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

2021 ◽  
pp. 1-10
Author(s):  
Maximilien Riche ◽  
Pauline Marijon ◽  
Aymeric Amelot ◽  
Franck Bielle ◽  
Karima Mokhtari ◽  
...  
Keyword(s):  
Medical Center ◽  
Brain Biopsy ◽  
Postoperative Management ◽  
Complication Rates ◽  
Stereotactic Brain Biopsy ◽  
Therapeutic Consequences ◽  
Increased Risk ◽  
Management Of Complications ◽  
Severity Grading ◽  
Grading Scale

OBJECTIVE The literature shows discrepancies in stereotactic brain biopsy complication rates, severities, and outcomes. Little is known about the timeline of postbiopsy complications. This study aimed to analyze 1) complications following brain biopsies, using a graded severity scale, and 2) a timeline of complication occurrence. The secondary objectives were to determine factors associated with an increased risk of complications and to assess complication-related management and extra costs. METHODS The authors retrospectively examined 1500 consecutive stereotactic brain biopsies performed in adult patients at their tertiary medical center between April 2009 and April 2019. RESULTS Three hundred eighty-one biopsies (25.4%) were followed by a complication, including 88.2% of asymptomatic hemorrhages. Symptomatic complications involved 3.0% of the biopsies, and 0.8% of the biopsies were fatal. The severity grading scale had a 97.6% interobserver reproducibility. Twenty-three (51.1%) of the 45 symptomatic complications occurred within the 1st hour following the biopsy, while 75.6% occurred within the first 6 hours. Age ≥ 65 years, second biopsy procedures, gadolinium-enhanced lesions, glioblastomas, and lymphomas were predictors of biopsy-related complications. Brainstem biopsy-targeted lesions and cerebral toxoplasmosis were predictive of mortality. Asymptomatic hemorrhage was associated with delayed (> 6 hours) symptomatic complications. Symptomatic complications led to extended hospitalization in 86.7% of patients. The average extra cost for management of a patient with postbiopsy symptomatic complication was $35,702. CONCLUSIONS Symptomatic complications from brain biopsies are infrequent but associated with substantial adverse effects and cost implications for the healthcare system. The use of a severity grading scale, as the authors propose in this article, helps to classify complications according to the therapeutic consequences and the patient’s outcome. Because this study indicates that most complications occur within the first few hours following the biopsy, postbiopsy monitoring can be tailored accordingly. The authors therefore recommend systematic monitoring for 2 hours in the recovery unit and a CT scan 2 hours after the end of the biopsy procedure. In addition, they propose a modern algorithm for optimal postoperative management of patients undergoing stereotactic biopsy.

scholarly journals Outpatient Stereotactic Brain Biopsies

2021 ◽  
Author(s):  
Bertrand MATHON ◽  
Pauline MARIJON ◽  
Maximilien RICHE ◽  
Vincent DEGOS ◽  
Alexandre CARPENTIER
Keyword(s):  
Health Care ◽  
Medical Center ◽  
Health Care Systems ◽  
Cost Savings ◽  
Brain Biopsy ◽  
Outpatient Setting ◽  
Stereotactic Brain Biopsy ◽  
Same Day Discharge ◽  
Care Systems ◽  
Few Data

Abstract BackgroundOutpatient 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. ObjectiveWe therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. MethodsWe prospectively examined all the consecutive stereotactic brain biopsies performed in an outpatient setting at our tertiary medical center, between June 2018 and September 2020.ResultsAmong 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 kms [3-47]. 95% of patients had prebiopsy 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%)ConclusionStereotactic 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.

IMPACT OF BRAIN BIOPSY ON THE MANAGEMENT OF PATIENTS WITH NONNEOPLASTIC UNDIAGNOSED NEUROLOGICAL DISORDERS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 833-838 ◽  
Author(s):  
Heinke Pulhorn ◽  
D. Gavin Quigley ◽  
Jark J.D. Bosma ◽  
Ramez Kirollos ◽  
Daniel G. du Plessis ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Stereotactic Biopsy ◽  
Diagnostic Yield ◽  
Diagnostic Category ◽  
Brain Biopsy ◽  
Clinical Impact ◽  
Complication Rates ◽  
Open Biopsy ◽  
Retrospective Case ◽  
Stereotactic Brain Biopsy

Abstract OBJECTIVE We sought to assess the diagnostic yield, complication rates, and therapeutic impact of open brain biopsy and serial stereotactic brain biopsy in the management of patients with nonneoplastic neurological conditions in which conventional investigations did not yield a definitive diagnosis. METHODS A retrospective case note analysis was undertaken in consecutive patients undergoing brain biopsy at The Walton Centre for Neurology and Neurosurgery during a 15-year period. The diagnostic yield, prebiopsy diagnostic category, biopsy technique (open versus stereotactic), complication rates, and impact on clinical management were assessed. Biopsies were grouped into one of five categories: diagnostic, suggestive, nonspecific, normal, or nondiagnostic. RESULTS Thirty-nine patients underwent biopsy. The diagnostic yield (combined diagnostic and suggestive) of targeted serial stereotactic biopsy was 64% (seven of 11 patients); in the open brain biopsy group, the diagnostic yield was 46% (13 of 28 patients). The prebiopsy diagnosis was confirmed in 100% (three of three patients) stereotactic biopsy patients and 75% (nine of 12 patients) of open biopsy patients. Two patients (7%) in the open biopsy group had short-term complications. The clinical impact was similar in both groups: nine of 28 (32%) open biopsy patients and four of 11 (36%) stereotactic biopsy patients. CONCLUSION Despite the low clinical impact, diagnostic brain biopsy should be considered in patients with nonneoplastic undiagnosed neurological disorders. Patients with neuroimaging abnormalities should preferentially undergo targeted biopsy.

scholarly journals NIMG-62. ATYPICAL IMAGING CHARACTERISTICS OF PRIMARY CNS LYMPHOMA AT INITIAL PRESENTATION LEADS TO FREQUENT MISDIAGNOSIS AND DELAYS IN DIAGNOSIS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi175-vi175
Author(s):  
Marissa Barbaro ◽  
Peter Pan ◽  
Kiran Thakur ◽  
Mary Welch
Keyword(s):  
Medical Center ◽  
Primary Cns Lymphoma ◽  
Brain Biopsy ◽  
Cns Lymphoma ◽  
Imaging Features ◽  
Columbia University ◽  
Imaging Characteristics ◽  
Increased Risk ◽  
Mri Scans ◽  
Delays In Diagnosis

Abstract BACKGROUND Primary CNS lymphoma (PCNSL) has protean appearances on magnetic resonance imaging (MRI) that may lead to delays in diagnosis. METHODS We retrospectively reviewed histologically-confirmed PCNSL at Columbia University Irving Medical Center (CUIMC, 2010–2019), and characterize imaging features on pre-treatment MRI scans. RESULTS 64 patients were analyzed. 61 of 64 (95%) presented with enhancement. 35 of 64 (55%) were multiply enhancing, and 26 of 64 (41%) were singly enhancing (of which 2 were dural-based). 3 of 64 (5%) were non-enhancing. 42 of 59 (71%) had diffusion restriction. 36 of 49 (73%) lacked susceptibility. 40 of 64 (63%) were periventricular. 28 of 64 (43%) had callosal involvement. In 14 of 54 (26%), lymphoma was either not included in the differential or specifically noted less likely in radiographic report – this radiographically misdiagnosed group was significantly more likely to be either non-enhancing or non-periventricular (p=0.026). Furthermore, radiographic misdiagnosis was associated with an increased risk of a more than 14-day delay from the initial MRI to the initial invasive study, either lumbar puncture or brain biopsy (p=0.04). Presentation with a single enhancing lesion, on the other hand, was associated with significantly faster time to diagnosis – median 4.6 days (IQR 3) vs 21.6 days (IQR 4.5) from initial MRI (p=0.04). CONCLUSION In PCNSL, imaging characteristics influence outcomes. While a classic single enhancing lesion is associated with rapid diagnosis, non-enhancing and non-periventricular disease are the most likely to be misdiagnosed and require a heightened index of suspicion to avoid delays to diagnosis.

scholarly journals Complications in 622 Cases of Frame-Based Stereotactic Biopsy, a Decreasing Procedure

2008 ◽  
Vol 35 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Paul N. Kongkham ◽  
Eva Knifed ◽  
Mandeep S. Tamber ◽  
Mark Bernstein
Keyword(s):  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Senior Author ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Surgical Experience ◽  
Perioperative Mortality ◽  
Stereotactic Brain Biopsy ◽  
Histologic Diagnosis ◽  
Intracranial Lesions

Background:Frame-based stereotactic brain biopsy has played an important role in the management of patients with suspected neoplastic intracranial lesions over the last three decades. We reviewed the surgical experience of one surgeon to determine the nature and frequency of complications associated with this procedure.Methods:Records were reviewed for 858 patients undergoing frame-based stereotactic procedures from January 1986 to May 2006. Data on each case were prospectively collected by the senior author. Procedures for Ommaya reservoir placement, brachytherapy, stereotactic craniotomy flap localization, shunt placement, or treatment of previously-diagnosed intracranial cystic lesions were excluded, leaving 614 patients in whom a total of 622 procedures were performed for purely diagnostic purposes. Complication rates and their association with clinical variables were sought.Results:Morbidity and mortality rates were 6.9% (43/622) and 1.3% (8/622), respectively. The risk of symptomatic hemorrhage (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], intraventricular hemorrhage [IVH]) was 4.8%. The risks of transient or permanent neurological deficits were 2.9% (18/622) and 1.5% (9/622), respectively. Biopsy of deep-seated lesions was associated with increased overall complication rate, while biopsy of Glioblastoma Multiforme (GBM) was associated with perioperative mortality.Conclusions:Overall, complication rates were comparable with those in previous reports. The subgroup of patients with deep-seated lesions or a histologic diagnosis of GBM may possess an elevated risk of overall complications or mortality, respectively, compared to other patients undergoing frame-based stereotactic brain biopsy.

Histological yield, complications, and technological considerations in 114 consecutive frameless stereotactic biopsy procedures aided by open intraoperative magnetic resonance imaging

2002 ◽  
Vol 97 (2) ◽  
pp. 354-362 ◽  
Author(s):  
René L. Bernays ◽  
Spyros S. Kollias ◽  
Nadia Khan ◽  
Sebastian Brandner ◽  
Sonja Meier ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Complication Rates ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. The authors undertook a prospective study of frameless, magnetic resonance (MR)—guided stereotactic brain biopsy procedures performed with the aid of an open MR system. Morbidity and mortality rates, frequency of postoperative hemorrhage, and histological yield were evaluated, as well as the size and location of the lesions under investigation. Methods. During a period of 51 months (July 1996–November 2000), 114 consecutive frameless stereotactic biopsy procedures were performed with the aid of an open intraoperative MR system to investigate supratentorial lesions in 113 patients. The median volume of the lesions was 33.5 cm3, and 31.9% were deep seated. All biopsy samples comprised pathological tissue and in 111 (97.4%) of 114 a specific neuropathological diagnosis was made. A follow-up computerized tomography (CT) scan was obtained on the 1st postoperative day in all patients to evaluate postoperative complications. In two cases (1.8%), a hemorrhage was found on postoperative CT scans, with no neurological worsening of the patients. Morbidity with neurological worsening was seen in three patients; it was transient in two of them (1.8%), and in one (0.9%) subsequent emergency craniotomy was necessary because of increased edema. There were no infections, but there was one death (0.9%) Conclusions. Open intraoperative MR imaging transforms a blind conventional stereotactic procedure into a visually controlled procedure that is adaptable to dynamic anatomical changes. Routine postprocedural MR imaging makes follow-up CT scanning obsolete. This largest reported series of intraoperative MR—guided biopsy procedures shows results that are at least comparable with those in reports of larger series of conventional stereotactic biopsy sampling. The mean procedure time was 60 minutes including planning, and this method produced low morbidity and complication rates and a high histological yield.

scholarly journals Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction Versus Mastectomy Alone

2017 ◽  
Vol 26 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Janelle Sousa ◽  
Ravi Sood ◽  
Daniel Liu ◽  
Kristine Calhoun ◽  
Otway Louie ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Patient Characteristics ◽  
Immediate Breast Reconstruction ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Management Of Complications ◽  
Immediate Implant ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Objectives: Immediate implant-based techniques are common practice in post-mastectomy breast reconstruction. Previous studies have shown an increased complication rate in the setting of immediate versus delayed, MD reconstruction. We aimed to quantify any additional risk in complications when implant-based immediate breast reconstruction (IBR) is performed versus mastectomy alone. Materials and Methods: We retrospectively reviewed all IBR cases and all mastectomies without reconstruction from 2007 to 2011. Patient characteristics, operative details, and complication rates were reviewed and analyzed. Results: IBR was performed in 315 consecutive women; mastectomy alone was performed in 401 women. Patients undergoing mastectomy alone were more often older, diabetic, and more frequently underwent neoadjuvant chemotherapy or radiation. Overall complications were higher in the IBR group, most commonly reoperation and delayed wound healing. In a multivariate analysis, IBR, increasing age, body mass index, history of radiation therapy, smoking, and nipple-sparing mastectomy were independently associated with increased risk of complications. However, IBR was only independently associated with increased risk of major complications such as reoperation or readmission for intravenous antibiotics, not minor complications. Conclusion: Patients selected for IBR are inherently different than those undergoing mastectomy alone. After adjusting for these differences, the increased risk of complications seen in IBR is moderately increased over the risk of complications in mastectomy alone. The observed increased risk of major complications after IBR is largely due to the aggressive management of complications in the setting of a prosthetic implant. IBR is a safe reconstructive strategy with only a slightly increased risk over mastectomy alone.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

scholarly journals Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 710
Author(s):  
Abel Botelho Quaresma ◽  
Fernanda da Silva Barbosa Baraúna ◽  
Fábio Vieira Teixeira ◽  
Rogério Saad-Hossne ◽  
Paulo Gustavo Kotze
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Randomized Studies ◽  
Pubmed Database ◽  
Increased Risk ◽  
The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

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