Benefit and Complications of Frame-Based Stereotactic Biopsy in Old and Very Old Patients.
OBJECTIVE
Stereotactic biopsy is an everyday procedure implemented in numerous neurosurgical departments. The procedure is performed to obtain tumor tissue of unclear diagnosis. Going in hand with low complication rates and high diagnostic yield, stereotactic biopsies can be performed in adults and children likewise for histopathologic evaluation of lesions in eloquent localizations. However, little is known about whether aged patients do benefit from stereotactic biopsy or rather the therapy that is derived from histopathologic results. In this study, we therefore focused on old (80-84 years) and very old patients (85 years and older) to evaluate whether stereotactic biopsy should be performed leading to further therapy. We also assessed the complication rates of the procedure in this aged population.


METHODS
We performed a retrospective analysis of our database and included all patients older than 80 years who underwent stereotactic biopsy at our department from October 2005 until May 2016. Forty-seven patients were included in this study. These patients were divided into 2 subgroups: group 1 consisted of patients from 80 to 84 years old and group 2 of patients aged 85 years and older. All patients underwent stereotactic biopsy to establish histopathologic diagnosis. We excluded patients who underwent cyst puncture or puncture of a hemorrhage because the procedure was not performed for diagnostic purposes. We assessed gender, neuroradiologic diagnosis, Karnofsky Performance Score (KPS), number of tissue samples taken, histopathologic diagnosis, localization, postoperative hemorrhage, modality of anesthesia anticoagulation, and further therapy.


RESULTS
Group 1 consisted of 34 patients and group 2 of 13 patients. KPS was 80 and 70, respectively. A histopathologic diagnosis was possible in all but 1 patient. In group 1, 61.8% of the patients agreed to further postoperative therapy (radiation, 35.3%; chemotherapy, 11.8%; combined radiochemotherapy, 11.8%; complication that prevented therapy, 2.9%), as did 53.8% of the patients in group 2 (resection, 7.7%; radiation, 15.4%; combined radiochemotherapy, 30.7%). In group 1, 38.2% declined further therapy, as did 64.1% in group 2.


CONCLUSIONS
Also in old and very old patients, a final histopathologic diagnosis should be established to provide adequate therapy. Our data show that most of these aged patients want to be treated.
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany. Electronic address: johanna.quick@gmx.de.
Johanna
J
Quick-Weller
Department of Neurooncology, Goethe-University Frankfurt, Frankfurt, Germany.
Julia
J
Tichy
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Nazife
N
Dinc
Institute for Neuroradiology, Goethe-University Frankfurt, Frankfurt, Germany.
Stephanie
S
Tritt
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Sae-Yeon
SY
Won
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Bedjan
B
Behmanesh
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Markus
M
Bruder
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Volker
V
Seifert
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany; Division of Neurosurgery, Department of Surgery, Dalhousie University Halifax, Nova Scotia, Canada.
Lutz M
LM
Weise
Neurosurgical Clinic, Goethe-University Frankfurt, Frankfurt, Germany.
Gerhard
G
Marquardt
D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D012189:Retrospective Studies; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D013997:Time Factors; D015898:Tomography Scanners, X-Ray Computed
Benefit of stereotactic biopsy; Brain lesion; Complications of stedreotaxtix biopsy; Frame-based stereotactic biopsy; Old patients