title: Hemorrhage after stereotactic biopsy from intra-axial brain lesions: incidence and avoidance.
abstract: BACKGROUND
  With the introduction of stereotactic surgery in humans by Spiegel and Wycis in 1947 and the great advances in neuroimaging, image-guided stereotactic brain biopsy is the mainstay for diagnosis of intrinsic deep-seated brain lesions. Stereotactic biopsy is usually safe, and the reported rate of complications is minimal, with mortality being reported in less than 1% and significant morbidity occurring in less than 5%. The complication most often encountered after stereotactic biopsy is hemorrhage.
  
  
  METHODS
  A total of 150 patients (84 male and 66 female) with the mean age of 52.8 years having intra-axial brain lesions were included in the study. Image-guided (114 computed tomography [CT] and 36 magnetic resonance imaging [MRI]) stereotactic biopsy were performed by a specialized stereotactic neurosurgeon. Routine preoperative coagulation studies were performed in all patients. A workstation with multiplanar trajectory planning software was used. Serial biopsies were done with Sedan-type side cutting needle. Any detectable bleeding was analyzed by CT within 4 hours after procedure. All medical charts, laboratory results, preoperative imaging studies, and postoperative imaging studies were reviewed.
  
  
  RESULTS
  A conclusive histopathological diagnosis was achieved in 147 patients (98%). In 7 patients (4.7%), hemorrhage was detected in post-biopsy CT scan (3.3% asymptomatic and 1.4% symptomatic). Hemorrhage occurred in patients with highly malignant tumors. There was no mortality.
  
  
  CONCLUSIONS
  Using multiplanar image-guided trajectory planning and a small biopsy needle decreases the incidence of post-biopsy hemorrhage. Neurologically intact patients with no hemorrhage in post-biopsy CT scan could safely be discharged home at the same operative day.
authors.affiliation: Department of Neurosurgery, Tanta University, Tanta, Gharbia, Egypt.
authors.forename: Ahmed Abdel Sallam
authors.initials: AA
authors.lastname: Shakal
authors.affiliation: Department of Neurosurgery, Tanta University, Tanta, Gharbia, Egypt.
authors.forename: Esam Abdel Hay
authors.initials: EA
authors.lastname: Mokbel
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*