FramedStereotacticBrainBiopsy

Frame placement
The patient should have adequate intravenous sedation but remain alert
enough to participate and maintain an upright seated posture, which
greatly facilitates frame placement. If sedation is performed without
monitored anesthesia care, then pulse oximetry and oxygen delivered
by nasal cannula should be used. The authors do not routinely perform
any head shave for frame placement, although this is preferred by some
surgeons. An approximate entry point should be anticipated to avoid
placement of a pin-site or frame post too close to the desired incision.
The frame should be assembled without pins in place, and placed on
the patients head in the approximate position. The posts can be rotated
into a position that optimizes fixation by avoiding excessively medial or
lateral location. The pins should be located at or below the greatest
circumference of the calvaria. This aids with fixation and places the
localizing carbon fiber rods appropriately. Ensuring that the frame is not
positioned too close to the bridge of the nose is also important.
The anticipated pin sites can then be wiped with an alcohol or Betadine
wipe and injected with local anesthetic. The pins are then placed in the
frame posts, with attention to use the appropriate length pins. With the
CRW frame, generally the shorter pair of pins are placed in the posterior
posts, while the longer pair of pins are placed in the anterior posts.
Antibiotic ointment is applied to the pins, and the pins are advanced
through the posts to each be flush with the skin surface.
The authors generally prefer to secure one anterior pin and a
contralateral posterior pin first, which then allows the frame to be
balanced relative to the horizon as desired. Once in satisfactory
position, the remaining 2 pins are advanced until each is rigidly secured.
As the pins are advanced, giving more local anesthetic as needed may
be necessary. Ensuring that the posts exert no pressure on the scalp is
important while advancing the pins. Placing 1 or 2 radio-opaque fiducial
markers on the scalp near the planned incision can be useful. This can
help tailor the incision, and, before the sterile stereotactic frame is
attached to the base, it can help with approximating the skin incision
and a smaller area of hair can be shaved if desired.
Trajectory planning
With the frame satisfactorily placed, the patient can then be taken for a
localizing CT scan or MRI. Generally, a contrast-enhanced head CT
scan is sufficient for identifying a target. With high-grade intrinsic brain
tumors, the area of thickest enhancement is conventionally targeted.[7] A
target can also be selected such that slightly deeper or shallower
samples could be obtained along the same trajectory. With low-grade
gliomas, a T2-weighted MRI may allow for better targeting. The
localizing CT scan is fused with the preoperative MRI, which provides
adequate accuracy. Advanced planning of an MRI-based trajectory with
subsequent fusion to a localizing CT scan reduces overall operative

time.[8]
The entry point should be planned to avoid entry into a dural blood
vessel, cortical blood vessel, or sulcus. Depending on whether or not
future attempts are resection are anticipated, the entry point could be
planned to be incorporated into the craniotomy incision. The trajectory
should then be reviewed to ensure that the biopsy cannula will avoid
unnecessarily traversing pial or ependymal surfaces. Generally, the
shortest distance that takes these structures into consideration and
avoids eloquent cortex is preferred.
Separate specimens can be obtained from a single trajectory by altering
the depth of the biopsy cannula and also by rotating the aperture of the
side-cutting biopsy cannula. Although even further sampling
heterogeneity may be afforded by planning multiple trajectories, this is
reported to increase the risk of postoperative deficits in deeper lesions.[9]
Biopsy
Once a trajectory is planned, the stereotactic coordinates should be
confirmed and transferred from the planning station into the operating
room. Once the patient arrives in the operating room, he or she can be
positioned on the operating table and intravenous sedation resumed.
The stereotactic frame should be assembled by a skilled operating room
nurse or the surgeon. The stereotactic coordinates should be registered
onto the frame and verified.
With the planned scalp entry site, a small area of hair can be shaved if
desired. The patient can be prepped with caution to avoid the eyes. A
custom drape, the Apuzzo Stereotactic Drape (Integra LifeSciences,
Plainsboro, NJ) can be useful when using the CRW frame because it
has 3 perforations in the drape that exist where the sterile stereotactic
ring attaches to the nonsterile patient frame. Once the ring is placed,
the trajectory should be verified, and any minor adjustments to the scalp
incision can be made. Local anesthetic is injected into the scalp for
patient comfort and hemostasis.
The 2 methods of trephination are twist-drill or bur hole. Twist-drill offers
the advantage of a small punctate skin incision that can be made with a
#11 or #15 scalpel and need measure no larger than a standard 2.7-mm
diameter twist-drill. This allows for less scalp bleeding, quicker closure,
improved cosmesis, and can also facilitate incorporation into a
craniotomy if staged tumor resection is anticipated.
In contrast, a bur hole can be made with a high-speed cranial perforator
or fluted matchstick bur. The theoretical advantage of making a bur hole
is that any dural or cortical blood vessels can be directly cauterized with
bipolar cautery. A bur hole requires a larger linear or curvilinear incision.
If a twist-drill is made, the drill bit should be guided through the guide
tube and reducer in the exact planned trajectory of the biopsy needle. If
a bur hole is made, the ring of the stereotactic arc can be temporarily
rotated out of the way to improve access.

Once the bur hole is made, the biopsy needle should be advanced
down the guide tube to confirm that no bony edges deflect its trajectory.
Once the dura is sharply opened, this should again be confirmed. The
biopsy needle should be measured to the appropriate depth. The
standard distance to the target should be borne in mind depending on
the exact configuration of reducers and guide tubes. The authors use a
disposable Nashold Biopsy Needle (Integra Radionics, Burlington, MA)
and measure the distance from the mid position of the side-cutting port
to the depth stop. The biopsy needle has a Luer lock attachment in
which a saline-filled syringe can be attached in order to apply slight
negative pressure.
The system is flushed with saline, and the side-cutting port is closed.
When the hub of the inner cannula of the needle is rotated 180, the
side-cutting port is opened. The port should be flushed and closed and
then gradually advanced to the planned depth, with attention to notice
any change in resistance as the needle is advanced, which can be an
indication that tumor is entered. Once at the planned depth, the sidecutting port is opened by rotating the inner hub 180, and slight negative
pressure is applied by withdrawing on the saline-filled syringe to pull
tissue into the needle. The side-cutting port is then closed and the
needle withdrawn.
The specimen can be retrieved in a similar manner, by opening the port
and flushing saline through to eject the specimen. Additional specimens
can be obtained by rotating the aperture in different directions, or
alternatively by varying the depth slightly. The authors generally avoid
taking more than 4 specimens. Once specimens are obtained, they can
be sent to pathology, where frozen sections are obtained at the
discretion of the surgeon. The scalp can be closed with a single figureof-8 absorbable suture in the case of twist drill. With a bur hole, the
scalp is closed in layers with buried suture in the galea and a running
suture or staples in the skin. The frame is removed, and any bleeding
encountered from the pin sites can generally be controlled with
tamponade or antibiotic ointment.

FramelessStereotacticBrainBiopsy
Frameless biopsy occurs without a stereotactic frame but typically is
performed with the patient in pin-fixation. Generally, pin-fixation is better
tolerated under general anesthesia, which is more common for
frameless procedures. Because a stereotactic frame is not used, a
coregistration process must be performed. Several methods for this
include fiducial markers, anatomic landmarks, and surface matching.
Fiducial marks can be placed on the patients scalp prior to acquisition
of CT scan or MR imaging. When placing fiducial markers on the scalp,
shaving a patch of hair so the adhesive backing can adhere to the scalp
may be necessary. The authors outline the fiducial with a marker in the
event that it is removed. A minimum of 4 fiducial marks are typically

necessary to accurately register the patient to an image set. The fiducial

markers should be placed a sufficient distance from each other so that
they can be easily distinguishable from one another. Effort should also
be made to avoid placing them in a single plane. Confirming that the
appropriately compatible fiducials are used depending on whether CT
scan or MRI is performed is also important.
After the CT scan or MRI is obtained and the target is planned, the
patient is brought to the operating room and placed under anesthetic.
Generally, pin-fixation is performed such that a rigid reference probe
can be attached to the frame. An optical imaging system is used to
register the patient, and a reference probe to the preoperative images
using one of the registration methods mentioned above is used to
match image space with physical space. If surface matching registration
is used with a laser, avoiding significant distortion of the scalp when
performing pin-fixation is important. Among the 3 registration methods,
no significant advantage exists regarding one method over another in
regards to accuracy.[10]
Once the patient is registered to the preoperative image with the
planned target, the patient is prepped and draped. A sterile reference
star is applied within the sterile field. Although a free-hand method can
be performed by registering the biopsy needle within the navigation
system, a guide tube may provide a more accurate method for smaller
lesions. A guide-tube can be registered to the navigation system and
then oriented in the desired trajectory and held rigidly in place with a
retractor system. Once this is satisfactorily done, a small incision is
made in the same manner as described above. A twist-drill is passed
through the guide tube when it is replaced in the desired trajectory.
Once the biopsy needle is measured to the appropriate depth,
specimens can be obtained in the same manner as described above for
frame-based biopsy.

Pearls
Having a clear conceptualization of framed stereotactic biopsy makes
surgery safer and simpler. In essence, the target is defined as a single
point within 3 axes, x,y, and z. The frame can translate in these 3 axes
to position the center of a sphere over that target. Termed the center-ofarc principle, this can be conceived as a sphere in space that is
centered at the target. Following a trajectory from any point along the
surface of that sphere still leads to the center of the sphere when the
trajectory remains perpendicular.
Thus, as long as the x, y, and z coordinates define the target, the arc
and ring angles can be used to vary the entry point. Although this will
alter the skin incision, the bur hole, the exact trajectory, and the
structures traversed, it will lead to the same target. Thus, modification of
the arc and ring angles can be used intraoperatively without
recalculating a target. Drastic alterations in these angles should be
reviewed on the planning station to confirm that no unexpected

structures are encountered by the trajectory of the probe.

Along the same lines, the distance to the target remains constant for a
given configuration of the biopsy set-up. With the Leksell system, the
radius measures 190 mm. With the CRW system, the radius measures
160 mm. As guide tubes and reducing cannulas are introduced, the
clinician needs to account for the distance to the target possibly
increasing.
With both frame systems, the trunnion rings can be flipped from the
standard left-right position to an anterior-posterior position in order to
access lower temporal lesions. When rotating the trunnion rings,
remember that the coordinates generated are no longer referenced to
the frame-space but to the patient-space and that the arc and ring
angles will differ.

Complications
Hemorrhage
In a consecutive series of 500 patients at a single institution undergoing
framed stereotactic brain biopsy between 1990 and 1999, the reported
rate of hemorrhage identified on routine postoperative CT scan was 8%,
whereas the rate of neurologically symptomatic hemorrhage was 1.2%
and the rate of fatal hemorrhage was 0.2%.[7] The authors identified a
platelet count below 150,000/mm3 and pineal region lesions as
predictors of hemorrhage. The method of biopsy described by the
authors is a small 4-mm twist-drill craniotomy as opposed to a standard
bur hole, which is also worth emphasizing. This small trephination does
not appear to confer any increased risk of extra-axial hemorrhage.
Another series reports no additional risk of an even smaller trephination
using a 2-mm twist-drill.[11]
Some have argued that the number of specimens obtained may confer
increased risk of hemorrhage,[12] although this was not borne out in a
large series, where the median number of specimens was 3, and over
10% of patients had more than 5 specimens sent.[7]
Nondiagnostic sample
The goal of performing a stereotactic brain biopsy is to obtain tissue
diagnosis. Thus, a nondiagnostic sample enables no therapeutic
decision-making and potentially commits the patient to an additional
procedure. Technical reasons for nondiagnostic tissue are minimized
with the use of stereotaxy, and diagnostic yields are consistently
reported to approach 100% in many series.[7, 13, 14]
Visual inspection of the specimens can help determine whether or not
diagnostic tissue is obtained. One consideration is to send a sample for
immediate frozen section pathology, while the patient remains on the
operating table such that further specimens can be obtained if
necessary. Some have argued that diagnostic tissue can be consistently
obtained without intraoperative pathology.[13] In a single series of 134
patients treated between 2005 and 2007, a diagnostic yield of 99.3%
was reported without the guidance of frozen section pathology to

determine the number of specimens to obtain.[13]

Increasing the number of specimens obtained has not been shown to
increase the diagnostic yield.[7] Use of frameless stereotactic technique
has not been shown to negatively affect diagnostic yield.[13, 14, 15, 16, 17]

Stereotactic Brain Biopsy

June 2015
Stereotactic Brain Biopsy is a common procedure that allows a
neurosurgeon to diagnose a brain lesion. Performed in the
operating room, the procedure involves the removal of a small
piece of tissue, most commonly from the brain but could
include samples from the scalp, blood vessels or dura mater
(the outermost membrane covering the brain). Typically,
patients present with symptoms that require a physician to
capture images of the brain. These images may reveal lesions
of uncertain causes. In order to recommend treatment, a
doctor may require a brain biopsy to obtain a specimen that a
pathologist can review for an official diagnosis. In most cases,
the neurosurgeon will use stereotactic equipment to localize
the preferable site for the biopsy. This allows the neurosurgeon
to map the brain in a three-dimensional coordinate system and
select the appropriate target coordinates for guiding the biopsy
needle.
Primary brain tumors affect almost 30,000 individuals each
year and metastatic tumors affect almost 200,000. The most
common primary brain tumors are glioma and meningioma.
Imaging studies such as an MRI (magnetic resonance imaging)
provide information about a tumors location, size and
relationship to surrounding structures. At times, it is
supplemented by MRS (magnetic resonance spectroscopy),
which provides information about the chemical composition of
the tumor. Additionally, diffusion/perfusion-weighted imaging
provides information about the blood and water flow through a
tumor.
However, the most definitive method to make a diagnosis, as
to the exact nature of a tumor, is by obtaining a tissue sample.
The decision as to whether a biopsy should be performed, as
opposed to attempting to completely remove a tumor, is made
with consideration of numerous factors and is done carefully
by a neurosurgeon often in consultation with other neurooncology colleagues. If it's decided that a biopsy is the best

course of action to guide further treatment, then the safest

and most accurate route to access the tumor is performed.
The same principle applies to metastatic brain tumors, where
the primary malignancy is not known, or in a situation where a
neurosurgeon suspects an infectious process, and there is
need for tissue to confirm the diagnosis.
About Stereotactic Surgery
Stereotaxis is the process by which neurosurgeons use MRI or
CT imaging studies, targeted algorithms and a computer
workstation to precisely locate and target a tumor, or other
lesion inside the brain. Previously, this was done by placing a
metal frame on a patients head. However, this has been
largely supplanted by a system that uses small fiducial
markers, about the size of a nickel, that are gently stuck to
different parts of the scalp, providing reference landmarks.
Systems that employ stereotaxis to facilitate neurosurgery
procedures are known as stereotactic navigation systems, and
since most of them use scalp fiducials rather than the old
frame, they are referred to as frameless stereotactic
neuronavigation systems. They are used in the operating room
to facilitate neurosurgical procedures, such as a biopsy.
There are several frameless stereotactic neuronavigation
systems available for use in neurosurgery procedures. They
are manufactured by different biomedical engineering
companies and are named differently. They all have
comparable accuracy and efficacy and use largely the same
principles to perform the task. Neurosurgeons use the system
they are most familiar and comfortable with, and one that they
can trust for accuracy and reliability. A stereotactic biopsy is
performed in the operating room and usually under general
anesthesia.
Technique
Once the patient is asleep, the head is secured and the
fiducials on the scalp are registered by cameras into the
computerized navigation system in the operating room. A
minimal amount of hair is shaved and a small incision marked
out. This area is meticulously cleaned and draped in a sterile
fashion. An opening in the skull about the size of a quarter is
made (burr hole) and the covering of the brain (the dura) is
opened. A stereotactic biopsy needle, which is long and has a
soft-nosed blunt tip, is introduced to the target using the
neuronavigation system in order to guide it and biopsy
samples are obtained.

These are examined in real-time by performing a frozen

section analysis with a pathologist and then additional samples
are obtained for permanent pathology studies. The final results
take three to four days to allow for special stains to be
completed, which enhances the accuracy of the diagnosis.
After the incision is closed, a clean and dry dressing is applied,
which is typically removed in two to three days. Hospitalization
is short and, at most, requires an overnight stay. Some
patients are treated on an outpatient basis. The sutures are
removed in 10 to 14 days.
Indications
The most common ailments that may be diagnosed by a
biopsy are tumors, infection (e.g. abscess), inflammation (e.g.
encephalitis), demyelinating diseases (e.g. multiple sclerosis),
or perhaps a neurodegenerative disease (e.g. Alzheimer's
disease). The biopsy may help identify lesions that do not
require surgical treatment, or diagnose patients who are poor
surgical candidates so they can pursue other appropriate
therapies.
Benefits
A needle biopsy makes it possible for neurosurgeons to reach
the deepest recesses of the brain, allowing them to obtain a
specimen in order to make a diagnosis in a relatively safe
manner. Hospitalization is short and, at most, requires an
overnight stay. Some patients are treated on an outpatient
basis.
Risks
The risks associated with a stereotactic biopsy include
intracranial hemorrhage (approximately 1%), infection (<1%),
or the inability to obtain tissue to make the diagnosis (1%),
which may require a repeat biopsy. For the most part, this is a
safe and useful procedure, performed by neurosurgeons with
exquisite planning and care, and can provide valuable
information, guiding further treatment. State-of-the-art
software and equipment assure a high level of accuracy with
minimal risk to surrounding brain tissue.
Recovery
Following a brain biopsy, bandages may be placed over the
incision sites and can be removed the following day. Patients
may be observed for a specified time after the treatment
before they go home, or they may be kept in the hospital
overnight for observation. Some people experience minimal
tenderness around the incision site. Most patients can return
to their usual activities the following day.

Follow-up
The neurosurgeon, generally in consultation with colleagues
from radiation oncology and medical oncology, will set up
follow-up care and treatment based on the results of the
biopsy. If an infectioun is suspected, consultation with
infectious disease specialists is forthcoming.

tereotacticBrainBiopsy

AboutStereotacticBrainBiopsy
Stereotactic neurosurgery involves mapping the brain in a three
dimensional coordinate system. With the help of MRI and CT scans and
3D computer workstations, neurosurgeons are able to accurately target
any area of the brain in stereotactic space (3D coordinate system).
Stereotactic brain biopsy is a minimally invasive procedure that uses this
technology to obtain samples of brain tissue for diagnostic purposes.

Indications

This procedure is used by neurosurgeons to obtain tissue samples of

areas within the brain that are suspicious for tumors or infections. The
main indications for stereotactic biopsy are deep-seated lesions,
multiple lesions, or lesions in a surgically poor candidate who cannot
tolerate anesthesia.

Technique

On the morning of surgery a headring is placed on the patient. This

involves numbing the skin in four areas and placing the ring on the head
with four pins. A CT scan is then performed.
In the operating room, the patient receives light sedation. An incision
only a few millimeters long is made in the scalp and a small hole is
drilled into the skull. A thin biopsy needle is inserted into the brain using
the coordinates obtained by the computer workstation. The specimen is
then sent to the pathologist for evaluation. Patients are monitored for
several hours following the procedure and usually go home the same
day.

Risks

The risks associated with stereotactic brain biopsy are minimal.

Sometimes the sample of tissue obtained may be non-diagnostic, which
may warrant a repeat biopsy. Other risks include intracranial
hemorrhage, seizure, or infection.
The University of Florida Department of Neurosurgery is one of the
leading centers in the country for stereotactic surgery. Please

contact Dr. Friedman or Dr. Foote for more information.

Biopsy
A biopsy is a surgical procedure in which a small amount of tumor tissue
is removed and sent to a lab for evaluation. The purpose of a biopsy is
to establish a diagnosis in a patient who has a tumor.
A biopsy can be performed as part of the surgery to remove a tumor, or
as a separate procedure. In either case, the surgeon removes a small
amount of tumor tissue and sends it to a lab for a pathologist to review.
H

Three types of biopsy are often performed in patients with brain tumors:
Needle Biopsy: A small cut is made and a small hole, called a
burr hole, is drilled in the skull. A narrow, hollow needle is inserted
through the hole, and tumor tissue is removed from the core of the
needle. The surgeon then sends the tumor tissue to a pathologist for
study and review.
Stereotactic Biopsy: The same procedure as a needle biopsy,
but performed with a computer-assisted guidance system that aids in
the location and diagnosis of the tumor. The computer, using
information from a CT or MRI scan, provides precise information about
a tumors location and its position relative to the many structures in the
brain. Stereotactically guided equipment might be moved into the burr
hole to remove a sample of the tumor. The surgeon then sends the
tumor sample to a pathologist for study and review. This is also called a
closed biopsy.
Open Biopsy: The tissue sample is taken during an operation
while the tumor is exposed. The surgeon then sends the sample to a
pathologist for study and review.
If the results of your biopsy are not normal, you will be sent back to the
doctor for further tests and advice.
It is important to note that the information provided here is basic and
does not take the place of an in-person assessment by a physician. If
you have any questions about how brain tumors are diagnosed, please
contact your doctor.

Brain Biopsy
Definition
H
H

A brain biopsy is a surgery that removes a small piece of brain tissue for
testing. The tissue may be removed by one of the following ways:
Stereotactic biopsyA computer is used to help locate where the biopsy will
be taken, so only a small hole will be needed
Burr holeA small hole is made in the skull over the biopsy area

CraniotomyA piece of skull is cut out and then put back in after the biopsy is
taken

Reasons for Procedure

Brain biopsies are used to make a diagnosis so that treatment can be started.
Some conditions that are diagnosed with this surgery include:
Brain cancer
Brain tumors or growths
Infection
Inflammation
Creutzfeldt Jakob disease

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are
planning to have a brain biopsy, your doctor will review a list of possible
complications, which may include:
Bleeding
Infection
Brain swelling
Damage to brain which may cause:
Changes in memory, behavior, thinking, or speech
Vision problems
Problems with balance
Bowel and bladder problems
Seizures
Paralysis or weakness
Reaction to the anesthesia
Heart attack
Blood clots
Smoking may increase the risk of complications.
Be sure to discuss these risks with your doctor before your biopsy.

What to Expect
Prior to Procedure

At the appointment before your surgery, you can expect:

A neurological examto find out how your nerves work, your mental status,
and your motor and sensory abilities
An MRI scan, CT scan, or PET scan of the brainimages of your body that
will help your doctor plan the surgery
Time set aside for questions:
Questions from your doctorDo you have any new symptoms? What kind of
help do you have at home?
Questions you should ask your doctorWhat will my recovery be like? How
soon will I know the biopsy results? When will I be able to return to work?
Arrange for a ride home from the hospital.
You will be asked to fast for 8-12 hours before surgery. Ask your doctor if you
should take your morning medicines with a sip of water before your surgery.
Talk to your doctor about your medications. You may be asked to stop taking
some medicines up to 1 week before the procedure.

Anesthesia
You may receive:

Local anesthesia and light sedation for stereotactic biopsiesblocks just the
area where surgery is taking place; light sedation makes you sleepy during
surgery
General anesthesia for craniotomies or burr holesblocks pain and keeps
you asleep during surgery; given through an IV

Description of the Procedure

After you are anesthetized and no longer feel any pain, an area of your head
will be shaved and washed with an antiseptic.
Stereotactic Brain Biopsy
The skin on your scalp will be numbed. Next, a device that holds your head
still will be placed on your head. Sometimes the device is not needed. A small
incision and a small hole will be made in your skull. A thin needle will be
inserted using a computer. The computer will help guide the needle to the
exact spot. Using the needle, tissue will be removed from your brain. A
dressing will then be applied.
Burr Hole
A CT or MRI scan might be used to help find the biopsy site. A hole will be
drilled into part of your scull. A needle will be inserted into your brain to
remove tissue. Staples or sutures may be used to close the incision. A
dressing will then be applied.
Craniotomy
An incision will be made in your scalp. Part of the skull will then be removed.
The sheets that cover your brain will be opened. A small sample of brain
tissue will be removed. The sheets that cover your brain will be closed and
stitched. The skull piece will be returned to its spot. Staples or stitches will be
used to close the area. A dressing will be wrapped around your head.

Immediately After Procedure

After the surgery, you will be taken to the recovery room for observation. Your
vital signs will be checked. When you are stable, you will be transferred to a
hospital room or be allowed to go home.

How Long Will It Take?

1 to several hours, depending on the type of biopsy

How Much Will It Hurt?

You will not feel pain during surgery. After surgery, you will be given pain
medication.

Average Hospital Stay

Depending on the type of biopsy, you may stay in the hospital for 1-2 days or
go home the same day. Your doctor may choose to keep you longer if
complications arise.

Post-procedure Care

At the Hospital
Your brain function will be checked frequently. This will include:
Pupil reactions
Mental status
Responsiveness
You may receive:
Medication to prevent seizures
Antibiotics to prevent bacterial infection

The dressing will be removed in 24-48 hours. A lighter dressing will be place
on your head.
While in the hospital, you may be asked to:
Try not to strain or hold your breath. This can increase pressure on your brain.
Get out of bed and walk. This will help to prevent problems, like blood clots
and pneumonia.
At Home
When you are at home, do the following for a smooth recovery:
Get plenty of rest.
Follow your doctor's instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
Any changes in physical abilitybalance, strength, or movement
Any changes in mental statuslevel of consciousness, memory, thinking, or
responsiveness
Redness, swelling, increasing pain, a lot of bleeding, or any discharge from
the incision site
Headache that does not go away
Changes in vision
Fainting
Signs of infection, including fever and chills
Nausea and/or vomiting that you cannot control with the medications you
were given, or that continue for more than 2 days after leaving the hospital
Pain that you cannot control with the medications you have been given
Trouble controlling your bladder and/or bowels
If any of the following occurs, someone should call for medical help for you:
New seizures
Shortness of breath, or chest pain
Loss of consciousness
In case of an emergency, call for emergency medical services right away.

RESOURCES
American Brain Tumor Association
http://www.abta.org
National Brain Tumor Society
http://www.braintumor.org

CANADIAN RESOURCES
Brain Tumor Foundation of Canada
http://www.braintumour.ca
Canadian Cancer Society
http://www.cancer.ca

References
About stereotactic brain biopsy. University of Florida Department of
Neurosurgery website. Available at:
http://www.http://neurosurgery.ufl.edu/residency/about-us/clinicalspecialties/stereotactic-brain-biopsy/. Accessed November 12, 2015.
Your surgery guide: Information about your craniotomy or biopsy for a brain
tumor. Cedars Sinai Medical Center website. Available at:
http://www.braintumortreatment.com/What-to-Expect/The-Treatment-

Experience/Your-Surgery-Guide.aspx. Accessed November 12, 2015.

6/3/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S,
Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a
systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: Michael Woods, MD

Review Date: 11/2015
Update Date: 12/20/2014
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