Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy

2001 ◽  
Vol 94 (4) ◽  
pp. 545-551 ◽  
Author(s):  
Melvin Field ◽  
Timothy F. Witham ◽  
John C. Flickinger ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford
Keyword(s):  
Platelet Count ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Imaging Studies ◽  
Stereotactic Brain Biopsy ◽  
Acute Hemorrhage ◽  
Content Type ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. Stereotactic brain biopsy has played an integral role in the diagnosis and management of brain lesions. At most centers, imaging studies following biopsy are rarely performed. The authors prospectively determined the acute hemorrhage rate after stereotactic biopsy by performing immediate postbiopsy intraoperative computerized tomography (CT) scanning. They then analyzed factors that may influence the risk of hemorrhage and the diagnostic accuracy rate. Methods. Five hundred consecutive patients undergoing stereotactic brain biopsy underwent immediate postbiopsy intraoperative CT scanning. Before surgery, routine preoperative coagulation studies were performed in all patients. All medical charts, laboratory results, preoperative imaging studies, and postoperative imaging studies were reviewed. In 40 patients (8%) hemorrhage was detected using immediate postbiopsy intraoperative CT scanning. Neurological deficits developed in six patients (1.2%) and one patient (0.2%) died. Symptomatic delayed neurological deficits developed in two patients (0.4%), despite the fact that the initial postbiopsy CT scans in these cases did not show acute hemorrhage. Both patients had large intracerebral hemorrhages that were confirmed at the time of repeated imaging. The results of a multivariate logistic regression analysis of the risk of postbiopsy hemorrhage of any size showed a significant correlation only with the degree to which the platelet count was below 150,000/mm3 (p = 0.006). The results of a multivariate analysis of a hemorrhage measuring greater than 5 mm in diameter also showed a correlation between the risk of hemorrhage and a lesion location in the pineal region (p = 0.0086). The rate at which a nondiagnostic biopsy specimen was obtained increased as the number of biopsy samples increased (p = 0.0073) and in accordance with younger patient age (p = 0.026). Conclusions. Stereotactic brain biopsy was associated with a low likelihood of postbiopsy hemorrhage. The risk of hemorrhage increased steadily as the platelet count fell below 150,000/mm3. The authors found a small but definable risk of delayed hemorrhage, despite unremarkable findings on an immediate postbiopsy head CT scan. This risk justifies an overnight hospital observation stay for all patients after having undergone stereotactic brain biopsy.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent 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.

Progressive neurological deficits with benign intracerebral cysts

1986 ◽  
Vol 65 (5) ◽  
pp. 706-709 ◽  
Author(s):  
Yoko Nakasu ◽  
Jyoji Handa ◽  
Kazuyoshi Watanabe
Keyword(s):  
Histological Examination ◽  
Computerized Tomography ◽  
Cyst Wall ◽  
Benign Lesion ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

✓ Two patients with benign intracerebral cysts are reported and a brief review of the literature is given. Although computerized tomography (CT) scanning is useful in detecting a variety of intracerebral cysts, the CT findings are not specific for any lesion. An exploratory operation with establishment of an adequate route of drainage and a histological examination of the cyst wall are mandatory in the management of patients with a progressive but benign lesion.

Nonsurgical treatment of subdural empyema

1985 ◽  
Vol 63 (1) ◽  
pp. 128-130 ◽  
Author(s):  
Henk W. Mauser ◽  
Robert A. P. Ravijst ◽  
Arthur Elderson ◽  
Jan van Gijn ◽  
Cees A. F. Tulleken
Keyword(s):  
Computerized Tomography ◽  
Antibiotic Treatment ◽  
Ct Scanning ◽  
Subdural Empyema ◽  
Nonsurgical Treatment ◽  
Neurological Deficits ◽  
Content Type ◽  
Intracranial Infection ◽  
Fine Print

✓ The nonsurgical treatment of a case of interhemispheric subdural empyema is reported. At the time of diagnosis, the patient had a mild decrease in consciousness and only moderate focal neurological deficits. Computerized tomography (CT) confirmed the limited (interhemispheric) extent of the intracranial infection. After drainage of the nasal sinuses and antibiotic treatment, the patient recovered, although the lesion was initially increased in size on CT scanning.

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

2005 ◽  
Vol 102 (5) ◽  
pp. 897-901 ◽  
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.

Stereotactic radiosurgery for residual neurocytoma

2001 ◽  
Vol 95 (5) ◽  
pp. 879-882 ◽  
Author(s):  
Elizabeth Tyler-Kabara ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Neurological Deficits ◽  
Response To Treatment ◽  
Imaging Studies ◽  
Content Type ◽  
Adjacent Structures ◽  
Initial Resection ◽  
Fine Print

✓ The purpose of this report was to review the results of stereotactic radiosurgery in the management of patients with residual neurocytomas after initial resection or biopsy procedures. Four patients underwent stereotactic radiosurgery for histologically proven neurocytoma. Clinical and imaging studies were performed to evaluate the response to treatment. Radiosurgery was performed to deliver doses to the tumor margin of 14, 15, 16, and 20 Gy, depending on tumor volume and proximity to critical adjacent structures. More than 3 years later, imaging studies revealed significant reductions in tumor size. No new neurological deficits were identified at 53, 50, 42, and 38 months of follow up. The authors' initial experience shows that stereotactic radiosurgery appears to be an effective treatment for neurocytoma.

Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy

2001 ◽  
Vol 94 (6) ◽  
pp. 892-898 ◽  
Author(s):  
Wayel Kaakaji ◽  
Gene H. Barnett ◽  
Diane Bernhard ◽  
Ann Warbel ◽  
Karen Valaitis ◽  
...  
Keyword(s):  
Ct Scan ◽  
Brain Biopsy ◽  
Early Discharge ◽  
Economic Consequences ◽  
Inpatient Hospitalization ◽  
Stereotactic Brain Biopsy ◽  
Intraoperative Bleeding ◽  
Content Type ◽  
Group B ◽  
Fine Print

Object. The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). Methods. The records of all patients who underwent percutaneous SBB at The Cleveland Clinic Foundation, a tertiary care teaching hospital, during 1994 and 1995 (Group A) were retrospectively reviewed to collect data on the nature and timing of perioperative (< 48 hours) clinical and radiological complications. Biopsies were performed using image-guided stereotaxy either with or without a frame. Based on the results, guidelines for early discharge of patients following SBB were implemented. Information on the nature and timing of perioperative complications was also collected prospectively in all patients who underwent percutaneous SBB from January 1996 through July 1998 (Group B). Hospital financial records for patients who underwent SBB in 1997 and 1998 were also reviewed and assessed for net revenue stratified by discharge status: early discharge (< 8 hours), extended outpatient observation (≥ 8 and < 24 hours), and inpatient hospitalization (≥ 24 hours). In Group A, 130 biopsies were performed. There were five serious complications (3.8%), of which four were transient, and there was one death (0.8%). The death and any sustained deficit occurred in patients in whom a clot had been demonstrated on postoperative CT scans. All complications were detected within 6 hours after surgery. Intraoperative bleeding occurred in 12 patients (9.2%), but was associated with only 40% of cases in which hemorrhage appeared on postoperative CT scans. Guidelines for early discharge (< 8 hours) following SBB were developed and stipulated the absence of the following: 1) intraoperative hemorrhage; 2) new postoperative deficit; and 3) clot on a postoperative CT scan. In Group B, 139 biopsies were performed. There were three serious complications (2.2%), one of which was sustained due to a clot that had been demonstrated on the postoperative CT scan. All complications were detected within 6 hours postsurgery. There were no deaths in this group. Intraoperative bleeding occurred in 11 patients (7.9%), requiring intraoperative craniotomy to control bleeding in one case. Hospital financial records were available for 96 patients, of whom 22 were discharged from the hospital early, 11 were observed for an extended outpatient period, and the remainder were retained for inpatient hospitalization. Average net hospital incomes on technical charges for patients in the inpatient hospitalization, extended outpatient observation, and short-stay (early discharge) groups were $1778, $1175, and $1219, respectively, in 1997, but declined to −$889, −$1339, and $671, respectively, in 1998. The ratios of indirect costs to direct technical costs were 132.5%, 128.7%, and 103.7%, respectively. Conclusions. Early discharge of patients following SBB of supratentorial lesions is safe in the absence of excessive intraoperative bleeding, new postoperative deficit, and clot on a postoperative CT scan. Extended outpatient observation (8–23 hours) is not clinically necessary and may be economically prohibitive in the setting of a teaching hospital.

Cervical laminoplasty: evaluation of bone bonding of a high porosity hydroxyapatite spacer

2003 ◽  
Vol 98 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Tetsuhiro Iguchi ◽  
Aritetsu Kanemura ◽  
Akira Kurihara ◽  
Koichi Kasahara ◽  
Shinichi Yoshiya ◽  
...  
Keyword(s):  
Cervical Spondylosis ◽  
Hounsfield Unit ◽  
Ct Scanning ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deficits ◽  
High Porosity ◽  
Cervical Laminoplasty ◽  
Content Type ◽  
Bone Regrowth ◽  
Fine Print

Object. The purpose of this study was to evaluate the usefulness of a high-porosity hydroxyapatite (HA) spacer in cervical laminoplasty. Bone—spacer bonding rates, complications associated with the implant, and factors related to bone bonding were examined. Methods. The authors evaluated 33 consecutive patients with cervical myelopathy who underwent high-porosity HA spacer—assisted laminoplasty and were followed for at least 1 year (mean 30 months). The results of bone—spacer bonding of the 147 implants were evaluated using computerized tomography (CT) scanning. The symptoms significantly improved in 30 patients. No difference in results was detected between patients with cervical spondylosis and those with ossification of posterior longitudinal ligament. Breakage of seven spacers occurred in four patients without causing neck pain or neurological deficits. There were no other HA spacer—related complications. The spacers became rigidly bound to bone in 61% of the cases, and bone regrowth developed around the spacer in 91%. The rate of bone—spacer bonding increased over time, and the CT-documented attenuation value (Hounsfield unit) of the spacer adjacent to the bone—spacer junction in the group in which union occurred was significantly higher than in the nonunion group. Conclusions. High-porosity HA spacer—augmented laminoplasty produced good bonding-related results. Bone bonding continued to progress 1 year after surgery, indicating the good osteoconductive capability of high-porosity HA. To avoid breakage of a spacer, a minimum 7-mm distance between spacers is necessary.

Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter

1999 ◽  
Vol 91 (6) ◽  
pp. 1031-1033 ◽  
Author(s):  
Reizo Shirane ◽  
Takeo Kondo ◽  
Yasuko K. Yoshida ◽  
Susumu Furuta ◽  
Takashi Yoshimoto
Keyword(s):  
Mr Angiography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Left Lateral Ventricle ◽  
Fine Print

✓ A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits.Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.

Surgical technique and results of endoscopic anterior spinal canal decompression

2005 ◽  
Vol 2 (2) ◽  
pp. 128-136 ◽  
Author(s):  
Rudolf Beisse ◽  
Thomas Mückley ◽  
Meic H. Schmidt ◽  
Matthias Hauschild ◽  
Volker Büren
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Ct Scanning ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Content Type ◽  
Neurological Improvement ◽  
Intercostal Neuralgia ◽  
Anterior Access ◽  
Fine Print

Object. Decompression of the spinal canal in the management of thoracolumbar trauma is controversial, but many authors have advocated decompression in patients with severe canal compromise and neurological deficits. Anterior decompression, corpectomy, and fusion have been shown to be more reliable for spinal canal reconstruction than posterior procedures; however, traditional anterior-access procedures, thoracotomy, and thoracoabdominal approaches are associated with significant complications. Endoscopy-guided spinal access avoids causing these morbidities, but it has not been shown to yield equivalent results in spinal canal clearance. This study was conducted to demonstrate the effectiveness of endoscopic spinal canal decompression and reconstruction quantitatively by using pre- and postoperative computerized tomography (CT) scanning. Methods. Thirty patients with thoracolumbar canal compromise underwent endoscopic anterior spinal canal decompression, interbody reconstruction, and stabilization for fractures (27 cases), and tumor, infection, and severe degenerative disc disease (one case each). The mean follow-up period was 42 months (range 24 months–6 years). Neurological examinations, Frankel grades, radiological studies, and intraoperative findings were prospectively collected. Spinal canal clearance quantified on pre- and postoperative CT scans improved from 55 to 110%. A total of 25% of patients with complete paraplegia and 65% of those with incomplete neurological deficit improved neurologically. The complication rate was 16.7% and included one reintubation, two pleural effusions, one intercostal neuralgia, and one persistent lesion of the sympathetic chain. Conclusions. The authors describe the endoscopic technique of anterior spinal canal decompression in the thoracolumbar spine. The morbidities associated with an open procedure were avoided, and excellent spinal canal clearance was accomplished as was associated neurological improvement.

Sign in / Sign up

Export Citation Format

Share Document