P27.22.B SEMISITTING POSITION VS. STANDARD SUPINE POSITION IN REDUCING INTRACEREBRAL BLEEDINGS DURING STEREOTACTIC BRAIN BIOPSY

Abstract

Abstract BACKGROUND Stereotactic brain biopsy (SBB) represents a minimally invasive procedure to acquire tissue samples for histological diagnosis. Despite SBB’s many benefits, there is a chance of hemorrhagic complications. The incidence of hemorrhagic complications following SBB is not well established, but studies suggest that it may be higher than previously thought. In semi-sitting position (30° elevation of the head), the intracranial pressure is lower than in supine position due to decreased venous congestion. In our hypothesis, intraoperative bleeding may be reduced by exploiting semi-sitting position, potentially leading to decreased surgical morbidity. MATERIAL AND METHODS We conducted a retrospective monocentric 2-arms cohort study at our institution (Istituto “C. Besta” in Milan, Italy). We reviewed all patients who underwent stereotactic brain biopsy from the 1st of March 2023 to the 1st of April 2024. The primary endpoint is to demonstrate the improved safety of the semi-sitting position, as assessed by the absence of intracranial bleeding on postoperative CT scans compared to standard supine position. RESULTS Our analysis covered 78 patients, with 39 undergoing biopsy in the semi-sitting position and the remaining 39 in supine positions. Out of those in the semi-sitting position, 5 exhibited a hemorrhagic spot along the catheter’s edge or within the lesion as revealed by CT scans. This contrasts with the 14 instances found among patients not in the semi-sitting position, indicating a statistically significant difference (p-value: 0.028). However, no other significant correlations were observed in CT findings, such as bleeding, when compared to age (p-value: 0.352), biopsy site (p-value: 0.355), number of samples (p-value: 0.141), or histology (p-value: 0.251). CONCLUSION This study can potentially shed light on an innovative approach for patient positioning in stereotactic brain biopsy. The observed decrease in intraoperative bleeding may decrease procedure-related risks and surgical morbidity. As a result, patient safety and outcomes can be improved.