Complications of CT-guided stereotactic biopsy of intra-axial brain lesions

A series of 300 consecutive stereotactic biopsies for intra-axial brain lesions performed by one neurosurgeon was critically analyzed regarding complications of the procedure. Complications were incurred by a total of 19 patients (6.3%). Five patients (1.7%) died following the procedure, all due to intracranial hypertension: one from subarachnoid hemorrhage, one from intracerebral hemorrhage, and three from increased edema without hemorrhage. The three patients who died without hemorrhage all had marked intracranial hypertension at the time of biopsy. All five patients who died harbored a glioblastoma multiforme. The surviving 14 patients (4.7%) with complications suffered increased neurological deficit due to hemorrhage. In 10 (3.3%), the deficit was mild and/or transient; in the other four (1.3%), a major deficit was incurred which markedly affected the remainder of the patient's life. Therefore, mortality or major morbidity was seen in 3.0% of patients and minor morbidity in 3.3%. Stereotactic biopsy is a very effective procedure with a complication rate significantly lower than that of craniotomy (particularly in the population of patients selected for stereotactic biopsy), but in a small number of patients the outcome is devastating.