Rate and Timing of Perioperative Complications of Image-Guided Stereotactic Brain Biopsy (IGSBB): Implications on Postoperative Management

Object The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques. Methods A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling. Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity. Conclusions With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.

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The Efficacy of Image-Guided Stereotactic Brain Biopsy in Neurologically Symptomatic Acquired Immunodeficiency Syndrome Patients

Neurosurgery ◽

10.1097/00006123-199202000-00006 ◽

1992 ◽

Vol 30 (2) ◽

pp. 186???190 ◽

Cited By ~ 5

Author(s):

Robert M. Levy ◽

Eric Russell ◽

Margaret Yungbluth ◽

Denise Frias Hidvegi ◽

Betty Ann Brody ◽

...

Keyword(s):

Acquired Immunodeficiency Syndrome ◽

Brain Biopsy ◽

Stereotactic Brain Biopsy ◽

Image Guided ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

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Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases

Journal of Neurosurgery ◽

10.3171/jns.2005.102.5.0897 ◽

2005 ◽

Vol 102 (5) ◽

pp. 897-901 ◽

Cited By ~ 123

Author(s):

Matthew J. McGirt ◽

Graeme F. Woodworth ◽

Alex L. Coon ◽

James M. Frazier ◽

Eric Amundson ◽

...

Keyword(s):

Risk Factors ◽

Basal Ganglia ◽

Predictive Value ◽

Brain Biopsy ◽

Stereotactic Brain Biopsy ◽

Content Type ◽

Image Guided ◽

Independent Risk Factors ◽

Thalamic Lesions ◽

Fine Print

Object. Image-guided stereotactic brain biopsy is associated with transient and permanent incidences of morbidity in 9 and 4.5% of patients, respectively. The goal of this study was to perform a critical analysis of risk factors predictive of an enhanced operative risk in frame-based and frameless stereotactic brain biopsy. Methods. The authors reviewed the clinical and neuroimaging records of 270 patients who underwent consecutive frame-based and frameless image-guided stereotactic brain biopsies. The association between preoperative variables and biopsy-related morbidity was assessed by performing a multivariate logistic regression analysis. Transient and permanent stereotactic biopsy-related morbidity was observed in 23 (9%) and 13 (5%) patients, respectively. A hematoma occurred at the biopsy site in 25 patients (9%); 10 patients (4%) were symptomatic. Diabetes mellitus (odds ratio [OR] 3.73, 95% confidence interval [CI] 1.37–10.17, p = 0.01), thalamic lesions (OR 4.06, 95% CI 1.63–10.11, p = 0.002), and basal ganglia lesions (OR 3.29, 95% CI 1.05–10.25, p = 0.04) were independent risk factors for morbidity. In diabetic patients, a serum level of glucose that was greater than 200 mg/dl on the day of biopsy had a 100% positive predictive value and a glucose level lower than 200 mg/dl on the same day had a 95% negative predictive value for biopsy-related morbidity. Pontine biopsy was not a risk factor for morbidity. Only two (4%) of 45 patients who had epilepsy before the biopsy experienced seizures postoperatively. The creation of more than one needle trajectory increased the incidence of neurological deficits from 17 to 44% when associated with the treatment of deep lesions (those in the basal ganglia or thalamus; p = 0.05), but was not associated with morbidity when associated with the treatment of cortex lesions. Conclusions. Basal ganglia lesions, thalamic lesions, and patients with diabetes were independent risk factors for biopsy-associated morbidity. Hyperglycemia on the day of biopsy predicted morbidity in the diabetic population. Epilepsy did not predispose to biopsy-associated seizure. For deep-seated lesions, increasing the number of biopsy samples along an established track rather than performing a second trajectory may minimize the incidence of morbidity. Close perioperative observation of glucose levels may be warranted.

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