Prospective feasibility study of outpatient stereotactic brain lesion biopsy

To assess the safety and feasibility of performing computed tomography-guided stereotactic brain lesion biopsy as an outpatient day-surgery procedure. In late 1996, a prospective trial of outpatient stereotactic biopsies was initiated. The protocol consists of preadmission education of the patient, computed tomography-guided biopsy with local anesthesia (using a Brown-Roberts-Wells or Cosman-Roberts-Wells frame), postoperative observation in the postanesthetic care unit for 2 hours and in the day surgery unit for 2 hours, and then discharge home 4 hours after the procedure. Seventy-six patients constituted the intent-to-treat group, of whom two were not discharged on the same day (97.4% success rate). The two patients underwent inpatient admission because one required intravenous antibiotic treatment of a brain abscess and the other had a hard lesion in the brainstem that precluded biopsy needle penetration; admission for further investigation of the lesion was elected. Two patients experienced complications (2.6%), i.e., one small area of intraventricular hemorrhage that produced only a mild headache and one case of mild worsening of preexisting leg weakness, with negative computed tomographic results. Discharging patients home after 4 hours of observation after stereotactic biopsies seems to be a safe, well-tolerated practice. In this series, there was no major morbidity and no patient was disadvantaged by participating in this protocol. This approach would be expected to result in health care resource and cost savings, with a potential increase in patient satisfaction because of shorter hospital stays.