COMPUTED IMAGING-ASSISTED STEREOTACTIC BRAIN BIOPSY - A RISK ANALYSISOF 225 CONSECUTIVE CASES

BACKGROUND Treatment strategies for intracranial mass lesions are most effective when based upon histopathological diagnoses. Image-guided s tereotaxy has provided the means to sample tissue from small or deeply seated intraparenchymal lesions with a relatively high degree of safe ty and accuracy. Although procedural complications are infrequent, dev astating neurological sequelae may result from hemorrhage or direct tr auma. This study was undertaken to identify factors that may confer an increased risk of morbidity from stereotactic brain biopsy. METHODS T wo hundred twenty-five consecutive computer-assisted stereotactic brai n biopsy procedures were reviewed. Patient age averaged 47.4 years (ra nge, 3-84 years); gender ratio was approximately 2:1 (male:female). Pr e-existing medical conditions were identified in nearly half of the co hort. 61.3% of biopsied lesions were lobar; the remainder (38.7%) were ''deep-seated'' (thalamus, basal ganglia, pineal, hypothalamus, cereb ellum, brainstem). Glial tumors accounted for the majority (44.4%) of biopsied lesions; metastases (12.9%) and lymphoma (11.6%) were also re latively common. Demographical, anatomical, surgical, and histological data were compiled and putative risk factors for morbidity identified . These variables were then subjected to univariate and logistic regre ssion analyses to determine their significance as independent predicto rs of operative risk. RESULTS Twelve patients suffered complications a s a consequence of the biopsy procedure (eight from hemorrhage, four f rom direct trauma). Major morbidity (hemiparesis, aphasia, obtundation ) occurred in eight patients (3.6%). Three patients (1.3%) suffered mi nor morbidity (transient, mild neurological deficits). One operative f atality occurred (0.4%). An increased risk of morbidity was associated with the preoperative use of antiplatelet agents, chronic corticoster oids, deep-seated lesions, malignant gliomas, and a greater number of biopsy attempts (p < 0.05). Factors not conferring increased morbidity included gender, age, pre-existing illness, extracranial malignancy, cardiac disease, hypertension, diabetes, HIV status, and instrument us ed to procure the specimen. CONCLUSIONS Complications arising from ste reotactic brain biopsy are infrequent but can be disastrous. Operative risk is a function of several independent variables, including lesion properties (location, histology), preoperative pharmacological therap y (corticosteroids, antiplatelet agents), and operative technique. Thi s analysis suggests that the morbidity of stereotactic brain biopsy ma y be minimized by risk factor modification. (C) 1998 by Elsevier Scien ce Inc.