Stereotactic Brain Biopsy Hemorrhage Risk Factors and Implications for Post-Operative Care at a Single Institution: An Argument For Post Operative Imaging.

Abstract Objective To determine pre-operative factors contributing to post-operative hemorrhage after stereotactic biopsy (STB), clinical implications of post-operative hemorrhage, and the role of post-operative imaging in clinical management. Methods Retrospective review of STB (2005-2018) across 2 institutions including patients >18 years undergoing first STB. Patients with prior craniotomy, open biopsy or prior STB were excluded. Pre-operative variables included age, gender, neurosurgeon seniority, STB method. Post-operative variables included pathology, post-operative hemorrhage on CT, immediate and 30-day post-operative seizure, infection, post-operative hospital stay duration, 30-day return to OR. Analysis used Fisher’s exact tests for categorical variables. Results Overall, 410 patients were included. Average age was 56.5 (±16.5) years; 60% (n=248) were male. The majority of biopsies were performed by senior neurosurgeons (66%, n=270); frontal lobe (42%, n=182) and glioblastoma (45%, n=186) were the most common location and pathology. Post-operative hemorrhage occurred in 28% (114) of patients with 20% 0.05 cm3. Post-operative hemorrhage of any size was associated with increased rate of post-operative deficit within both 24 hours and 30 days, post-operative seizure, and length of hospital stay when controlling for pathology. Hemorrhages >0.05cm3 had a 16% higher rate of return to the OR for evacuation, due to clinical deterioration as opposed to radiographic progression. Conclusion Post biopsy hemorrhage was associated with higher risk of immediate and delayed post-operative deficit and seizure. Post-operative CT should be used to determine whether STB patients can be discharged same day or admitted for observation; clinical evaluation should determine return to OR for evacuation.