Hemorrhage after stereotactic biopsy from intra-axial brain lesions: incidence and avoidance. Shakal, Sallam, A. A., Mokbel, & Hay, E. A. Journal of neurological surgery. Part A, Central European neurosurgery, 75(3):177--82, May, 2014.
Hemorrhage after stereotactic biopsy from intra-axial brain lesions: incidence and avoidance. [link]Paper  doi  abstract   bibtex   
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.
@article{ shakal_hemorrhage_2014,
  title = {Hemorrhage after stereotactic biopsy from intra-axial brain lesions: incidence and avoidance.},
  volume = {75},
  url = {http://www.ncbi.nlm.nih.gov/pubmed/23526202},
  doi = {10.1055/s-0032-1325633},
  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.},
  number = {3},
  journal = {Journal of neurological surgery. Part A, Central European neurosurgery},
  author = {Shakal, Ahmed Abdel Sallam and Mokbel, Esam Abdel Hay},
  month = {May},
  year = {2014},
  keywords = {Aged, Blood Loss, Surgical, Blood Loss, Surgical: prevention \& control, Blood Loss, Surgical: statistics \& numerical data, Brain, Brain Neoplasms, Brain Neoplasms: diagnosis, Brain Neoplasms: pathology, Brain: pathology, Brain: radiography, Brain: surgery, Child, Preschool, Computer-Assisted, Computer-Assisted: adverse effects, Female, Humans, Intracranial Hemorrhages, Intracranial Hemorrhages: epidemiology, Intracranial Hemorrhages: etiology, Intracranial Hemorrhages: prevention \& control, Male, Middle Aged, Preschool, Stereotaxic Techniques, Stereotaxic Techniques: adverse effects, Surgery, Computer-Assisted, Surgery, Computer-Assisted: adverse effects, Surgical, Surgical: prevention \& control, Surgical: statistics \& numerical data},
  pages = {177--82}
}
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