Combining Brain Diagnosis and Therapy in a Single Strategy: The Safety, Reliability, and Cost Implications Using Same-Day versus Separate-Day Stereotactic Procedures

Abstract

Background: A therapeutic radiosurgery procedure usually follows a separate diagnostic stereotactic procedure after days or weeks. Objectives: To define the clinical reliability, safety, and cost implications of same-day diagnostic stereotactic biopsy and therapeutic radiosurgery. Methods: During an 8-year interval, 26 patients underwent stereotactic brain biopsy followed by immediate therapeutic stereotactic radiosurgery in a single-day combined procedure. The intraoperative diagnosis was determined using standard histopathological techniques. Diagnostic accuracy, hospital costs, and contribution margins associated with this treatment strategy were compared to those of 26 case-matched patients (controls) who underwent a stereotactic diagnostic procedure followed by a separate-day outpatient SRS procedure within 6 weeks during the same time interval. Results: The intraoperative diagnosis correlated with the final histopathological diagnosis in 96% of the patients. Biopsy-related morbidity did not occur in this series. The mean total costs of same-day patients was significantly lower than the costs of patients who had two-stage procedures (USD 9,077 ± 2,366 vs. 11,284 ± 3,025; p = 0.008). The net contribution to the hospital margin of USD 13,736 was not significantly different between the two management strategies. Conclusions: The advantages of the same-day approach included a single stereotactic head frame application, reduced total admission time, consecutive histopathological diagnosis and therapy in a single hospital admission, and reduced total hospital costs. For patients who are highly suspected to have a brain tumor for which SRS is likely to be an effective therapeutic strategy, same-day diagnostic stereotactic biopsy followed by therapeutic SRS proved to be a safe, reliable, and cost-effective management strategy.

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“…3). 14,26,33 Debates Although the beneficial effect of radiation in the treatment of craniopharyngiomas has been well recognized, 2 critical issues remain sources of significant controversy: 1) the merits of GTR versus subtotal resection followed by irradiation given the surgical morbidity and mortality rates associated with aggressive resection and 2) the role of RT immediately after resection without first monitoring for tumor progression and the role of RT in the absence of resection (up-front or salvage treatment).…”

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

“…Adverse radiation rates in larger case series have ranged from 6.2-10.9%, most commonly hypopituitarism, followed by visual deficits and hypothalamic obesity [83,86]. Furthermore, radiation therapy may not address the cystic component of craniopharyngiomas, which may require surgical intervention in the form of stereotactic or neuroendoscopic drainage beforehand or at the time of radiation in cases of large cysts causing symptoms [89][90][91].…”

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“…Additional information pamphlet and contact information was provided for further concerns. Park et al [33] (2011) Not reported. Au et al [14] (2016) Patients were given a prescription for analgesia and a steroid taper, along with written instructions for pain control, possible adverse symptoms, and follow-up.…”

“…A therapeutic radiosurgery procedure usually follows a separate diagnostic stereotactic procedure after days or weeks. Park et al, [33] conducted a prospective study to define the clinical reliability, safety, and cost implications of same-day diagnostic stereotactic biopsy and therapeutic radiosurgery. The intraoperative diagnosis correlated with the final histopathological diagnosis in 96% of the patients with no biopsy-related morbidity.…”