Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-25T00:28:03.515Z Has data issue: false hasContentIssue false
  • English
  • Français

Complications in 622 Cases of Frame-Based Stereotactic Biopsy, a Decreasing Procedure

Published online by Cambridge University Press:  02 December 2014

Paul N. Kongkham ,
Eva Knifed ,
Mandeep S. Tamber  and
Mark Bernstein
Paul N. Kongkham
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Eva Knifed
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Mandeep S. Tamber
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Mark Bernstein
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Frame-based stereotactic brain biopsy has played an important role in the management of patients with suspected neoplastic intracranial lesions over the last three decades. We reviewed the surgical experience of one surgeon to determine the nature and frequency of complications associated with this procedure.

Methods:

Records were reviewed for 858 patients undergoing frame-based stereotactic procedures from January 1986 to May 2006. Data on each case were prospectively collected by the senior author. Procedures for Ommaya reservoir placement, brachytherapy, stereotactic craniotomy flap localization, shunt placement, or treatment of previously-diagnosed intracranial cystic lesions were excluded, leaving 614 patients in whom a total of 622 procedures were performed for purely diagnostic purposes. Complication rates and their association with clinical variables were sought.

Results:

Morbidity and mortality rates were 6.9% (43/622) and 1.3% (8/622), respectively. The risk of symptomatic hemorrhage (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], intraventricular hemorrhage [IVH]) was 4.8%. The risks of transient or permanent neurological deficits were 2.9% (18/622) and 1.5% (9/622), respectively. Biopsy of deep-seated lesions was associated with increased overall complication rate, while biopsy of Glioblastoma Multiforme (GBM) was associated with perioperative mortality.

Conclusions:

Overall, complication rates were comparable with those in previous reports. The subgroup of patients with deep-seated lesions or a histologic diagnosis of GBM may possess an elevated risk of overall complications or mortality, respectively, compared to other patients undergoing frame-based stereotactic brain biopsy.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Contexte</span></span>:

Au cours des trente dernières années, la biopsie du cerveau avec cadre stétéotaxique a joué un rôle important dans l'évaluation des patients chez qui on soupçonnait la présence de lésions néoplasiques intracrâniennes. Nous avons revu l'expérience d'un chirurgien afm de déterminer la nature et la fréquence des complications associées à cette intervention.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Les dossiers de 858 patients ayant subi cette intervention entre janvier 1986 et mai 2006 ont été révisés. Les données concernant chaque patient ont été recueillies de façon prospective par l'auteur principal. Les dossiers de patients qui avaient subi une intervention pour mettre en place un réservoir d'Ommaya, une brachythérapie, la localisation stéréotaxique d'un volet osseux, la mise en place d'une dérivation ou le traitement de lésions kystiques intracrâniennes dont le diagnostic était déjà posé ont été exclus. Il restait donc 614 dossiers de patients qui avaient subi au total 622 interventions à des fms diagnostiques. Nous avons déterminé le taux de complications et leur association à des variables cliniques.

<span class='italic'> <span class='bold'>Résultats</span></span>:

Les taux de morbidité et de mortalité étaient respectivement de 6,9% (43/622) et 1,3% (8/622). Le risque d'hémorragie symptomatique (HIC, HSA, IIIV) était de 4,8%. Le risque de déficits neurologiques transitoires ou permanents était respectivement de 2,9% (18/622) et 1,5% (9/622). La biopsie de lésions profondes était associée à un taux de complications plus élevé alors que la biopsie de glioblastomes multiformes (GBM) était associée à la mortalité périopératoire.

<span class='italic'> <span class='bold'>Conclusions</span></span>:

En général, les taux de complications étaient comparables à ceux rapportés antérieurement. Le sous-groupe de patients ayant des lésions profondes présenterait un risque accru de complications et le sous-groupe chez qui un diagnostic histologique de GBM a été posé aurait un risque accru de mortalité par rapport aux autres patients qui subissent une biopsie cérébrale stéréotaxique avec cadre.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 79 - 84
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Linskey, ME. The changing role of stereotaxis in surgical neurooncology. J Neurooncol. 2004; 69(1-3):35–54.CrossRefGoogle Scholar
2. Bhardwaj, RD, Bernstein, M. Prospective feasibility study of outpatient stereotactic brain lesion biopsy. Neurosurgery. 2002; 51(2):358–61; discussion 61-4.CrossRefGoogle ScholarPubMed
3. Kleihues, P, Burger, PC, Scheithauer, BW. The new WHO classification of brain tumours. Brain Pathol. 1993; 3(3):255–68.CrossRefGoogle ScholarPubMed
4. Kulkarni, AV, Guha, A, Lozano, A, Bernstein, M. Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy. J Neurosurg. 1998; 89(1):31–5.CrossRefGoogle ScholarPubMed
5. 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):930–7.CrossRefGoogle ScholarPubMed
6. Bernstein, M, Parrent, AG. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg. 1994; 81(2):165–8.CrossRefGoogle ScholarPubMed
7. Blaauw, G, Braakman, R. Pitfalls in diagnostic stereotactic brain surgery. Acta Neurochir Suppl (Wien). 1988; 42: 161–5.Google ScholarPubMed
8. Davis, DH, Kelly, PJ, Marsh, WR, Kall, BA, Goerss, SJ. Computer-assisted stereotactic biopsy of intracranial lesions. Appl Neurophysiol. 1987; 50(1-6):172–7.Google ScholarPubMed
9. Edner, G. Stereotactic biopsy of intracranial space occupying lesions. Acta Neurochir (Wien). 1981; 57(3-4):213–34.CrossRefGoogle ScholarPubMed
10. 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 1:S1:27–1:32.CrossRefGoogle ScholarPubMed
11. 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):545–51.CrossRefGoogle ScholarPubMed
12. 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):627–31; discussion 31.CrossRefGoogle ScholarPubMed
13. Grunert, P, Ungersbock, K, Bohl, J, Kitz, K, Hopf, N. Results of 200 intracranial stereotactic biopsies. Neurosurg Rev. 1994; 17(1):59–66.CrossRefGoogle ScholarPubMed
14. Hall, WA. The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer. 1998; 82(9):1749–55.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
15. Heper, AO, Erden, E, Savas, A, Ceyhan, K, Erden, I, Akyar, S, et al. An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: a prospective clinicopathologic study. Surg Neurol. 2005; 64 Suppl 2:S82–8.CrossRefGoogle ScholarPubMed
16. Kelly, PJ. Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery. 1989; 25(2):185–94; discussion 94-5.CrossRefGoogle ScholarPubMed
17. Kelly, PJ. Tumor stereotaxis. Philadelphia: WB Saunders; 1991.Google Scholar
18. Kim, JE, Kim, DG, Paek, SH, Jung, HW. Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment. Acta Neurochir (Wien). 2003; 145(7):547–54; discussion 54-5.CrossRefGoogle ScholarPubMed
19. 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):539–45; discussion 45-6.CrossRefGoogle ScholarPubMed
20. Lobato, RD, Rivas, JJ, Cabello, A, Roger, R. Stereotactic biopsy of brain lesions visualized with computed tomography. Appl Neurophysiol. 1982; 45(4-5):426–30.Google ScholarPubMed
21. Lunsford, LD, Coffey, RJ, Cojocaru, T, Leksell, D. Image-guided stereotactic surgery: a 10-year evolutionary experience. Stereotact Funct Neurosurg. 1990;54-55:375–87.CrossRefGoogle ScholarPubMed
22. Lunsford, LD, Martinez, AJ. Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol. 1984; 22(3): 222–30.CrossRefGoogle ScholarPubMed
23. McGirt, MJ, Woodworth, GF, Coon, AL, Frazier, JM, Amundson, E, Garonzik, I, et al. Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg. 2005; 102(5):897–901.CrossRefGoogle ScholarPubMed
24. Mundinger, F. CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir Suppl (Wien). 1985; 35: 70–4.CrossRefGoogle ScholarPubMed
25. Nicolato, A, Gerosa, M, Piovan, E, Ghimenton, C, Luzzati, R, Ferrari, S, et al. Computerized tomography and magnetic resonance guided stereotactic brain biopsy in nonimmunocompromised and AIDS patients. Surg Neurol. 1997; 48(3):267–76; discussion 76-7.CrossRefGoogle ScholarPubMed
26. 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: 157–60.Google ScholarPubMed
27. O’Neill, KS, Dyer, PV, Bell, BA, Wilkins, PR, Uttley, D, Marsh, HT. Is peroperative smear cytology necessary for CT-guided stereotaxic biopsy? Br J Neurosurg. 1992; 6(5):421–7.CrossRefGoogle ScholarPubMed
28. Ostertag, CB, Mennel, HD, Kiessling, M. Stereotactic biopsy of brain tumors. Surg Neurol. 1980; 14(4):275–83.Google ScholarPubMed
29. Regis, J, Bouillot, P, Rouby-Volot, F, Figarella-Branger, D, Dufour, H, Peragut, JC. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery. 1996; 39(5):907–12; discussion 12-4.Google ScholarPubMed
30. 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):640–9.CrossRefGoogle ScholarPubMed
31. Sedan, R PJ, Farnarier, P. Intra-encephalic stereotactic biopsies (309 patients/318 biopsies). Acta Neurochir Suppl (Wien). 1984; 33: 207–10.Google Scholar
32. Smith, JS, Quinones-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):173–9.CrossRefGoogle ScholarPubMed
33. Thomas, DG, Nouby, RM. Experience in 300 cases of CT-directed stereotactic surgery for lesion biopsy and aspiration of haematoma. Br J Neurosurg. 1989; 3(3):321–5.CrossRefGoogle ScholarPubMed
34. Ulm, AJ, Bova, FJ, Friedman, WA. Stereotactic biopsy aided by a computer graphics workstation: experience with 200 consecutive cases. Surg Neurol. 2001; 56(6):366–71; discussion 71-2.CrossRefGoogle ScholarPubMed
35. Voges, J, Schroder, R, Treuer, H, Pastyr, O, Schlegel, W, Lorenz, WJ, et al. CT-guided and computer assisted stereotactic biopsy. Technique, results, indications. Acta Neurochir (Wien). 1993; 125(1-4):142–9.CrossRefGoogle ScholarPubMed
36. Wild, AM, Xuereb, JH, Marks, PV, Gleave, JR. Computerized tomographic stereotaxy in the management of 200 consecutive intracranial mass lesions. Analysis of indications, benefits and outcome. Br J Neurosurg. 1990; 4(5):407–15.CrossRefGoogle ScholarPubMed
37. Yu, X, Liu, Z, Tian, Z, Li, S, Huang, H, Xiu, B, et al. Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases. Stereotact Funct Neurosurg. 2000; 75(2-3):103–8.CrossRefGoogle ScholarPubMed