Severity, timeline, and management of complications after stereotactic brain biopsy

Riche, Maximilien; Marijon, Pauline; Amelot, Aymeric; Bielle, Franck; Mokhtari, Karima; Chambrun, Marc Pineton de; Joncour, Alexandre Le; Idbaïh, Ahmed; Touat, Mehdi; Do, Chung-Hi; Deme, Mamadou; Pasqualotto, Romain; Jacquens, Alice; Degos, Vincent; Shotar, Eimad; Chougar, Lydia; Mathon, Bertrand

doi:10.3171/2021.3.jns21134

Cited by 25 publications

(22 citation statements)

References 47 publications

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“…Complications related to brain biopsy were monitored during the 30 days following the intervention. In view of existing literature on complications in neurosurgery, we used a previously published grading severity scale tailored for diagnostic intracerebral procedures (6, 12):…”

Section: Methodsmentioning

confidence: 99%

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Mathon

Favreau

Degos

et al. 2022

Critical Care Medicine

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Brain biopsy is a useful surgical procedure in the management of patients with suspected neoplastic lesions. Its role in neurologic diseases of unknown etiology remains controversial, especially in ICU patients. This study was undertaken to determine the feasibility, safety, and the diagnostic yield of brain biopsy in critically ill patients with neurologic diseases of unknown etiology. We also aimed to compare these endpoints to those of non-ICU patients who underwent a brain biopsy in the same clinical context. DESIGN: Monocenter, retrospective, observational cohort study. SETTING:A French tertiary center. PATIENTS:All adult patients with neurologic diseases of unknown etiology under mechanical ventilation undergoing in-ICU brain biopsy between January 2008 and October 2020 were compared with a cohort of non-ICU patients. INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Among the 2,207 brain-biopsied patients during the study period, 234 biopsies were performed for neurologic diseases of unknown etiology, including 29 who were mechanically ventilated and 205 who were not ICU patients. Specific histological diagnosis and final diagnosis rates were 62.1% and 75.9%, respectively, leading to therapeutic management modification in 62.1% of cases. Meningitis on prebiopsy cerebrospinal fluid analysis was the sole predictor of obtaining a final diagnosis (2.3 [1.4-3.8]; p = 0.02). ICU patients who experienced therapeutic management modification after the biopsy had longer survival (p = 0.03). The grade 1 to 4 (mild to severe) complication rates were: 24.1%, 3.5%, 0%, and 6.9%, respectively. Biopsyrelated mortality was significantly higher in ICU patients compared with non-ICU patients (6.9% vs 0%; p = 0.02). Hematological malignancy was associated with biopsy-related mortality (1.5 [1.01-2.6]; p = 0.04). CONCLUSIONS:Brain biopsy in critically ill patients with neurologic disease of unknown etiology is associated with high diagnostic yield, therapeutic modifications and postbiopsy survival advantage. Safety profile seems acceptable in most patients. The benefit/risk ratio of brain biopsy in this population should be carefully weighted.

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Section: Methodsmentioning

confidence: 99%

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Mathon

Favreau

Degos

et al. 2022

Critical Care Medicine

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“…One of the main risks of stereotactic biopsy is to provide a sample that is non-contributory to a diagnosis. In a case series of patients with brain tumors, the rate of negative biopsies is close to 5%, exposing the patient to a second biopsy with potential morbidity and additional health care costs [ 8 , 20 , 53 ]. In patients biopsied for cryptogenic neurological disease, this rate reaches 30% [ 3 , 36 – 38 ].…”

Section: Innovations To Increase Biopsy Diagnostic Yieldmentioning

confidence: 99%

“…The most serious consequences of minimally invasive stereotactic biopsy are vessel damage and subsequent bleeding. The rate of postbiopsy symptomatic hemorrhage is reported to be between 0.9 and 8.6% [ 26 , 53 ]. When considering all bleeding observed on systematic postoperative CT scans (symptomatic or asymptomatic), the range is much higher, up to 60% [ 27 , 52 ].…”

Section: Innovations To Improve Patient’s Safetymentioning

confidence: 99%

“…As little consensus exists on the postoperative care of patients undergoing stereotactic biopsy, several teams have sought to establish novel algorithms for their postoperative management and notably investigated the location of postbiopsy imaging. Recently, Riche et al retrospectively examined 1500 consecutive cases to analyze the severity, timeline, risks factors, and management of complications after stereotactic brain biopsies [ 53 ]. The team proposed an algorithm for a better and safer postoperative management of stereotactic biopsy based on the results of the study and their experience.…”

Section: Advances To Improve Postbiopsy Workflow and Patient’s Manage...mentioning

confidence: 99%

“…Complications following a brain biopsy are rare, but like all neurosurgical procedures, they carry some risks, such as seizures, brain edema, or infection [ 52 ]. The most specific and frequent complications related to this procedure are negative sampling, requiring a second biopsy procedure [ 8 ], and brain hemorrhage with potentially serious consequences [ 53 ]. In a mission to become safer and more effective, constant innovations are being made in this field of neurosurgery.…”

Section: Introductionmentioning

confidence: 99%

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Advances, technological innovations, and future prospects in stereotactic brain biopsies

Bex

Mathon

2022

Neurosurg Rev

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Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients’ management algorithms based on early discharge after biopsy optimize the patient’s personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients’ postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.

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Glioblastoma and Solitary Brain Metastasis: Differentiation by Integrating Demographic‐MRI and Deep‐Learning Radiomics Signatures

Zhang,

Zhang

et al. 2023

Magnetic Resonance Imaging

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BackgroundStudies have shown that deep‐learning radiomics (DLR) could help differentiate glioblastoma (GBM) from solitary brain metastasis (SBM), but whether integrating demographic‐MRI and DLR features can more accurately distinguish GBM from SBM remains uncertain.PurposeTo construct and validate a demographic‐MRI deep‐learning radiomics nomogram (DDLRN) integrating demographic‐MRI and DLR signatures to differentiate GBM from SBM preoperatively.Study TypeRetrospective.PopulationTwo hundred and thirty‐five patients with GBM (N = 115) or SBM (N = 120), randomly divided into a training cohort (90 GBM and 98 SBM) and a validation cohort (25 GBM and 22 SBM).Field Strength/SequenceAxial T2‐weighted fast spin‐echo sequence (T2WI), T2‐weighted fluid‐attenuated inversion recovery sequence (T2‐FLAIR), and contrast‐enhanced T1‐weighted spin‐echo sequence (CE‐T1WI) using 1.5‐T and 3.0‐T scanners.AssessmentThe demographic‐MRI signature was constructed with seven imaging features (“pool sign,” “irregular ring sign,” “regular ring sign,” “intratumoral vessel sign,” the ratio of the area of peritumoral edema to the enhanced tumor, the ratio of the lesion area on T2‐FLAIR to CE‐T1WI, and the tumor location) and demographic factors (age and sex). Based on multiparametric MRI, radiomics and deep‐learning (DL) models, DLR signature, and DDLRN were developed and validated.Statistical TestsThe Mann–Whitney U test, Pearson test, least absolute shrinkage and selection operator, and support vector machine algorithm were applied for feature selection and construction of radiomics and DL models.ResultsDDLRN showed the best performance in differentiating GBM from SBM with area under the curves (AUCs) of 0.999 and 0.947 in the training and validation cohorts, respectively. Additionally, the DLR signature (AUC = 0.938) outperformed the radiomics and DL models, and the demographic‐MRI signature (AUC = 0.775) was comparable to the T2‐FLAIR radiomics and DL models in the validation cohort (AUC = 0.762 and 0.749, respectively).Data ConclusionDDLRN integrating demographic‐MRI and DLR signatures showed excellent performance in differentiating GBM from SBM.Level of Evidence3Technical EfficacyStage 2

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Severity, timeline, and management of complications after stereotactic brain biopsy

Cited by 25 publications

References 47 publications

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Brain Biopsy for Neurological Diseases of Unknown Etiology in Critically Ill Patients: Feasibility, Safety, and Diagnostic Yield

Advances, technological innovations, and future prospects in stereotactic brain biopsies

Glioblastoma and Solitary Brain Metastasis: Differentiation by Integrating Demographic‐MRI and Deep‐Learning Radiomics Signatures

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