title: Efficacy and safety of local versus general anesthesia in stereotactic biopsies: a matched-pairs cohort study.
abstract: BACKGROUND
  Frame-based stereotactic biopsies remain the gold standard for the diagnosis of intracerebral lesions. A major advantage is the ability to perform these procedures under local anesthesia (LA). However, there is no consensus on whether or when to use LA or general anesthesia (GA). It has been postulated that the use of LA may reduce the risk of complications. This study aims to objectify the efficacy and safety of stereotactic biopsies under LA versus GA by analyzing a prospective registry for stereotactic biopsies.
  
  
  METHODS
  A prospective registry for stereotactic procedures was analyzed for the activities performed between May 2009 and August 2011. Inclusion criteria were patients undergoing a stereotactic biopsy. Patients with functional stereotactic procedures, cyst or abscess evacuation, and children were excluded. Of the remaining 274 patients, 204 could be randomly matched considering sex, age, American Society of Anesthesiologists (ASA) classification, and type of hospitalization. The primary endpoint was the diagnostic yield. Secondary endpoints were safety and procedural time intervals.
  
  
  RESULTS
  Ninety-six percent of diagnosis was achieved in the LA group and 94% within the GA group. There was no significant difference in the overall complication rate. However, the rate of pulmonary complications was higher in the GA group (P=0.059). The rate of bleeding was significantly higher in the LA group (P=0.003) intraoperatively. However, no significant difference was found clinically or on routine postoperative computed tomography scan reports. There was a significant reduction in the time spent in the operating room within the LA group (P<0.001).
  
  
  CONCLUSIONS
  The type of anesthesia may not interfere with the diagnostic yield in stereotactic biopsies. Patients operated under LA are less likely to suffer pulmonary complications. Furthermore, LA could spare hospital resources in this setting.
authors.affiliation: Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany. lutz.weise@med.uni-frankfurt.de
authors.forename: Lutz M
authors.initials: LM
authors.lastname: Weise
authors.forename: Markus
authors.initials: M
authors.lastname: Bruder
authors.forename: Sebastian
authors.initials: S
authors.lastname: Eibach
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Gerhard
authors.initials: G
authors.lastname: Marquardt
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
mesh_terms: D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects; D001706:Biopsy / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D001932:Brain Neoplasms / Q000175:diagnosis; D003000:Clonidine / Q000627:therapeutic use; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D023381:Endpoint Determination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013238:Stereotaxic Techniques; D055815:Young Adult
chemical_list: D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D003000:Clonidine; D008874:Midazolam