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

Shakal, Ahmed; Mokbel, Esam

doi:10.1055/s-0032-1325633

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…STB[ 2 3 4 5 13 15 18 19 20 21 22 23 24 ] has been demonstrated to be a low-risk procedure and may be performed with extreme accuracy (1 mm variance), especially with use of recent system compatible with CT scan and/or MRI. On the other hand, ultrasound-guided biopsy is also safe, cheap, quick, simple to perform, and technically reliable real-time method for superficially located lesions as well as for deep-seated lesions, independent of size.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of stereotactic and ultrasound-guided biopsy of solid supratentorial tumor: A preliminary report

et al. 2017

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Introduction:The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure.Clinical Materials and Methods:Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB.Results:The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head.Conclusions:The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure.

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Section: Discussionmentioning

confidence: 99%

“…In the postoperative period, CT scan revealed hemorrhage in 7 patients (4.7%), of which only two cases were symptomatic. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of stereotactic and ultrasound-guided biopsy of solid supratentorial tumor: A preliminary report

et al. 2017

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“…The common postoperative complications of stereotactic biopsy were hemorrhage, edema, epilepsy, infections, and more, whereas the most frequent complication was hemorrhage. [10,29] In this study, 1 patient had an early sampling area with bleeding and a seizure. To reduce the possibility of post-operation hemorrhage, the preoperative platelet count should be more than 100,000/mL, [30] and careful surgical planning should be performed to avoid the vessels within the trajectory.…”

Section: Discussionmentioning

confidence: 99%

Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China

Zhang

Fu²,

Gong³

et al. 2016

Medicine

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Rationale:The aim of the study was to evaluate stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS.Patient concerns:Seven AIDS patients with an intracranial lesion who underwent stereotactic biopsy were included in this retrospective study (4 males and 3 females, 15 to 49 years old). The patients’ disease history ranged from 1 month to 1 year. The samples were examined by hematoxylin-eosin (HE) staining and immunohistochemical examination.Diagnoses, interventions and outcomes:All patients were successfully sampled, and the histological results showed inflammation in 4 cases, toxoplasma gondii infection in 1 case, astrocytoma in 1 case, and abscess in 1 case. The clinical diagnosis included toxoplasma encephalitis (TE) in 2 cases, cryptococcus encephalitis in 2 cases, cytomegalovirus (CMV) encephalitis in 2 case, tubercular abscess in 1 case, astrocytoma in 1 case, and co-infection of TE with Cryptococcus infection in 1 patient. The clinical diagnosis was made according to the plasma and cerebrospinal fluid (CSF) laboratory testing, the imaging data and the histological findings. The diagnostic yield was 100%, and the post-operation morbidity was 14.3% (1/7) with an asymptomatic haemorrhage and seizure in 1 case. There was no operation-related mortality. Patients were followed up for 6 months to 6 years; 1 case fully recovered, 4 cases significantly improved in symptoms, and 2 died.Lessons:Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patient with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. Due to the broad spectrum of nervous system abnormalities in AIDS, histological findings are very valuable. However, histology is not a unique tool for making a definite diagnosis, whereas the combination of molecular pathology and stereotactic biopsy should play a more important role in the future.

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“…They are commonly performed interventions, displaying a favorable safety profile, and the frequency and timing of their complications are well-known [12,14,15,20,30]. Several studies have demonstrated that symptomatic postbiopsy complications occur usually either within 6 h, or more than 24 h after the biopsy [5,16,30,31,33]. These findings have thereby enabled to propose an early hospitalization discharge.…”

Section: Introductionmentioning

confidence: 99%

Outpatient stereotactic brain biopsies

et al. 2021

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Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of outpatient stereotactic brain biopsies, few data from other countries with different health care systems are available. We therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. We prospectively examined all the consecutive stereotactic brain biopsies performed in an outpatient setting at our tertiary medical center, between June 2018 and September 2020. Among the 437 patients who underwent stereotactic brain biopsy during the study period, 40 (9.2%) patients were enrolled for an outpatient management. The sex ratio was 1 and the median age on biopsy day was 55 [41-66] years. The median distance from patients' home to hospital was 17 km . 95% of patients had pre-biopsy ASA score of 1 or 2 and mRs equal to 2 or less. The rate of same-day discharge was 100%. No patient experienced post-biopsy symptomatic complication necessitating readmission within the month following the biopsy. One patient (2.5%) resorted to an unplanned consultation. Histological findings obtained from brain biopsy led to a diagnosis in all patients; the most frequently found were neoplastic lesions (77.5%). Stereotactic brain biopsies can therefore be safely achieved on an outpatient setting in carefully selected patients. This process could be more widely adopted in other neurosurgical centers, without affecting the quality of patient's health care and safety. In this article, we propose management guidelines and pre-biopsy checklist for performing ambulatory stereotactic brain biopsies.

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

Abstract: 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.

Cited by 16 publications

References 18 publications

Comparison of stereotactic and ultrasound-guided biopsy of solid supratentorial tumor: A preliminary report

Comparison of stereotactic and ultrasound-guided biopsy of solid supratentorial tumor: A preliminary report

Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China

Outpatient stereotactic brain biopsies

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