Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

Abhaya V. Kulkarni Division of Neurosurgery, Toronto Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Search for other papers by Abhaya V. Kulkarni in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Abhijit Guha Division of Neurosurgery, Toronto Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Search for other papers by Abhijit Guha in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Andres Lozano Division of Neurosurgery, Toronto Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Search for other papers by Andres Lozano in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Mark Bernstein Division of Neurosurgery, Toronto Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Search for other papers by Mark Bernstein in
Current site
Google Scholar
PubMed
Close
 M.D., F.R.C.S.(C)
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $536.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $536.00
USD  $636.00
Print or Print + Online Sign in

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.

  • Collapse
  • Expand
  • 1.

    Apuzzo MLJ, , Chandrasoma PT, & Cohen D, et al: Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20:930937, 1987 Apuzzo MLJ, Chandrasoma PT, Cohen D, et al: Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20:930–937, 1987

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bernstein M, & Parrent AG: Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81:165168, 1994 Bernstein M, Parrent AG: Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 81:165–168, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Bullard DE, , Makachinas TT, & Nashold BS Jr: The role of monopolar stimulation during computed-tomography-guided stereotactic biopsies. Appl Neurophysiol 51:4554, 1988 Bullard DE, Makachinas TT, Nashold BS Jr: The role of monopolar stimulation during computed-tomography-guided stereotactic biopsies. Appl Neurophysiol 51:45–54, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Bullard DE, , Osborne D, & Burger PC, et al: Further experience utilizing the Gildenberg technique for computed tomographyguided stereotactic biopsies. Neurosurgery 19:386391, 1986 Bullard DE, Osborne D, Burger PC, et al: Further experience utilizing the Gildenberg technique for computed tomographyguided stereotactic biopsies. Neurosurgery 19:386–391, 1986

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Cook RJ, & Guthrie BL: Complications of stereotactic biopsy. Perspect Neurol Surg 4:131140, 1993 Cook RJ, Guthrie BL: Complications of stereotactic biopsy. Perspect Neurol Surg 4:131–140, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hahn JF, , Levy WJ, & Weinstein MJ: Needle biopsy of intracranial lesions guided by computerized tomography. Neurosurgery 5:1115, 1979 Hahn JF, Levy WJ, Weinstein MJ: Needle biopsy of intracranial lesions guided by computerized tomography. Neurosurgery 5:11–15, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    James HE, , Wells M, & Alksne JF, et al: Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions. Neurosurgery 5:671674, 1979 James HE, Wells M, Alksne JF, et al: Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions. Neurosurgery 5:671–674, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 183223 Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 183–223

  • 9.

    Levin AB: Experience in the first 100 patients undergoing computerized tomography-guided stereotactic procedures utilizing the Brown-Roberts-Wells guidance system. Appl Neurophysiol 48:4549, 1985 Levin AB: Experience in the first 100 patients undergoing computerized tomography-guided stereotactic procedures utilizing the Brown-Roberts-Wells guidance system. Appl Neurophysiol 48:45–49, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Lunsford LD, & Martinez AJ: Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22:222230, 1984 Lunsford LD, Martinez AJ: Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22:222–230, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Moran CJ, , Naidich TP, & Gado MH, et al: Central nervous system lesions biopsied or treated by CT-guided needle placement. Radiology 131:681686, 1979 Moran CJ, Naidich TP, Gado MH, et al: Central nervous system lesions biopsied or treated by CT-guided needle placement. Radiology 131:681–686, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Mundinger F: CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir Suppl 35:7074, 1985 Mundinger F: CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir Suppl 35:70–74, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Niizuma H, , Otsuki T, & Yonemitsu T, et al: Experiences with CT-guided stereotaxic biopsies in 121 cases. Acta Neurochir Suppl 42:157160, 1988 Niizuma H, Otsuki T, Yonemitsu T, et al: Experiences with CT-guided stereotaxic biopsies in 121 cases. Acta Neurochir Suppl 42:157–160, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ostertag CB, , Mennel HD, & Kiessling M: Stereotactic biopsy of brain tumors. Surg Neurol 14:275283, 1980 Ostertag CB, Mennel HD, Kiessling M: Stereotactic biopsy of brain tumors. Surg Neurol 14:275–283, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Sedan R, , Peragut JC, & Farnarier P, et al: Intra-encephalic stereotactic biopsies (309 patients/318 biopsies). Acta Neurochir Suppl 33:207210, 1984 Sedan R, Peragut JC, Farnarier P, et al: Intra-encephalic stereotactic biopsies (309 patients/318 biopsies). Acta Neurochir Suppl 33:207–210, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Soo TM, , Bernstein M, & Provias J, et al: Failed stereotactic biopsy in a series of 518 cases. Stereotact Funct Neurosurg 64:183196, 1995 Soo TM, Bernstein M, Provias J, et al: Failed stereotactic biopsy in a series of 518 cases. Stereotact Funct Neurosurg 64:183–196, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Voges J, , Schröder R, & Treuer H, et al: CT-guided and computer assisted stereotactic biopsy. Technique, results, indications. Acta Neurochir 125:142149, 1993 Voges J, Schröder R, Treuer H, et al: CT-guided and computer assisted stereotactic biopsy. Technique, results, indications. Acta Neurochir 125:142–149, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1090 220 18
Full Text Views 224 22 1
PDF Downloads 120 26 1
EPUB Downloads 0 0 0