Name of the Procedure:

Stereotactic Biopsy, Aspiration, or Excision (Including Burr Holes) for Intracranial Lesion

Summary

This procedure involves using a precise, computer-assisted technique called "stereotaxy" to take a tissue sample (biopsy), remove fluid (aspiration), or excise (surgically remove) an abnormal area, often a tumor, within the brain. A small hole, known as a burr hole, is drilled into the skull to allow access to the brain.

Purpose

Stereotactic biopsy, aspiration, or excision of an intracranial lesion is performed to diagnose, treat, or manage abnormalities within the brain such as tumors, abscesses, or cysts. The goal is to obtain tissue samples for diagnosis or to relieve symptoms by removing or reducing the lesion.

Indications

• Suspected brain tumors or cancers
• Unexplained neurological symptoms (e.g., seizures, headaches, changes in vision, or motor skills)
• Brain abscesses or cysts
• Known intracranial lesions requiring further evaluation or treatment

Preparation

• Fasting: Patients may need to fast for several hours before the procedure.
• Medication adjustments: Certain medications, especially blood thinners, may need to be stopped or adjusted.
• Pre-procedure testing: MRI or CT scans are generally required to locate the lesion and plan the procedure. Blood tests may also be necessary.

Procedure Description

1. The patient is made to lie on the operating table and given anesthesia, either general or local with sedation.
2. The head is secured in a frame to keep it still.
3. Using imaging (CT or MRI) and software, the precise target within the brain is identified.
4. A small hole (burr hole) is drilled into the skull at the predefined point.
5. A biopsy needle or surgical instrument is then inserted through the burr hole to the lesion's location.
6. The tissue sample is taken, fluid is aspirated, or the lesion is excised as necessary.
7. The burr hole is then covered, and the incision, if any, is closed.

Duration

The procedure typically lasts between 1 to 3 hours, depending on complexity.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Radiologist (for imaging support)

Risks and Complications

• Infection
• Bleeding or hemorrhage
• Brain swelling
• Neurological deficits (e.g., motor or sensory changes)
• Seizures
• Adverse reactions to anesthesia

Benefits

• Accurate diagnosis of intracranial lesions
• Potential relief from symptoms caused by the lesion
• Minimally invasive compared to open brain surgery
• Faster recovery time

Recovery

• Post-procedure monitoring in a recovery room or ICU.
• Pain management and medication for preventing infection.
• Follow-up appointments to discuss biopsy results and further treatment.
• Most patients can return to normal activities within a few days to a week, though this varies.

Alternatives

• Open brain biopsy or craniotomy: More invasive, longer recovery.
• Imaging alone (MRI/CT scans): Non-invasive but may not provide sufficient diagnostic information.
• Watchful waiting: Monitoring lesion growth without immediate intervention.

Patient Experience

During the procedure, patients under local anesthesia with sedation may feel pressure but should not feel pain; those under general anesthesia will be unconscious. Post-procedure, patients may experience mild pain or discomfort at the incision site, manageable with pain medication. Dizziness, nausea, or headaches might occur initially but typically resolve within a few days.