Symptomatic intracranial hemorrhages and frame-based stereotactic brain biopsy

Abstract

Background: Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the emergence of postbiopsy symptomatic intracranial hemorrhage. Based on our findings, we suggest recommendations to improve its usual clinical practice. Methods: We made a retrospective study of 429 cases with stereotactic biopsies performed in the past 37 years. The surgical procedure-was adapted in terms of the stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs available in the hospital. Fifty-three variables were analyzed for each patient (SPSS.23). Results: The diagnostic yield was 90.7%. Forty-one patients (9.5%) suffered a symptomatic postbiopsy hemorrhage; only 17 (3.9%) had permanent morbidity. The mortality was 0.93% (n = 4). A postsurgical CT scan was requested only in 99 patients (23%) of our series. Lesion mass effect, cystic component, contrast enhancement, histological nature, or number of targets were not associated with a greater risk of symptomatic postbiopsy hemorrhage (P > 0.05). On the other hand, the biopsies made by nonexpert neurosurgeons (P = 0.01) or under general anesthesia (P = 0.02) resulted in a greater risk of symptomatic postbiopsy hemorrhage. Anesthetic type was the clearest predictive factor of bleeding with this technique (OR: 0.24). Conclusion: Stereotactic biopsy is a very valuable tool. To optimize its safety and minimize the risk of intracranial bleeding, it requires both a knowledge of stereotactic techniques and very careful surgical planning. While the patient’s stay in intensive vigilance units after the procedure is a useful strategy, the request for control CT scans should be conditioned by the clinical evolution of each patient.

Indicators of correct targeting in stereotactic biopsy of intracranial lesions

“…[ 22 , 34 , 37 , 51 , 52 ] However, as aforementioned, its use has been reported only in 13 out of 57 studies on stereotactic biopsy in humans. [ 2 , 6 , 12 , 28 , 32 , 34 - 36 , 51 , 52 , 54 , 55 , 57 ] Furthermore, it increases the operative time and, consequently, the risk of complications. [ 35 ] Maybe even more importantly, the accuracy rate of this technique in the central nervous system lesions is only 77.9%, when compared to permanent section.…”

“…[ 52 ] However, on reviewing the literature over a period of 5 years (pubmed.com: June 2015/June 2020), only 13 out of the 59 original publications on stereotactic biopsy in humans[ 1 - 59 ] reported the use of frozen section. [ 2 , 6 , 12 , 28 , 32 , 34 - 36 , 51 , 52 , 54 , 55 , 57 ] In cases of cystic lesions, such as brain abscesses, the mere aspiration of pus is enough to confirm appropriate targeting, making pathology consultation unnecessary.…”

“…the use of frozen section. [2,6,12,28,32,[34][35][36]51,52,54,55,57] In cases of cystic lesions, such as brain abscesses, the mere aspiration of pus is enough to confirm appropriate targeting, making pathology consultation unnecessary.…”

Frame-Based Stereotactic Surgery in Thalamic Lesions

“…9 Unlike our results, it was mentioned in Lara-Almunia and Hernandez-Vicente's study that Seizures, de novo neurological impairments, infections, and hemorrhages are the most prevalent problems linked with this technique. 10 Post-biopsy cerebral hemorrhages are both the most significant and the most commonly reported complication in the literature, with a presentation rate of 1.4-9.6 percent, according to numerous different research. 11,12,13 According to Esquenazi et al, In 9 patients (16%), acute postoperative surgical problems occurred: Following stereotactic biopsy, 7 (15%) patients had permanent neurological abnormalities (worsened hemiparesis in 5, hemiplegia in 1, and visual field reduction in 1), while 2 occurrences of asymptomatic intra-tumoral bleeding occurred.…”

Outpatient stereotactic brain biopsies

“…Literature suggests that most symptomatic complications occur promptly after the biopsy. Several retrospective studies showed that all the neurological complications were observed within 6 h after the biopsy [13,17,37], while for some other authors, symptomatic complication may appear with a delay when related to brain edema or seizure [10,16]. In a prospective study, Bhardwaj and Bernstein concluded that 4 h were sufficient observation time to detect a complication or not in the patient [6].…”