Abstract
Background With the introduction of stereotactic surgery in humans by Spiegel and Wycis in 1947
and the great advances in neuroimaging, image-guided stereotactic brain biopsy is
the mainstay for diagnosis of intrinsic deep-seated brain lesions. Stereotactic biopsy
is usually safe, and the reported rate of complications is minimal, with mortality
being reported in less than 1% and significant morbidity occurring in less than 5%.
The complication most often encountered after stereotactic biopsy is hemorrhage.
Patients and Methods A total of 150 patients (84 male and 66 female) with the mean age of 52.8 years having
intra-axial brain lesions were included in the study. Image-guided (114 computed tomography
[CT] and 36 magnetic resonance imaging [MRI]) stereotactic biopsy were performed by
a specialized stereotactic neurosurgeon. Routine preoperative coagulation studies
were performed in all patients. A workstation with multiplanar trajectory planning
software was used. Serial biopsies were done with Sedan-type side cutting needle.
Any detectable bleeding was analyzed by CT within 4 hours after procedure. All medical
charts, laboratory results, preoperative imaging studies, and postoperative imaging
studies were reviewed.
Results A conclusive histopathological diagnosis was achieved in 147 patients (98%). In 7
patients (4.7%), hemorrhage was detected in post-biopsy CT scan (3.3% asymptomatic
and 1.4% symptomatic). Hemorrhage occurred in patients with highly malignant tumors.
There was no mortality.
Conclusion Using multiplanar image-guided trajectory planning and a small biopsy needle decreases
the incidence of post-biopsy hemorrhage. Neurologically intact patients with no hemorrhage
in post-biopsy CT scan could safely be discharged home at the same operative day.
Keywords
stereotactic biopsy - intra-axial brain lesions - complications - hemorrhage
