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Complications of CT-guided stereotactic biopsy of intra-axial brain lesions
1Division of Neurosurgery, Toronto Hospital, University of Toronto, Ontario, Canada.
Insights
Stereotactic brain biopsies for intra-axial lesions have a 6.3% complication rate, including a 1.7% mortality rate, primarily from intracranial hypertension. Despite potential devastating outcomes in a few, the procedure is effective with a lower complication rate than craniotomy.
Area of Science:
- Neurosurgery
- Neuropathology
- Medical Imaging
Background:
- Stereotactic biopsy is a minimally invasive technique for diagnosing intra-axial brain lesions.
- Assessing the complication profile of stereotactic biopsy is crucial for patient safety and procedural refinement.
Purpose of the Study:
- To critically analyze the complications associated with a series of 300 consecutive stereotactic biopsies for intra-axial brain lesions.
- To determine the mortality and morbidity rates, and identify risk factors for adverse outcomes.
Main Methods:
- Retrospective analysis of 300 consecutive stereotactic biopsies performed by a single neurosurgeon.
- Detailed review of patient records to identify and categorize complications, including mortality, hemorrhage, and neurological deficits.
Main Results:
- Overall complication rate was 6.3% (19/300 patients).
- Mortality rate was 1.7% (5/300 patients), primarily due to intracranial hypertension, with all deaths occurring in glioblastoma multiforme patients.
- Morbidity occurred in 4.7% (14/300 patients) due to hemorrhage, with 1.3% experiencing major, life-altering deficits.
Conclusions:
- Stereotactic biopsy is an effective procedure for intra-axial brain lesions with a significantly lower complication rate compared to craniotomy.
- While generally safe, devastating outcomes including mortality and major morbidity can occur in a small percentage of patients, particularly those with glioblastoma multiforme and intracranial hypertension.
Abstract:
A series of 300 consecutive stereotactic biopsies for intra-axial brain lesions performed by one neurosurgeon was critically analyzed regarding complications of the procedure. Complications were incurred by a total of 19 patients (6.3%). Five patients (1.7%) died following the procedure, all due to intracranial hypertension: one from subarachnoid hemorrhage, one from intracerebral hemorrhage, and three from increased edema without hemorrhage. The three patients who died without hemorrhage all had marked intracranial hypertension at the time of biopsy. All five patients who died harbored a glioblastoma multiforme. The surviving 14 patients (4.7%) with complications suffered increased neurological deficit due to hemorrhage. In 10 (3.3%), the deficit was mild and/or transient; in the other four (1.3%), a major deficit was incurred which markedly affected the remainder of the patient's life. Therefore, mortality or major morbidity was seen in 3.0% of patients and minor morbidity in 3.3%. Stereotactic biopsy is a very effective procedure with a complication rate significantly lower than that of craniotomy (particularly in the population of patients selected for stereotactic biopsy), but in a small number of patients the outcome is devastating.