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World Neurosurg. 2015 Oct;84(4):1084-9. doi: 10.1016/j.wneu.2015.05.025. Epub 2015 May 22.

Complications Following Stereotactic Needle Biopsy of Intracranial Tumors.

Author information

1
Department of Neurological Surgery, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
2
Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
3
Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
4
Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Obstetrics & Gynecology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA.
5
Department of Epidemiology, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Medicine, College of Physicians & Surgeons and the Mailman School of Public Health, Columbia University, New York, New York, USA. Electronic address: ain1@cumc.columbia.edu.

Abstract

BACKGROUND:

Data from single-institution studies suggest that perioperative complication rates after stereotactic needle brain biopsies range from 6% to 12%, with permanent morbidity and mortality ranging from 3.1% to 6.4% and 0% to 1.7%, respectively. However, no population-level data are available. We conducted a population-based analysis to study complications after needle brain biopsy.

METHODS:

We analyzed patients recorded in the Nationwide Inpatient Sample who underwent stereotactic needle brain biopsy for neoplastic lesions between 2006 and 2012. A multivariate logistic model was used to identify factors associated with complications.

RESULTS:

We identified 7514 patients who underwent biopsy for various intracranial pathologies, including primary malignant neoplasm (52.3%), unspecified neoplasm (17.9%), metastasis (9.7%), meningioma (1.5%), radiation necrosis (0.8%), lymphoma (0.5%), and pineal region neoplasm (0.3%). Intracranial hemorrhage was the most frequent complication (5.8%). Other complications, including operative infection (0.1%) and wound breakdown (0.2%), were rare. Multivariate logistic regression analysis revealed that hemorrhage is associated with older age (reference <40 years; 40-59 years, odds ratio [OR] 2.26, 95% confidence interval [CI] 1.51-3.38; ≥60 years, OR 1.90, 95% CI 1.22-2.97), hydrocephalus (OR 3.02, 95% CI 2.20-4.14), and cerebral edema (OR 2.16, 95% CI 1.72-2.72). Hemorrhage is less likely when taking a biopsy from a primary malignant neoplasm (OR 0.73, 95% CI 0.59-0.90). Overall inpatient mortality after biopsy was 2.8%. Patients with intracranial hemorrhage were significantly more likely than patients without hemorrhage to die in the hospital (12.8% vs. 2.2%, P < 0.001) or be discharged to a rehabilitation/nursing facility (45.2% vs. 23.1%, P < 0.001).

CONCLUSIONS:

Intracranial hemorrhage is the most frequent complication associated with needle brain biopsy and is associated with inpatient mortality and hospital disposition. Other complications are rare.

KEYWORDS:

Brain biopsy; Complications; Intracranial hemorrhage; Intracranial tumors; Stereotactic needle biopsy

Comment in

PMID:
26008141
DOI:
10.1016/j.wneu.2015.05.025
[Indexed for MEDLINE]

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