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. 2019 Apr:124:e169-e175.
doi: 10.1016/j.wneu.2018.12.058. Epub 2018 Dec 24.

Biopsy During Minimally Invasive Intracerebral Hemorrhage Clot Evacuation

Adam C Lieber  1 , Ian T McNeill  1 , Jacopo Scaggiante  1 , Dominic A Nistal  1 , Mary Fowkes  2 , Melissa Umphlett  2 , Jonathan Pan  1 , Panos Roussos  3 , Charles V Mobbs  4 , J Mocco  1 , Christopher P Kellner  5
Affiliations

Biopsy During Minimally Invasive Intracerebral Hemorrhage Clot Evacuation

Adam C Lieber et al. World Neurosurg. 2019 Apr.

Abstract

Background: The safety and efficacy of brain parenchyma biopsy during minimally invasive (MIS) intracerebral hemorrhage (ICH) clot evacuation has not been previously reported. The objective of this study was to establish the safety and diagnostic efficacy of brain biopsy during MIS ICH clot evacuation and to validate the modified Boston criteria as a predictor of cerebral amyloid angiopathy (CAA) in this cohort.

Methods: From October 2016 to March 2018, superficial and perihematomal biopsies were collected for 40 patients undergoing MIS ICH clot evacuation and analyzed by the pathology department to assess for various ICH etiologies. Additionally, the admission magnetic resonance imaging or computed tomography scan of each patient was analyzed and evaluated for the likelihood of a CAA etiology based on the modified Boston criteria. Student t test was used to analyze intergroup differences in continuous variables, and a 2-tailed Fisher exact test was used to determine intergroup differences of categorical variables, with significance set at P < 0.05.

Results: Two of the 40 patients (5%) experienced postoperative rebleed. Four of the 40 patients (10%) had evidence of CAA on biopsy. Patients with CAA on biopsy were older (P = 0.005) and had a higher prevalence of parietal lobe (P = 0.02) and occipital lobe (P = 0.001) hemorrhage. The modified Boston criteria had a sensitivity of 100% (95% confidence interval [CI], 39.6%-100%) and a specificity of 72.2% (95% CI, 54.6%-84.2%) for predicting CAA on biopsy.

Conclusions: Brain biopsy in MIS ICH clot evacuation is safe and allows for the diagnosis of various ICH etiologies.

Keywords: Biopsies; Cerebral amyloid angiopathy; Intracerebral hemorrhage; Minimally invasive surgery.

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Conflict of interest statement

Conflict of interest statement: This research was supported in part by a grant from Arminio and Lucyna Fraga and by a grant from Mr. and Mrs. Durkovic.

Figures

Figure 1.
Figure 1.
Schematic of the burr hole procedure (A), the incision of the dura (B), and the collection of a superficial biopsy at the gray/white matter junction (C). (Created by Amy Zhong at the Mount Sinai Hospital and reproduced with permission.)
Figure 2.
Figure 2.
Photograph of a superficial biopsy collected for analysis during a minimally invasive stereotactic intracerebral hemorrhage underwater blood aspiration procedure.
Figure 3.
Figure 3.
Collection of a deeper, perihematomal biopsy with the neuroendoscope in place. (Created by Amy Zhong at the Mount Sinai Hospital and reproduced with permission.)
Figure 4.
Figure 4.
Perihematomal biopsy location is marked on the stereotactic guidance system (green dot), after which the sheath passage is continued along the trajectory line into the hematoma.
Figure 5.
Figure 5.
Congo red stain with apple-green birefringence (original magnification ×40).
Figure 6.
Figure 6.
Beta-amyloid immunohistochemical staining (original magnification ×20).
See this image and copyright information in PMC

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