Postoperative management of patients after stereotactic biopsy: results of a survey of the AANS/CNS section on Tumors and a single institution study

• Published in: Journal of neuro-oncology Vol. 62; no. 3; pp. 289 - 296
• Main Authors: WARNICK, Ronald E, LONGMORE, Lynn M, PAUL, Christian A, BODE, Laurie A
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer 01.05.2003; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - therapy; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Female; Humans; Intensive care medicine; Intensive Care Units - statistics & numerical data; Male; Medical sciences; Middle Aged; Neurologic Examination; Patient Selection; Postoperative Care - methods; Practice Patterns, Physicians; Retrospective Studies; Stereotaxic Techniques - adverse effects; Surveys and Questionnaires; Tomography, X-Ray Computed; Treatment Outcome; Surgical biopsy; Human; Postoperative; computed tomography; Nervous system diseases; Intensive care; Radiodiagnosis; complications; Stereotaxia; Nervous system; postoperative care; Algorithm; Recommendation; Intensive care unit; Clinical management; Surgery; Professional practice; Medical imagery; Tumor; Computerized axial tomography; stereotactic biopsy; Monitoring
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1023/A:1023315206736

As little consensus exists on the postoperative care of patients undergoing stereotactic biopsy, we sought to establish a new algorithm for their postoperative management. First, we surveyed active members of the AANS/CNS Section on Tumors to determine national practice patterns for patients after stereotactic biopsy. Second, we retrospectively reviewed 84 consecutive stereotactic biopsy procedures at our institution to assess the potential benefit of routine computed tomography (CT) scanning and intensive care unit (ICU) monitoring. Finally, we prospectively applied this new algorithm in 54 patients to assess its validity. Of 629 surgeons, 263 (42%) responded; they were experienced neurosurgeons (mean 15 years in practice) who performed more than 10 stereotactic biopsies per year. Most surgeons (59%) routinely ordered postoperative CT scans, and the remainder ordered scans based on specific indications. Patients were transferred from the recovery room to a special care unit (47%), regular room (47%), or home (6%). In our retrospective review, 81 patients underwent 84 stereotactic biopsy procedures; 79 underwent postoperative CT scanning and all 81 were monitored overnight in the ICU. Among five (6%) patients who experienced intraoperative hemorrhage, two (2%) underwent craniotomy to control arterial bleeding. Three (4%) patients developed new neurological deficits, which occurred within 2 h of surgery. In both groups, CT scans were helpful in excluding hemorrhage that would require re-operation. In the remaining patients (90%), findings on routine postoperative CT did not alter patient management and ICU monitoring appeared unnecessary because neurological complications occurred within 2 h postoperatively. We confirmed these results in the prospective study of 54 patients undergoing stereotactic biopsy without routine postoperative CT scanning or ICU monitoring. In contrast with national practice patterns reported, we recommend that CT scanning and ICU monitoring be reserved for patients who have intraoperative hemorrhage or new deficits after surgery. All other patients can be monitored for 2 h in the recovery room and transferred to a regular hospital room without a postoperative CT scan.