Outpatient stereotactic brain biopsies.

Bertrand Mathon,Vincent Degos,Alexandre Carpentier,Pauline Marijon,Maximilien Riche,The Psl Brain-Biopsy Study Group

doi:10.1007/s10143-021-01593-3

Abstract

Outpatient neurosurgery is rising popularity leading to patients’ satisfaction and cost-savings. Although several North-American teams have shown the safety of outpatient stereotactic brain biopsies, few data from other countries with different health care systems are available. We therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. We prospectively examined all the consecutive stereotactic brain biopsies performed in an outpatient setting at our tertiary medical center, between June 2018 and September 2020. Among the 437 patients who underwent stereotactic brain biopsy during the study period, 40 (9.2%) patients were enrolled for an outpatient management. The sex ratio was 1 and the median age on biopsy day was 55 [41–66] years. The median distance from patients’ home to hospital was 17 km [3–47]. 95% of patients had pre-biopsy ASA score of 1 or 2 and mRs equal to 2 or less. The rate of same-day discharge was 100%. No patient experienced post-biopsy symptomatic complication necessitating readmission within the month following the biopsy. One patient (2.5%) resorted to an unplanned consultation. Histological findings obtained from brain biopsy led to a diagnosis in all patients; the most frequently found were neoplastic lesions (77.5%). Stereotactic brain biopsies can therefore be safely achieved on an outpatient setting in carefully selected patients. This process could be more widely adopted in other neurosurgical centers, without affecting the quality of patient’s health care and safety. In this article, we propose management guidelines and pre-biopsy checklist for performing ambulatory stereotactic brain biopsies.

Highlights

Given improved perioperative care and reduced intervention invasiveness as well as increasing budget constraints on health care systems, there is a trend towards shorter hospital stays in all surgical subspecialities
The exclusion criteria for ambulatory stereotactic brain biopsy were (i) whether the patient has refused an outpatient management, (ii) whether the patient was over 80 years, (iii) whether the patient had medical comorbidity necessitating more than 4 h of postoperative observation, (iv) whether the patient was living no more than 1 h away from the hospital, and (v) whether the patient was already an inpatient because of a poor neurological status
Several retrospective studies showed that all the neurological complications were observed within 6 h after the biopsy [13, 17, 37], while for some other authors, symptomatic complication may appear with a delay when related to brain edema or seizure [10, 16]

Summary

Introduction

Given improved perioperative care and reduced intervention invasiveness as well as increasing budget constraints on health care systems, there is a trend towards shorter hospital stays in all surgical subspecialities As minimally invasive and time-efficient procedures, stereotactic brain biopsies were some of the first cranial neurosurgical operations to be achieved on an ambulatory basis. They are commonly performed interventions, displaying a favorable safety profile, and the frequency and timing of their complications are well-known [12, 14, 15, 20, 30].

Methods

Results

Discussion

Conclusion