OP10. DAY-CASE IMAGE-GUIDED BIOPSY FOR BRAIN TUMOURS: A DECADE OF EXPERIENCE
Authors: Ms Victoria Wykes
Journal: Neuro-Oncology (2017)

ABSTRACT: In the United Kingdom widespread adoption of day-case image-guided biopsy (DIB) for brain tumour has not occurred. To qualify for DIB patients are selected in the outpatient clinic and day-case is defined as arriving and being discharged from hospital on the same day. Discharge is allowed providing patients have no new neurology, are ambulant, have eaten, drunk passed urine, and have no significant pathology on their 4-hour postoperative CT head (CTH). Here we review a decade of experience within a single department. MATERIAL AND METHODS: Published protocols and procedures for DIB of brain tumours were used (1). All patients were under the care of a neurosurgeon with a specialist interest in neuro-oncology (JD & PLG). All Patients undergoing an image-guided biopsy for tumour were retrospectively identified from operative logbooks (October 2006 - March 2016 inclusive), and information recorded from online records or notes. RESULTS: In this 9.5 year study, 645 image-guided biopsies for tumour were performed of which 355 (55%) cases were planned DIB of a supratentorial tumour. Histological diagnosis included high grade glioma (62%), low grade glioma (18%), lymphoma (8%), metastasis (5%), meningioma (1%), primitive neuroectodermal tumour (1%), other (2%) and no diagnosis (3%). 92% of DIB patients were successfully discharged at 6 hours postoperatively. 16/355 (4.5%) of DIB patients were directly admitted following identification of a postoperative haematoma greater than 2 cm diameter on CTH. 9/16 had no associated new neurological deficit and were discharged the following day. 3/355 (0.8%) required surgical evacuation of the haematoma. 3/355 (0.8%) experienced a generalised tonic clonic seizure (GTCS) prior to discharge at 6 hours, one patient also had an associated drug reaction requiring a stay on intensive care (Duration Inpatient Stay (DIS): 2–11 median 2 days). 6/355 (2%) experienced a new mild focal neurological deficit, however were suitable for discharge home within 1–2 days, median 2. 8/355 (2%) patients were discharged home after 6 hours and later readmitted between 1–14 days post biopsy: 1 with imbalance and confusion (readmission day 1), 4 with GTCS (readmission day 1, 2, 8, 14), 1 with steroid induced psychosis (d5), 1 developed staphylococcus aureus wound infection requiring wound debridement in theatre (d8). 1 patient experienced serosanguinous wound leak and attended the ward for re-suturing. (DIS: range 0–3, median 1.5 days). DISCUSSION: DIB surgery with close clinical and radiological surveillance is well-tolerated, safe and feasible. 0.3% DIB were complicated by infection. 0% experienced significant permanent neurological deficit that influenced further oncological treatment. 0.8% of patients required further surgery due to postoperative haematoma however all made a full recovery. 3% of cases were non diagnostic on first biopsy. 1/355 CTH identified an asymptomatic extradural requiring evacuation that otherwise would have been discharged home at 6 hours post DIB. 0.8% of patients were readmitted within 48 hours of biopsy and none of our patients came to harm as a result of being a DIB. We advocate this concept is more widely adopted. Reference 1. Grundy P.L et al (2008) Br. J. Neurosurg (22) 360–367.