Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy

Object. Stereotactic brain biopsy has played an integral role in the diagno sis and management of brain lesions. Pit most centers, imaging studies foll owing biopsy are rarely performed. The authors prospectively determined the acute hemorrhage rate after stereotactic biopsy by performing immediate po stbiopsy intraoperative computerized tomography (CT) scanning. They then an alyzed factors that may influence the risk of hemorrhage and the diagnostic accuracy rate. Methods. Five hundred consecutive patients undergoing stereotactic brain bi opsy underwent immediate postbiopsy intraoperative CT scanning. Before surg ery, routine preoperative coagulation studies were performed in all patient s. All medical charts, laboratory results, preoperative imaging studies, an d postoperative imaging studies were reviewed. In 40 patients (8%) hemorrhage was detected using immediate postbiopsy intr aoperative CT scanning. Neurological deficits developed in six patients (1. 2%) and one patient (0.2%) died. Symptomatic delayed neurological deficits developed in two patients (0.4%), despite the fact that the initial postbio psy CT scans in these cases did not show acute hemorrhage. Both patients ha d large intracerebral hemorrhages that were confirmed at the time of repeat ed imaging. The results of a multivariate logistic regression analysis of t he risk of postbiopsy hemorrhage of any size showed a significant correlati on only with the degree to which the platelet count was below 150,000/mm(3) (p = 0.006). The results of a multivariate analysis of a hemorrhage measur ing greater than 5 mm in diameter also showed a correlation between the ris k of hemorrhage and a lesion location in the pineal region (p = 0.0086). Th e rate at which a nondiagnostic biopsy specimen was obtained increased as t he number of biopsy samples increased (p = 0.0073) and in accordance with y ounger patient age (p = 0.026). Conclusions. Stereotactic brain biopsy was associated with a low likelihood of postbiopsy hemorrhage. The risk of hemorrhage increased steadily as the platelet count fell below 150,000/mm(3). The authors found a small but def inable risk of delayed hemorrhage, despite unremarkable findings on an imme diate postbiopsy head CT scan. This risk justifies an overnight hospital ob servation stay for all patients after having undergone stereotactic brain b iopsy.