title: Complications Following Stereotactic Needle Biopsy of Intracranial Tumors.
abstract: BACKGROUND
  Data from single-institution studies suggest that perioperative complication rates after stereotactic needle brain biopsies range from 6% to 12%, with permanent morbidity and mortality ranging from 3.1% to 6.4% and 0% to 1.7%, respectively. However, no population-level data are available. We conducted a population-based analysis to study complications after needle brain biopsy.
  
  
  METHODS
  We analyzed patients recorded in the Nationwide Inpatient Sample who underwent stereotactic needle brain biopsy for neoplastic lesions between 2006 and 2012. A multivariate logistic model was used to identify factors associated with complications.
  
  
  RESULTS
  We identified 7514 patients who underwent biopsy for various intracranial pathologies, including primary malignant neoplasm (52.3%), unspecified neoplasm (17.9%), metastasis (9.7%), meningioma (1.5%), radiation necrosis (0.8%), lymphoma (0.5%), and pineal region neoplasm (0.3%). Intracranial hemorrhage was the most frequent complication (5.8%). Other complications, including operative infection (0.1%) and wound breakdown (0.2%), were rare. Multivariate logistic regression analysis revealed that hemorrhage is associated with older age (reference <40 years; 40-59 years, odds ratio [OR] 2.26, 95% confidence interval [CI] 1.51-3.38; ≥60 years, OR 1.90, 95% CI 1.22-2.97), hydrocephalus (OR 3.02, 95% CI 2.20-4.14), and cerebral edema (OR 2.16, 95% CI 1.72-2.72). Hemorrhage is less likely when taking a biopsy from a primary malignant neoplasm (OR 0.73, 95% CI 0.59-0.90). Overall inpatient mortality after biopsy was 2.8%. Patients with intracranial hemorrhage were significantly more likely than patients without hemorrhage to die in the hospital (12.8% vs. 2.2%, P < 0.001) or be discharged to a rehabilitation/nursing facility (45.2% vs. 23.1%, P < 0.001).
  
  
  CONCLUSIONS
  Intracranial hemorrhage is the most frequent complication associated with needle brain biopsy and is associated with inpatient mortality and hospital disposition. Other complications are rare.
authors.affiliation: Department of Neurological Surgery, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Malone
authors.affiliation: Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.affiliation: Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Obstetrics & Gynecology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Department of Neurological Surgery, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA. Electronic address: ain1@cumc.columbia.edu.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000401:mortality; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013238:Stereotaxic Techniques / Q000009:adverse effects* / Q000401:mortality; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Brain biopsy; Complications; Intracranial hemorrhage; Intracranial tumors; Stereotactic needle biopsy