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

Published online by Cambridge University Press:  02 December 2014

Paul N. Kongkham ,
Eva Knifed ,
Mandeep S. Tamber  and
Mark Bernstein
Paul N. Kongkham
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Eva Knifed
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Mandeep S. Tamber
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Mark Bernstein
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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Abstract

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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.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Contexte</span></span>:

Au cours des trente dernières années, la biopsie du cerveau avec cadre stétéotaxique a joué un rôle important dans l'évaluation des patients chez qui on soupçonnait la présence de lésions néoplasiques intracrâniennes. Nous avons revu l'expérience d'un chirurgien afm de déterminer la nature et la fréquence des complications associées à cette intervention.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Les dossiers de 858 patients ayant subi cette intervention entre janvier 1986 et mai 2006 ont été révisés. Les données concernant chaque patient ont été recueillies de façon prospective par l'auteur principal. Les dossiers de patients qui avaient subi une intervention pour mettre en place un réservoir d'Ommaya, une brachythérapie, la localisation stéréotaxique d'un volet osseux, la mise en place d'une dérivation ou le traitement de lésions kystiques intracrâniennes dont le diagnostic était déjà posé ont été exclus. Il restait donc 614 dossiers de patients qui avaient subi au total 622 interventions à des fms diagnostiques. Nous avons déterminé le taux de complications et leur association à des variables cliniques.

<span class='italic'> <span class='bold'>Résultats</span></span>:

Les taux de morbidité et de mortalité étaient respectivement de 6,9% (43/622) et 1,3% (8/622). Le risque d'hémorragie symptomatique (HIC, HSA, IIIV) était de 4,8%. Le risque de déficits neurologiques transitoires ou permanents était respectivement de 2,9% (18/622) et 1,5% (9/622). La biopsie de lésions profondes était associée à un taux de complications plus élevé alors que la biopsie de glioblastomes multiformes (GBM) était associée à la mortalité périopératoire.

<span class='italic'> <span class='bold'>Conclusions</span></span>:

En général, les taux de complications étaient comparables à ceux rapportés antérieurement. Le sous-groupe de patients ayant des lésions profondes présenterait un risque accru de complications et le sous-groupe chez qui un diagnostic histologique de GBM a été posé aurait un risque accru de mortalité par rapport aux autres patients qui subissent une biopsie cérébrale stéréotaxique avec cadre.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 79 - 84
Copyright
Copyright © The Canadian Journal of Neurological 2008

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