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Observational Study
. 2020 Feb;99(8):e18572.
doi: 10.1097/MD.0000000000018572.

Complications of stereotactic biopsy of lesions in the sellar region, pineal gland, and brainstem: A retrospective, single-center study

Gang Cheng  1 , Xin Yu, Hulin Zhao, Weidong Cao, Hailong Li, Qinggang Li, Zhicaho Li, Feng Yin, Rui Liu, Jianning Zhang
Affiliations
Observational Study

Complications of stereotactic biopsy of lesions in the sellar region, pineal gland, and brainstem: A retrospective, single-center study

Gang Cheng et al. Medicine (Baltimore). 2020 Feb.

Abstract

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline.To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem.This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed.A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing.STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Planning the approach for stereotactic biopsy of a lesion in the sellar region. Generally, drilling was carried out 3 cm from the sagittal suture and in front of the coronal suture.
Figure 2
Figure 2
Planning the approach for stereotactic biopsy of a lesion in the pineal region. Generally, drilling was performed at the parietal lobe.
Figure 3
Figure 3
Planning the approach for stereotactic biopsy of a lesion in the midbrain. Generally, a transfrontal approach was used with the patient supine. The hole was drilled 1 to 2 cm behind the coronal suture and 3 cm from the midline to ensure that the approach was parallel to the longitudinal axis of the brainstem.
Figure 4
Figure 4
Planning the approach for stereotactic biopsy of a lesion in the pons or medulla. Generally, a transcerebellar posterior cranial fossa approach was used with the patient in a seated position. The hole was drilled 3 to 5 cm below the external occipital protuberance and 5 cm from the midline.
Figure 5
Figure 5
Preoperative MRI of a patient with glioblastoma showing evidence of hemorrhagic necrosis within the lesion. This patient died during biopsy due to bleeding in the surgical area.
See this image and copyright information in PMC

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