title: The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours--a prospective study.
abstract: OBJECTIVE
  To analyze prospectively the frequency and the risk of symptomatic and asymptomatic haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours.
  
  
  METHODS
  The study was conducted within a time frame of 24 months (April 1998-April 2000). 326 patients (150 males, 176 females; mean age 56.8 years) were included and 345 computerized tomography (CT)-guided stereotactic biopsies were performed/supervised by a specialized stereotactic neurosurgeon. A modified Riechert Stereotaxy System and a workstation for multiplanar trajectory planning were used in all patients. Serial biopsies (median, 5 samples) were done with small forceps (diameter 1 mm), smear preparations of the biopsy specimens were intra-operatively examined. Frequency, size, and location of any detectable bleeding were analyzed by post-biopsy CT-scan investigation. For risk estimation, logistic regression analysis was performed. The chi-square statistic was used for comparative analysis of the study results with available data from the literature.
  
  
  RESULTS
  A conclusive tissue diagnosis could be achieved in 98%. Overall treatment morbidity was 3.1%. There was no mortality. Haemorrhage related morbidity was 0.9%. Age, Karnofsky score, mass effect of the tumour, tumour histology, tumour location and the number of specimens taken did not have any prognostic significance. The clinically silent bleeding rate was 9.6% and more often seen in patients with high grade gliomas (p = 0.03). Both the silent and non-silent bleeding rate were significantly lower as compared to available prospective data in the literature (p < 0.01).
  
  
  CONCLUSIONS
  Using multiplanar image guided trajectory planning, small biopsy forceps and intra-operative smear preparations the risk of major haemorrhage related morbidity after stereotactic brain tumour biopsy is extremely low (<1%) in experienced hands.
authors.affiliation: Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: F W
authors.initials: FW
authors.lastname: Kreth
authors.forename: A
authors.initials: A
authors.lastname: Muacevic
authors.forename: R
authors.initials: R
authors.lastname: Medele
authors.forename: K
authors.initials: K
authors.lastname: Bise
authors.forename: T
authors.initials: T
authors.lastname: Meyer
authors.forename: H J
authors.initials: HJ
authors.lastname: Reulen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D025321:Surgery, Computer-Assisted / Q000379:methods