The risk of haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours - A prospective study

被引:127
作者
Kreth, FW
Muacevic, A
Medele, R
Bise, K
Meyer, T
Reulen, HJ
机构
[1] Univ Munich, Dept Neurosurg, Klinikum Grosshadern, D-81377 Munich, Germany
[2] Univ Munich, Div Neuroradiol, Klinikum Grosshadern, Inst Radiol Diagnost, D-81377 Munich, Germany
关键词
stereotactic biopsy; intra-axial brain rumours; complications;
D O I
10.1007/s007010170058
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective. To analyze prospectively the frequency and the risk of symptomatic and asymptomatic haemorrhage after image guided stereotactic biopsy of intra-axial brain tumours. Methods. The study was conducted within a time frame of 24 months (April 1998-April 2000). 326 patients (150 males. 176 females; mean age 56.8 years) were included and 335 computerized tomography (CT)-guided stereotactic biopsies were performed/supervised by a specialized stereotactic neurosurgeon. A modified Riechert Stereotaxy System and a workstation for multiplanar trajectory planning were used in all patients. Serial biopsies (median, 5 samples) were done with small forceps (diameter 1 mm), smear preparations of the biopsy specimens were intra-operatively examined. Frequency. size, and location of any detectable bleeding were analyzed by post-biopsy CT-scan investigation. For risk estimation, logistic regression analysis was performed. The chi-square statistic was used for comparative analysis of the study results with available data from the literature. Results A conclusive tissue diagnosis could be achieved in 98%. Overall treatment morbidity was 3.1%. There was no mortality. Haemorrhage related morbidity was 0.9%. Age, Karnofsky score, mass effect of the tumour. tumour histology, tumour location and the number of specimens taken did not have any prognostic significance. The clinically silent bleeding rate was 9.6% and more often seen in patients with high grade gliomas (p = 0.03). Both the silent and non-silent bleeding rate were significantly lower as compared to available prospective data in the literature. (p < 0.01). Conclusion. Using multiplanar image guided trajectory planning. small biopsy forceps and intra-operative smear preparations the risk of major haemorrhage related morbidity after stereotactic brain tumour biopsy is extremely low (<1%) in experienced hands.
引用
收藏
页码:539 / 545
页数:7
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