gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

Preoperative assessment of haemostasis in patients undergoing stereotactic brain biopsy

Meeting Abstract

Search Medline for

  • Christopher Beynon - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Shilai Wei - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Alexander Radbruch - Universitätsklinikum Heidelberg, Neuroradiologische Klinik, Heidelberg, Deutschland
  • David Capper - Universitätsklinikum Heidelberg, Neuropathologisches Institut, Heidelberg, Deutschland
  • Andreas Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Karl Kiening - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 049

doi: 10.3205/17dgnc612, urn:nbn:de:0183-17dgnc6121

Published: June 9, 2017

© 2017 Beynon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Parenchymal hemorrhage is considered the main risk of stereotactic brain biopsy. Impaired haemostasis may increase the risk of haemorrhage and therefore, appropriate measures should be undertaken to minimize this risk. The role of standard laboratory evaluation of haemostatic parameters is unclear and subject to intense debate. While results from series on patients undergoing surgical procedures have suggested that evaluation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) is of limited value in regard to prevention of haemorrhagic complications, this issue has not yet been addressed in patients undergoing stereotactic biopsy of intracranial lesions.

Methods: We retrospectively analysed the medical records of 189 consecutive patients undergoing stereotactic biopsy of supratentorial intracranial lesions during a three-year period (single-center/single-surgeon: senior author). Laboratory values (PT, aPTT), platelets) were reviewed as well as clinical characteristics, modalities of surgical treatment, histopathological results and the postoperative course of patients. Furthermore, laboratory values and their correlation with postoperative haemorrhage were analysed.

Results: The overall diagnostic yield was 92.5%. Histopathological examination revealed glioma (WHO°I: 5, WHO°II: 25, WHO°III: 23, WHO°IV: 65), lymphoma (n=14), inflammation (n=8) and other entities (n=7). Surgery-associated neurological deficits occurred in 7 patients (3.7%) and completely resolved in 6 of these patients. CT-confirmed intracranial hemorrhage occurred in 3 patients (1.9%) and in all cases, histopathological examination revealed glioblastoma. Results of hemostatic parameters (PT: 99±13%, aPTT: 24±3s, platelet count: 274±87 103/μL) were within normal range values and did not correlate with postsurgical morbidity.

Conclusion: Standard assessment of haemostasis seems to be of limited value in patients with intracranial lesions undergoing stereotactic biopsy. The intratumoural vasculature may have a major impact on biopsy-related risk of haemorrhage. Further studies on this issue are needed, but improvement of preoperative imaging may reduce surgical morbidity in stereotactic brain biopsy.