Complications in 622 cases of frame-based stereotactic biopsy, a decreasing procedure.
BACKGROUND
Frame-based stereotactic brain biopsy has played an important role in the management of patients with suspected neoplastic intracranial lesions over the last three decades. We reviewed the surgical experience of one surgeon to determine the nature and frequency of complications associated with this procedure.


METHODS
Records were reviewed for 858 patients undergoing frame-based stereotactic procedures from January 1986 to May 2006. Data on each case were prospectively collected by the senior author. Procedures for Ommaya reservoir placement, brachytherapy, stereotactic craniotomy flap localization, shunt placement, or treatment of previously-diagnosed intracranial cystic lesions were excluded, leaving 614 patients in whom a total of 622 procedures were performed for purely diagnostic purposes. Complication rates and their association with clinical variables were sought.


RESULTS
Morbidity and mortality rates were 6.9% (43/622) and 1.3% (8/622), respectively. The risk of symptomatic hemorrhage (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], intraventricular hemorrhage [IVH]) was 4.8%. The risks of transient or permanent neurological deficits were 2.9% (18/622) and 1.5% (9/622), respectively. Biopsy of deep-seated lesions was associated with increased overall complication rate, while biopsy of Glioblastoma Multiforme (GBM) was associated with perioperative mortality.


CONCLUSIONS
Overall, complication rates were comparable with those in previous reports. The subgroup of patients with deep-seated lesions or a histologic diagnosis of GBM may possess an elevated risk of overall complications or mortality, respectively, compared to other patients undergoing frame-based stereotactic brain biopsy.
Kongkham
Paul N
PN
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
Knifed
Eva
E
Tamber
Mandeep S
MS
Bernstein
Mark
M
D001706:Biopsy / Q000009:adverse effects* / Q000401:mortality; D001921:Brain / Q000473:pathology*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D012307:Risk Factors; D013238:Stereotaxic Techniques / Q000009:adverse effects* / Q000401:mortality; D014057:Tomography, X-Ray Computed