Background and goal of study:
Brain biopsy (BB) is a minimally invasive neurosurgical procedure that is conducted either as an ambulatory procedure in selected cases or with ICU admission for postoperatively control in others. We describe our experience in the management of BB in a University Hospital.
Materials and methods:
We retrospectively reviewed patients who underwent a BB (2006–2011). Sex, age, anaesthesia type, monitoring, intraoperative and postoperative complications, postoperative imaging, time and location for postoperative care were collected.
Results and discussion:
Seventy patients underwent BB (21 open BB, 49 burr-hole neuronavigation BB), 37 M/33W, 54 ± 14yo. General anaesthesia with TCI of propofol and remifentanyl was performed in all patients but 1 (awake BB with conscious sedation). ECG, SpO2, invasive arterial blood pressure, central venous access, BIS and urine output were monitored. Intraoperative complications: 2 haemorrhages through needle track; 3 bradycardia with 2 severe arterial hypertension; 3 brain swelling, one of them requiring decompressive craniotomy; 1 air embolism; 1 suspected intraoperative seizures diagnosed by BIS. In 1 patient the burr hole needed to be converted into an open craniotomy for technical reasons. All patients were awakened and recovered consciousness in the operating room except 2. After awakening from general anaesthesia 8 patients showed new neurological deficits (6 paresia, 1 anisocoria, 1 seizure). Postoperatively 12 patients remained in the recovery room for 6 h and 58 had an overnight intensive care. During the first 24 h, 5 patients had new neurological deficits (2 paresia, 1 anisocoria, 1 incoherent language, 1 hallucination), and 2 patients after the first 24 h (deterioration of consciousness level). 6 CT were emergently done for neurological deterioration (2 haematomas, 1 swelling, 2 pneumoencephalus, 1 haematoma + pneumoenchephalus). In 16 patients the cerebral imaging (CT, RM) was done during the first 24 h (main finding: pneumoencephalus and little haematomas in biopsy track) even they did no present any neurological deficit. The other 48 of them had an ambulatory control. Six patients died during admission. In 3 cases death was related to complications occurred along the procedure. Mean stay in the hospital was 5.9 days.
In our series neurological complications associated with BB recommend a close neurological surveillance at least during first 24 h. It is difficult to determine the benefit of routine TC in patients without any added neurological deficit.
Postoperative management of patients after stereotactic biopsy: results of a survey of the AANS/CNS Section on Tumors and a single institution studyRonald E. Warnick1, Lynn M. Longmore2, Christian A. Paul1 and Laurie A. Bode1. Journal of Neuro-Oncology 62: 289–296, 2003A review of perioperative complications during frameless stereotacticsurgery: our institutional experience. Zulfiqar Ali, Hemanshu Prabhakar, Parmod K. Bithal, and Hari H. Dash, J Anesth (2009) 23:358–362
© 2012 European Society of Anaesthesiology