Severity, timeline, and management of complications after stereotactic brain biopsy.

Autor:	Riche M; Departments of1Neurosurgery.; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM., Marijon P; Departments of1Neurosurgery.; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM., Amelot A; Departments of1Neurosurgery., Bielle F; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.; 3Neuropathology., Mokhtari K; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.; 3Neuropathology., Chambrun MP; 4Internal Medicine 2.; 5Intensive Care Medicine.; 6INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition., Joncour AL; 7Internal Medicine and Clinical Immunology., Idbaih A; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.; 8Neurology Mazarin., Touat M; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.; 8Neurology Mazarin., Do CH; 9Anesthesia, Critical Care, and Perioperative Medicine, and., Deme M; 9Anesthesia, Critical Care, and Perioperative Medicine, and., Pasqualotto R; 9Anesthesia, Critical Care, and Perioperative Medicine, and., Jacquens A; 9Anesthesia, Critical Care, and Perioperative Medicine, and., Degos V; 9Anesthesia, Critical Care, and Perioperative Medicine, and.; 10Clinical Research Group ARPE, Sorbonne University.; 11INSERM UMR 1141, PROTECT, Paris, France., Shotar E; 12Neuroradiology, APHP, Sorbonne University, La Pitié-Salpêtrière Hospital., Chougar L; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.; 12Neuroradiology, APHP, Sorbonne University, La Pitié-Salpêtrière Hospital., Carpentier A; Departments of1Neurosurgery.; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM., Mathon B; Departments of1Neurosurgery.; 2INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMR S 1127, Paris Brain Institute, ICM.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2021 Sep 10; Vol. 136 (3), pp. 867-876. Date of Electronic Publication: 2021 Sep 10 (Print Publication: 2022).
DOI:	10.3171/2021.3.JNS21134
Abstrakt:	Objective: The literature shows discrepancies in stereotactic brain biopsy complication rates, severities, and outcomes. Little is known about the timeline of postbiopsy complications. This study aimed to analyze 1) complications following brain biopsies, using a graded severity scale, and 2) a timeline of complication occurrence. The secondary objectives were to determine factors associated with an increased risk of complications and to assess complication-related management and extra costs. Methods: The authors retrospectively examined 1500 consecutive stereotactic brain biopsies performed in adult patients at their tertiary medical center between April 2009 and April 2019. Results: Three hundred eighty-one biopsies (25.4%) were followed by a complication, including 88.2% of asymptomatic hemorrhages. Symptomatic complications involved 3.0% of the biopsies, and 0.8% of the biopsies were fatal. The severity grading scale had a 97.6% interobserver reproducibility. Twenty-three (51.1%) of the 45 symptomatic complications occurred within the 1st hour following the biopsy, while 75.6% occurred within the first 6 hours. Age ≥ 65 years, second biopsy procedures, gadolinium-enhanced lesions, glioblastomas, and lymphomas were predictors of biopsy-related complications. Brainstem biopsy-targeted lesions and cerebral toxoplasmosis were predictive of mortality. Asymptomatic hemorrhage was associated with delayed (> 6 hours) symptomatic complications. Symptomatic complications led to extended hospitalization in 86.7% of patients. The average extra cost for management of a patient with postbiopsy symptomatic complication was $35,702. Conclusions: Symptomatic complications from brain biopsies are infrequent but associated with substantial adverse effects and cost implications for the healthcare system. The use of a severity grading scale, as the authors propose in this article, helps to classify complications according to the therapeutic consequences and the patient's outcome. Because this study indicates that most complications occur within the first few hours following the biopsy, postbiopsy monitoring can be tailored accordingly. The authors therefore recommend systematic monitoring for 2 hours in the recovery unit and a CT scan 2 hours after the end of the biopsy procedure. In addition, they propose a modern algorithm for optimal postoperative management of patients undergoing stereotactic biopsy.
Databáze:	MEDLINE
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