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Abstract

Techniques in Neurosurgery & Neurology

Is there a Role for Stereotactic Biopsy of Unresectable High-Grade Gliomas? A Retrospective Cohort Study of Short-Term Morbidity and Mortality

Submission: December 1, 2020 Published: February 10, 2021

DOI: 10.31031/TNN.2021.04.000578

ISSN 2637-7748
Volume4 Issue1

Abstract

Purpose: Management of high-grade gliomas currently relies heavily on a tissue diagnosis to guide treatment decisions, often obtained by stereotactic biopsy.Patients with unresectable high-grade gliomas have a dismal prognosis even with optimal therapy.Sparing them the cost, potential morbidity, and risk of biopsy may be in their best interest.

Method: All patients at one institution over a 9-year period (2005-2013) who had pathological confirmation of high-grade gliomas with stereotactic biopsy and did not undergo any additional surgery were included in this retrospective analysis.Data were collected on patient demographics, performance status (PS), overall survival (OS), 60-day mortality, and iatrogenic hemorrhage.

Result: 160 patients underwent analysis. Median OS was 5.1 months.46 patients died within 60 days after biopsy.8 patients suffered iatrogenic hemorrhage. Older age predicted worse OS and 60-day mortality. Combining PS and age provided superior prognostic information rather than age or PS alone.Patients with PS 0-2 and age ≤ 65 had a median OS of 10.1 months and 14% mortality within 60 days post-operatively.

Conclusion: High grade glioma patients with low performance status and/or advanced age may be better served by avoiding the cost and risk of stereotactic biopsy.Age has a strong effect on overall survival following biopsy in this cohort.In the setting of suspected unresectable high-grade glioma with poor performance status, advanced age, and low likelihood of improvement, there appears to be little gained from biopsy.Careful patient selection is necessary to avoid overtreatment in this population.

Keywords: Glioblastoma;Anaplastic astrocytoma;High-grade glioma;Stereotactic biopsy;Performance status;Inoperable brain tumor

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