Safety and efficacy of brain biopsy: Results from a single institution retrospective cohort study

Felix Jozsa; Celia Gaier; Yangxinrui Ma; Neil Kitchen; Andrew McEvoy; Anna Miserocchi; George Samandouras; Huma Sethi; Lewis Thorne; Ciaran Hill; Lucia Darie

Brain and Spine (Jan 2023)

Safety and efficacy of brain biopsy: Results from a single institution retrospective cohort study

Felix Jozsa,
Celia Gaier,
Yangxinrui Ma,
Neil Kitchen,
Andrew McEvoy,
Anna Miserocchi,
George Samandouras,
Huma Sethi,
Lewis Thorne,
Ciaran Hill,
Lucia Darie

Affiliations

Felix Jozsa: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Celia Gaier: University College London Medical School, London, UK
Yangxinrui Ma: University College London Medical School, London, UK
Neil Kitchen: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Andrew McEvoy: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Anna Miserocchi: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
George Samandouras: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Huma Sethi: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Lewis Thorne: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Ciaran Hill: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK; UCL Cancer Institute, University College London, 72 Huntley Street, London, UK
Lucia Darie: Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK; Corresponding author. Victor Horsley Department of Neurosurgery, The National Hospital of Neurology and Neurosurgery, University College London Hospitals NHS Trust, Queen Square, London, WC1N 3BG, UK.

Journal volume & issue: Vol. 3
p. 101763

Abstract

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Introduction: Brain biopsy provides important histopathological diagnostic information for patients with new intracranial lesions. Although a minimally invasive technique, previous studies report an associated morbidity and mortality between 0.6% and 6.8%. We sought to characterise the risk linked to this procedure, and to establish the feasibility of instigating a day-case brain biopsy pathway at our institution. Materials and methods: This single-centre retrospective case series study included neuronavigation guided mini craniotomy and frameless stereotactic brain biopsies carried out between April 2019 and December 2021. Exclusion criteria were interventions performed for non-neoplastic lesions. Demographic data, clinical and radiological presentation, type of biopsy, histology and complications in the post-operative period were recorded. Results: Data from 196 patients with a mean age of 58.7 years (SD+/-14.4 years) was analysed. 79% (n=155) were frameless stereotactic biopsies and 21% (n=41) neuronavigation guided mini craniotomy biopsies. Complications resulting in acute intracerebral haemorrhage and death, or new persistent neurological deficits were observed in 2% of patients (n=4; 2 frameless stereotactic; 2 open). Less severe complications or transient symptoms were noted in 2.5% of cases (n=5). 8 patients had minor haemorrhages in the biopsy tract with no clinical ramifications. Biopsy was non-diagnostic in 2.5% (n=5) of cases. Two cases were subsequently identified as lymphoma. Other reasons included insufficient sampling, necrotic tissue, and target error. Discussion and conclusion: This study demonstrates that brain biopsy is a procedure with an acceptably low rate of severe complications and mortality, in line with previously published literature. This supports the development of day-case pathway allowing improved patient flow, reducing the risk of iatrogenic complications associated with hospital stay, such as infection and thrombosis.

Published in Brain and Spine

ISSN: 2772-5294 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: https://www.journals.elsevier.com/brain-and-spine

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