Mathon Bertrand, Lavé Alexandre, Kerhuel Lionel, Bernstein Mark, Degos Vincent, Jacquens Alice, Carpentier Alexandre
Department of Neurosurgery, APHP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, F-75013, France.
Paris Brain Institute, ICM, INSERM U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, INSERM U 1127UMRS 1127, Paris, F-75013, France.
Neurosurg Rev. 2025 May 21;48(1):431. doi: 10.1007/s10143-025-03584-0.
Stereotactic brain biopsy is a fundamental procedure in neurosurgery that enables the histomolecular diagnosis of brain tumors and cryptogenic neurological diseases. Traditionally, this procedure requires hospitalization because of potential complications, particularly hemorrhagic events. However, the increasing emphasis on ambulatory surgery and its medico-economic benefits have led to the exploration of outpatient stereotactic brain biopsies. This study aimed to evaluate the safety and feasibility of outpatient stereotactic brain biopsy in a large, real-world patient cohort. This retrospective study analyzed all adult patients who underwent stereotactic brain biopsy at our institution between November 2021 and October 2024. We compared the outpatient and inpatient groups based on demographics, clinical and radiological data, biopsy characteristics, and post-procedure outcomes. The primary endpoints were the rate of unplanned hospitalization following biopsy (failure of outpatient management), biopsy-related complications, and unplanned medical consultations or admissions within 30 days after biopsy. Statistical analyses included univariate and multivariate models to assess factors influencing outpatient eligibility and outcomes. Among the 565 patients who underwent stereotactic brain biopsy, 191 (33.8%) were managed as outpatients. The same-day discharge success rate was 95.8%. Post-biopsy complications were comparable between the outpatient and inpatient groups (p = 0.97), with only one outpatient requiring unplanned hospitalization within 30 days (0.5%). Multivariate analysis identified factors favoring outpatient management, including low ASA scores, high Karnofsky Performance Status, shorter travel distances, and diagnoses of lower-grade gliomas. Patients aged ≥ 75 years and those with high-risk biopsy locations (e.g., brainstem) were successfully managed in an outpatient setting. Outpatient stereotactic brain biopsy is a safe and feasible approach for carefully selected patients, with high success rates and no increase in complication risks compared with inpatient management. This study supports expanding outpatient stereotactic brain biopsy as a standard practice, improving healthcare efficiency while maintaining patient safety.
立体定向脑活检是神经外科的一项基本操作，可实现对脑肿瘤和不明原因神经系统疾病的组织分子诊断。传统上，由于存在潜在并发症，尤其是出血事件，该操作需要住院治疗。然而，对门诊手术及其医疗经济效益的日益重视促使人们探索门诊立体定向脑活检。本研究旨在评估在一个大型真实世界患者队列中进行门诊立体定向脑活检的安全性和可行性。这项回顾性研究分析了2021年11月至2024年10月期间在我们机构接受立体定向脑活检的所有成年患者。我们根据人口统计学、临床和放射学数据、活检特征以及术后结果对门诊组和住院组进行了比较。主要终点是活检后计划外住院率（门诊管理失败）、活检相关并发症以及活检后30天内计划外医疗咨询或住院情况。统计分析包括单变量和多变量模型，以评估影响门诊资格和结果的因素。在565例接受立体定向脑活检的患者中，191例（33.8%）作为门诊患者进行管理。当日出院成功率为95.8%。门诊组和住院组活检后并发症相当（p = 0.97），只有1例门诊患者在30天内需要计划外住院（0.5%）。多变量分析确定了有利于门诊管理的因素，包括低ASA评分、高卡诺夫斯基功能状态、较短的出行距离以及低级别胶质瘤的诊断。年龄≥75岁的患者和活检部位高危（如脑干）的患者在门诊环境中也成功进行了管理。对于精心挑选的患者，门诊立体定向脑活检是一种安全可行的方法，成功率高，与住院管理相比并发症风险没有增加。本研究支持将门诊立体定向脑活检作为一种标准做法加以推广，在保持患者安全的同时提高医疗效率。
