The value of micro-Doppler in stereotactic brain biopsy.
OBJECTIVE
The aim of this study was to analyse the value of intraoperative micro-Doppler in stereotactic brain biopsy (SBB). So far, only a few studies have reported about the usefulness of micro-Doppler in stereotactic brain biopsy.


METHODS
Between 1998 and 2003, 155 SBBs were performed in 153 patients with micro-Doppler (81 males, 72 females, mean age: 59 years). All operations were performed using a ZD-frame and a multiplanar computer tomography-guided trajectory planning system (Leibinger SPP). A 16 MHz micro-Doppler probe (diameter 1 mm, DWL) was used in all cases to explore the area of biopsy before the tissue probes were taken. Serial biopsies (mean, 6 samples) were taken with the Sedan side-cutting cannula (n = 145) or the small forceps (n = 10). We evaluated the number of intraoperative detectable vessel signals by micro-Doppler, intraoperative bleedings as well as bleedings detected by postoperative CT (which was performed in all cases). We compared our results according to bleeding-related complications with the data of stereotactic biopsy series from the recent literature.


RESULTS
A conclusive histopathological diagnosis was achieved in 150/153 patients (98 %). A re-biopsy had to be undertaken in 2 cases. In 98 biopsies (63 %), no vessel could be detected with the micro-Doppler. In the remainder, a signal of arterial vessels was detected in 22 (14 %) and a signal of venous vessels in 35 cases (23 %). Detection of a vessel in the micro-Doppler led to a change of the biopsy site in each case within the same trajectory. Biopsy-related bleedings were detected in 4 cases (2.6 %). Among these, the only bleeding which occurred without any signs of vessels in the micro-Doppler happened in a case of a melanoma. The overall biopsy-related permanent morbidity was 0.6 % (n = 1). The biopsy-related mortality was 0.


CONCLUSIONS
Despite the overall high security of SBB, the use of intraoperative micro-Doppler may lead to an additional reduction of the risk for a biopsy-related bleeding without enormous expense.
Hertel
F
F
Department of Neurosurgery, Brüderkrankenhaus, Trier, Germany. f.hertel@bk-trier.de
Feiden
W
W
Bettag
M
M
D001706:Biopsy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D018617:Ultrasonography, Doppler, Pulsed