General anesthesia versus local anesthesia in stereotactic biopsies of brain lesions – a prospective randomized study

• Published in: World neurosurgery Vol. 97; pp. 16 - 20
• Main Authors: Quick-Weller, Johanna, Konczalla, Juergen, Duetzmann, Stephan, Franz-Jaeger, Claudia, Strouhal, Ulrich, Brawanski, Nina, Setzer, Matthias, Lescher, Stephanie, Seifert, Volker, Marquardt, Gerhard, Weise, Lutz M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia, General - methods; Anesthesia, Local - methods; Biopsy - methods; Brain Injuries - complications; Brain Injuries - diagnosis; Female; General anesthesia; Humans; Local anesthesia; Male; Middle Aged; Neurosurgery; PTSS questionnaire; Retrospective Studies; Stereotactic biopsy; Stereotaxic Techniques; Stress level; Surveys and Questionnaires; Tomography Scanners, X-Ray Computed; RR; PTSS; Stereotactic Biopsy; OR; Local Anesthesia; MRI; Operating Room; Glioblastoma; blood pressure according to Riva Rocci; Post Traumatic Stress Score; CT; GBM; Magnetic resonance imaging; LA; STX; GA; Computed Tomography; General Anesthesia; Stress level; Local anesthesia; General anesthesia; Stereotactic biopsy; PTSS questionnaire; WHO
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.09.064

Abstract Background Stereotactic biopsies (STX) of brain lesions with unknown entities, is a common neurosurgical procedure to obtain tumor tissue. Pathologist can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy or chemotherapy can be based on. It is widely known that these procedures can be performed under local or general anesthesia. In this prospective study we aim to show whether stress levels are higher for patients who underwent stereotactic biopsy under local or general anesthesia. Methods Between January 2013 and December 2014 we screened 157 patients. Of these, 43 were included and evaluated in this study. 21 patients gave their written consent, so they were randomized for either local or general anesthesia. PTSS- questionnaire was filled out by the patients preoperatively and postoperatively. Also patients who did not agree in randomization, had the possibility to fill out the PTSS questionnaire. 22 patients agreed in only filling out the stress level questionnaire, but refused randomization. These patients were evaluated as a subgroup. Scores achieved in the PTSS were compared by using Fisher’s exact test. Results Among the randomized patients, 9 underwent the procedure under local anesthesia and 12 under general anesthesia. Median PTSS was 24 preoperatively in the patients who received local anesthesia vs 20 among the patients with general anesthesia (p 0.37, Fishers exact test). Postoperatively PTSS was 29.5 in median for patients with local anesthesia vs 23 for patients with general anesthesia (p 0.30, Fishers exact test). Postoperatively, the PTSS showed a median increase of 5.5 points in the LA and 3 points in the GA group (p =0.87, fisher’s exact test). P-values of 0.05 and below were considered statistically significant. Conclusion The willingness of patients to undergo randomization in this setting was very low (13.3%). Within this highly selective group of patients there was no significant difference for stress levels in patients who underwent STX under local anesthesia vs general anesthesia. However, median values indicate a trend for higher stress-level values for patients with local anesthesia.