , et al. An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: a prospective clinicopathologic study. Surg Neurol 2005; 64 (Suppl. 02) S82-S88