Stereotactic Brain Biopsy Hemorrhage Risk Factors and Implications for Postoperative Care at a Single Institution: An Argument For Postoperative Imaging

Barkley, Ariana; Sullivan, Liam; Gibson, Alec W; Camacho, David; Barber, Jason; Silbergeld, Daniel L.; Ravanpay, Ali C.

doi:10.1016/j.wneu.2020.09.084

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…With the development of the stereotactic biopsy planning software merged with imaging examinations (e.g., CT and MRI), it is important for neurosurgeons to provide accurate and safe biopsies to prevent cerebral hemorrhage. Barkley et al reported that immediate and delayed postoperative de cits and seizures were highly correlated to post-biopsy hemorrhage, and they recommended the use of postoperative CT as a screening tool to evaluate a patient's clinical status after biopsy [27], which was consistent with the objectives of our research. Thus, cranial CT as a routine examination after biopsy is recommended to avoid hemorrhage-associated adverse events.…”

Section: Discussionsupporting

confidence: 85%

A single-institution study of so-called “non-secreting” intracranial germinomas: neurological characteristics, treatment procedures, and clinical outcomes

Zhou

Lei

Zuo

et al. 2022

Preprint

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Background and PurposeIntracranial germinomas are rare brain tumors. In the present study, we collected data of patients with histology-proven germinomas, and analyzed their neurological characteristics, treatment procedures, and clinical short-term outcomes.MethodsWe reviewed the data of patients with “non-secreting” intracranial germinomas from January 2012 to June 2021 in our institution from Beijing, China.ResultsThere were 162 (69.8%) male patients and 70 (30.2%) female patients. Pineal germinomas were mainly found in male patients (98.3%), and germinomas in sellar/suprasellar region were often observed in female patients (67.5%). The most common clinical presentations were polyuria/polydipsia (42.7%), headache (40.5%), visual disturbance (37.5%), and motor impairment (28.4%). The symptoms of endocrinological alteration had significantly longer duration before hospital admission. Patients with pure germinoma had a higher serum beta-human chorionic gonadotropin (β-HCG) level than the germinoma with syncytiotrophoblastic giant cells (STGCs) (P=0.001), and no significant difference was noted in serum alpha-fetoprotein (AFP) level between the two groups (P=0.540). Tumors with multiple lesions such as bifocal and multifocal diseases had a higher tendency to intracranial dissemination and spinal seeding at diagnosis (P<0.001 and P<0.001, respectively). The mean duration of open craniotomy was 268.8 min with an average volume of blood loss of 316.9 mL, compared with 27.0 min and 6.2 mL in cases who received stereotactic biopsy (P<0.001 and P<0.001). The most common complication in both groups was postoperative hemorrhage (7.0% and 8.5%). Patients who received biopsy had higher KPS scores at hospital discharge than on admission in contrast to open craniotomy (P=0.047). Deterioration of KPS at hospital discharge than on admission was observed in 29 and 1 cases who received craniotomy and biopsy (P<0.001).ConclusionsEndocrinological alteration has longer duration before diagnosis. Patients with multiple lesions such as bifocal and multifocal germinomas have a higher tendency of dissemination, and additional attention should be paid to the imaging findings. Patients may not necessarily benefit from the surgical resection because of the surgical trauma and the postoperative complications, and stereotactic biopsy is highly significant in clinical practice.

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Section: Discussionsupporting

confidence: 85%

A single-institution study of so-called “non-secreting” intracranial germinomas: neurological characteristics, treatment procedures, and clinical outcomes

Zhou

Lei

Zuo

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…With the development of the stereotactic biopsy planning software merged with imaging examinations (e.g., CT and MRI), it is important for neurosurgeons to provide accurate and safe biopsies to prevent cerebral hemorrhage. Barkley et al reported that immediate and delayed postoperative de cits and seizures were highly correlated to post-biopsy hemorrhage, and they recommended the use of postoperative CT as a screening tool to evaluate a patient's clinical status after biopsy 25 , which was consistent with the objectives of our research. Besides, cranial CT as a routine examination after biopsy is recommended to avoid hemorrhage-associated adverse events.…”

Section: Discussionsupporting

confidence: 85%

A Single-institution Study of So-called “non-secreting” Intracranial Germinomas: Neurological Characteristics, Treatment Procedures, and Clinical Outcomes

Lei

Zuo

et al. 2021

Preprint

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Background and ObjectiveIntracranial germinomas are rare brain tumors. In the present study, we collected data of patients with histology-proven germinomas, and analyzed their neurological characteristics, treatment procedures, and clinical outcomes.MethodsWe reviewed the data of patients with “non-secreting” intracranial germinomas, and analyzed the neurological characteristics, treatment procedures, and clinical outcomes.ResultsThere were 162 (69.8%) male patients and 70 (30.2%) female patients. Pineal germinomas were mainly found in male patients (98.3%), and germinomas in sellar/suprasellar region were often observed in female patients (67.5%). The most common clinical presentations were polyuria/polydipsia (42.7%), headache (40.5%), visual disturbance (37.5%), and motor impairment (28.4%). Patients in the pure germinoma group had a higher serum beta-human chorionic gonadotropin (β-HCG) level than in the germinoma plus syncytiotrophoblastic giant cells (STGCs) group (P=0.001), and no significant difference was noted in serum alpha-fetoprotein (AFP) level between the two groups (P=0.540). Bifocal or multifocal tumors had a higher tendency to intracranial dissemination and spinal seeding (P<0.001 and P<0.001, respectively). The mean duration of open craniotomy was 268.8 min with an average volume of blood loss of 316.9 mL, compared with 27.0 min and 6.2 mL in cases who received stereotactic biopsy (P<0.001 and P<0.001). The most common complication in both groups was postoperative hemorrhage (7.0% and 8.5%). Patients who received biopsy had higher KPS scores after surgery and at hospital discharge than on admission in contrast to open craniotomy (P<0.001 and P=0.047, respectively). Deterioration of KPS at hospital discharge than on admission was observed in 4, 7, 18, and 1 cases who received partial resection, subtotal resection, gross total resection, and biopsy (P<0.001).ConclusionsBifocal and multifocal germinomas have a higher tendency of dissemination, and additional attention should be paid to the imaging findings. Patients may not necessarily benefit from the surgical resection because of the surgical trauma and the postoperative complications, and stereotactic biopsy is highly significant in clinical practice.

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“…Stereotactic brain biopsy: ASMs are not recommended for routine prophylactic use after stereotactic biopsy; 56 , 57 however, when there are high-risk factors for seizures after biopsy (there is visible bleeding on imaging and the penetration point is located in the functional area), ASMs can be used prophylactically. 58 …”

Section: Resultsmentioning

confidence: 99%

“…The 56,57 however, when there are high-risk factors for seizures after biopsy (there is visible bleeding on imaging and the penetration point is located in the functional area), ASMs can be used prophylactically. 58 Other surgeries that the risk of postoperative seizures is high and ASM can be used prophylactically 1. Brain abscess surgery, especially resective surgery.…”

Section: Yunqian LImentioning

confidence: 99%

Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery

Liang

Fan

Chen

et al. 2022

Ther Adv Neurol Disord

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Seizures are a common symptom of craniocerebral diseases, and epilepsy is one of the comorbidities of craniocerebral diseases. However, how to rationally use anti-seizure medications (ASMs) in the perioperative period of craniocerebral surgery to control or avoid seizures and reduce their associated harm is a problem. The China Association Against Epilepsy (CAAE) united with the Trauma Group of the Chinese Neurosurgery Society, Glioma Professional Committee of the Chinese Anti-Cancer Association, Neuro-Oncology Branch of the Chinese Neuroscience Society, and Neurotraumatic Group of Chinese Trauma Society, and selected experts for consultancy regarding outcomes from evidence-based medicine in domestic and foreign literature. These experts referred to the existing research evidence, drug characteristics, Chinese FDA-approved indications, and expert experience, and finished the current guideline on the application of ASMs during the perioperative period of craniocerebral surgery, aiming to guide relevant clinical practice. This guideline consists of six sections: application scope of guideline, concepts of craniocerebral surgery-related seizures and epilepsy, postoperative application of ASMs in patients without seizures before surgery, application of ASMs in patients with seizures associated with lesions before surgery, emergency treatment of postoperative seizures, and 16 recommendations.

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Stereotactic Brain Biopsy Hemorrhage Risk Factors and Implications for Postoperative Care at a Single Institution: An Argument For Postoperative Imaging

Cited by 7 publications

References 18 publications

A single-institution study of so-called “non-secreting” intracranial germinomas: neurological characteristics, treatment procedures, and clinical outcomes

A single-institution study of so-called “non-secreting” intracranial germinomas: neurological characteristics, treatment procedures, and clinical outcomes

A Single-institution Study of So-called “non-secreting” Intracranial Germinomas: Neurological Characteristics, Treatment Procedures, and Clinical Outcomes

Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery

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