Preoperative assessment of haemostasis in patients undergoing stereotactic brain biopsy. (July 2018)

• Record Type: Journal Article
• Authors: Beynon, Christopher; Wei, Shilai; Radbruch, Alexander; Capper, David; Unterberg, Andreas W.; Kiening, Karl L.
• Is Part Of: Journal of clinical neuroscience. Volume 53(2018)
• Page Start: 112
• Page End: 116
• Publication Date: 2018-07
• Subjects: Blood coagulation -- Brain neoplasms -- Hemostasis -- Image-guided biopsy -- Magnetic resonance imaging -- Preoperative care; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.04.035
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Intracranial haemorrhage is a feared risk in stereotactic biopsy. The value of preoperative assessment of haemostasis is unclear in these patients. 159 patients undergoing stereotactic biopsy at our institution were analysed. Preoperative values of haemostasis were not correlated with haemorrhage and morbidity. Abstract: Parenchymal hemorrhage is considered a major risk factor for perioperative morbidity in patients undergoing stereotactic brain biopsy. Studies on patients undergoing surgical procedures have suggested that evaluation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) is of limited value with regard to prevention of haemorrhagic complications. However, this issue has not yet been addressed in patients undergoing stereotactic biopsy of intracranial lesions. We retrospectively analysed the medical records of 159 consecutive patients undergoing stereotactic biopsy of supratentorial intracranial lesions during a three-year period. Laboratory values (PT, aPTT, platelet count) were reviewed as well as clinical characteristics, modalities of surgical treatment, histopathological results and the postoperative course of patients. The overall diagnostic yield was 93.7%. Histopathological examination revealed glioma (WHO°I: 5, WHO°II: 25, WHO°III: 23, WHO°IV: 65), lymphoma (n = 14), inflammation (n = 8) and other entities (n = 6). Surgery-associated neurological deficits occurred in 7 patients (4.4%) and completely resolved in 6 of these patients. CT-confirmed intracranial hemorrhage occurred in 2 patients (1.3%) and in both cases, histopathological examination revealed glioblastoma. Results of hemostatic parameters (PT: 99 ± 13%, aPTT: 24 ± 3s, platelet count: 274 ± 87 10 3 /μL) were within normal range values in all patients and did not correlate with postsurgical morbidity. Standard assessment of haemostasis seems to be of limited value in patients with intracranial lesions undergoing stereotactic biopsy. Further studies regarding the intratumoural vasculature's impact on the risk of biopsy-related bleeding are necessary.