Name of the Procedure:

Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial lesion with computed tomography (CT) and/or magnetic resonance (MR) guidance

Summary

This is a minimally invasive surgical procedure used to obtain a tissue sample, remove fluid, or excise part of a lesion inside the brain. It utilizes precise imaging techniques such as CT or MR to guide the surgeon in accessing the lesion through a small opening in the skull, known as a burr hole.

Purpose

The procedure is designed to diagnose or treat intracranial lesions, which can include tumors, cysts, or abscesses. Its goals are to provide a definitive diagnosis through biopsy and/or to reduce the mass effect of a lesion through aspiration or excision.

Indications

• Unexplained neurological symptoms such as persistent headaches, seizures, or changes in mental status.
• Detection of abnormal lesions in brain imaging scans (CT or MR).
• Need for a tissue diagnosis to determine the nature of a brain lesion (benign or malignant).
• Therapeutic relief from symptoms caused by fluid-filled lesions or mass effects.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustment of current medications, especially blood thinners, as instructed by the healthcare provider.
• Pre-procedure imaging studies to identify the exact location of the lesion.
• Routine preoperative blood tests and physical examinations.

Procedure Description

1. Anesthesia: The patient is given general or local anesthesia, depending on the specifics of the case.
2. Imaging: Continuous CT or MR imaging is used for precise guidance.
3. Burr Hole: A small hole is drilled into the skull.
4. Insertion: A thin needle or probe is inserted through the burr hole to reach the lesion.
5. Biopsy/Aspiration/Excision: Depending on the intent, tissue samples are obtained, fluid is aspirated, or part of the lesion is excised.
6. Closure: The hole is closed, often with a small plate and screws, and the scalp is stitched up.

Duration

The procedure typically takes about 2-4 hours, including preparation and anesthesia.

Setting

It is performed in a hospital under sterile conditions, usually within a specialized operating room equipped with imaging technology.

Personnel

• Neurosurgeon
• Radiologist
• Anesthesiologist
• Surgical nurses
• Radiology technicians

Risks and Complications

Common risks include infection, bleeding, and swelling. Rare complications may include stroke, brain damage, or other neurological deficits. These are managed through careful monitoring and prompt intervention when necessary.

Benefits

• Accurate diagnosis of intracranial lesions.
• Relief of symptoms caused by mass effect or fluid accumulation.
• Minimally invasive compared to open brain surgery, leading to shorter recovery times.

Recovery

• Hospital stay ranging from 1-2 days.
• Post-procedure monitoring for neurological status.
• Pain management protocols.
• Recovery time varies; patients can usually resume normal activities within a few weeks, with restrictions on strenuous activities.
• Follow-up appointments for suture removal and monitoring.

Alternatives

• Open craniotomy, which is more invasive.
• Observation and repeat imaging, which may be suitable in non-urgent cases.
• Non-surgical options such as medication or radiotherapy, depending on the lesion type and symptoms.

Patient Experience

Patients may experience mild discomfort at the surgical site, which is managed with pain relief medications. Postoperative headaches are common but typically resolve within a few days. Neurological assessments and imaging follow-ups ensure a smooth recovery and monitor for any complications.