PATIENT GUIDE TO STEREOTACTIC BRAIN BIOPSIES
IS A STEREOTACTIC BRAIN BIOPSY?
A stereotactic brain biopsy is a surgical procedure. Its purpose
is to obtain a small specimen from a specific part of the brain
so we can tell you what condition you have. If the concern is that
you may have a growth, the biopsy is intended to determine if it
is a benign or aggressive tumor, and if it started in the brain
or spread there from another part of the body. This in turn determines
what treatment would be appropriate for it.
FOR THE BIOPSY
You should eat nothing after midnight on the evening
before the procedure. Otherwise, there is no special preparation.
You come into the admitting area of the hospital early on the
day of the biopsy. You will fill out some paperwork, and then be
transported to either the MRI or CT scan area. An intravenous line
will be started. Then a metal frame called a "Leksell head
frame" or "BRW frame" is attached to you by Dr. Saris.
frame is difficult to describe. It is a metal device (see picture)
that weighs about three pounds that you can see through. It attaches
to the head with posts that are advanced through the frame to put
pressure on the scalp and head. Two posts are in the front (in the
forehead), and two are in the back of the head. You have this frame
on for several hours, and any discomfort from the posts will be
relieved with Novocaine.
A CT scan or MRI scan is then obtained. This takes about 30 minutes.
You will then be transported to the operating room while I analyze
the scan and make calculations as to how the biopsy will be taken.
In the operating room, you will lie on the operating table, and
the frame will be secured to it. An area about the size of a postage
stamp is shaved and cleansed with soap solution to prevent infection.
After these preparations,
the biopsy itself begins. We numb a small area of the skin with
Novocaine. A small nick is made in the scalp, and using a very small
drill, a hole about the diameter of a piece of spaghetti is made
in the skull. A biopsy probe is advanced through this to a pre-determined
spot in the brain. We take a small specimen about the size of the
kernel of rice. This is immediately processed and looked at under
the microscope by the pathologist. This takes about 10 minutes.
The pathologist will
tell us one of three things: (1) they know immediately what the
diagnosis is, (2) they will almost certainly know in a few days
what the diagnosis is, (3) they would like us to obtain more biopsies.
The usually tell us (2).
If the pathologist tells
us we need to take more biopsies, we will do so. Otherwise, the
procedure is over. The biopsy probe is removed, and a single stitch
is placed in the skin that will dissolve on its own. The frame is
removed and you return to your room. From the time you enter the
operating room to the time you leave is usually 45 minutes. You
are awake during that time, but are medicated by a member of the
Anesthesiology Department to eliminate any discomfort.
AFTER THE BIOPSY
On returning to your room, you should feel largely back to normal.
Some people have a mild to moderate headache on the evening of the
The nurses will watch
you for several hours. If all is well, we will obtain a CT scan
to determine if there has been any internal bleeding or new swelling
at the biopsy site. If all seems well, you are free to leave at
your convenience either that same day or the next morning. We will
arrange a time to review the biopsy results.
RISKS OF OUTPATIENT
SURGERY: During my years of surgical training in the 1980s,
the standard of care was to remain in the hospital for several days
after this operation. However, as anesthesia has improved, and as
the operation has become less invasive, many surgeons have begun
performing this as an outpatient. We have sent patients home shortly
after these procedures many times without a single mishap at home
on the night of the surgery. However, like any medical decision,
there are benefits and risks.
The benefit is the simple advantage of being in your own
home and bed to recover from the operation. Any painkiller you might
receive via an intravenous in the hospital, you can take as easily
by mouth at home. We have become increasingly concerned about hospital-acquired
infections. There is a particularly dangerous strain called "MERSA"
that is resistant to many of our best antibiotics and is potentially
fatal. The sooner you go home, the less you are exposed to these
kinds of problems. The main risk is a one percent risk of
internal bleeding or swelling after the operation. In the brain
this could cause either a seizure or stroke, and either can cause
death. If the CAT scan performed after the surgery shows nothing
worrisome, we have not had any problems since we have been treating
patients in this manner
It is ultimately your decision as to whether to remain in the hospital
or return home after your surgery.
REMOVING THE STITCH
You can shower and wash your hair as you normally would the
day of the biopsy. The stitch will dissolve over about 2 weeks and
does not need to be removed.
Stephen Saris M.D.