Evaluation of 126 consecutive stereotactic procedures: Brain biopsy, diagnostic yield, accuracy, non-diagnostic results, complications and follow-up

Abstract

Aim: A retrospective analysis of 126 consecutive computed tomography (CT)-guided, frame-based stereotactic procedures in 121 patients is presented to evaluate the diagnostic yield, accuracy, complications, management of non-diagnostic cases and followup. Material and methods: The medical records of the identified patients were investigated retrospectively. Age, sex, surgical procedures, histopathological diagnosis, diagnostic yield, accuracy, complications, management of non-diagnostic cases and follow-up were analyzed in 121 consecutive patients. Stereotactic procedures were performed by the author by using Leksell's stereotactic system, and stereotactic biopsies were conducted under local anesthesia except for those patients who were not able to tolerate this treatment. These patients had control CT scans two hours after the operation. Results: Patient age ranged from 2 to 82 years (mean 48 years). Stereotactic biopsy was performed in 112 patients. Cyst and abscess aspiration, intracystic catheter replacement and tumor resection with stereotactic craniotomy were among the other procedures. The diagnostic yield was 93%, and the histological accuracy was 63% with no mortality. Craniotomy and hematoma evacuation were required in two cases. The patients were followed up from one month to 17 years. Conclusion: Frame-based stereotactic biopsy is a safe and efficacious method with acceptable complications. Experience is important, but not sufficient for preventing complications and performing procedures accurately. Necrosis and gliosis are the most common non-diagnostic findings. Empirical treatment with presumptive diagnoses based on clinical and radiological findings and close clinical follow-up may not affect patients adversely. The follow-up of patients through examination and imaging is important to allow the revision of treatment when necessary.