PATIENT GUIDE TO STEREOTACTIC BRAIN BIOPSIES

WHAT 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.

PREPARATION FOR THE BIOPSY
You should eat nothing after midnight on the evening before the procedure. Otherwise, there is no special preparation.

THE BIOPSY
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.

The frame is difficult to describe. It is a metal device (see picture) that weighs about three pounds that you can easily 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 20 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 procedure.

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 that same day. 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 your option to remain in the hospital or return home after your surgery. I recommend returning home, and waiting until at least 11pm before going to sleep. If there are any problems, call an ambulance or come immediately to the emergency room. If you are more comfortable remaining in the hospital overnight, let our staff know and we will arrange this for you.

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.

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Stephen Saris M.D.

Neurosurgery Associates, Inc.
3 Davol Square, Suite B200
Providence, Rhode Island 02903

(401) 453-3545
FAX (401) 453-3533

email: questions@neurosurgery-associates.com

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