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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Stereotactic biopsy in elderly patients: Risk assessment and impact on treatment decision

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  • Stephanie G. Kellermann - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Christina A. Hamisch - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Vanessa Hafkemeyer - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Daniel Rueß - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Stefan J. Grau - Klinik und Poliklinik für Allgemeine Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany
  • Maximilian I. Ruge - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.01.07

doi: 10.3205/16dgnc088, urn:nbn:de:0183-16dgnc0889

Published: June 8, 2016

© 2016 Kellermann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To evaluate feasibility and risk profile of stereotactic biopsy (SB) in elderly patients and to analyze its impact upon treatment decision.

Method: In this single center retrospective analysis we identified all patients aged ≥ 70 years receiving SB in a defined period between March 2011 and August 2015. We documented age, gender, Karnofsky Performance Status (KPS), histology, co-morbidity (by CHA2DS2-VASc Score) and use of anticoagulation. We then scrutinized feasibility, diagnostic yield, procedural complications (mortality, transient and permanent morbidity), time as in-patient and the overall therapeutic consequence. For correlational analysis regarding outcome Chi-Square, Mann-Whitney rank sum test and binary regression were used.

Results: One hundred and fourty-nine patients were included. In 148 patients SB was successfully performed. Median age was 74 (70-86) years, gender distribution was male in 58.1% and median KPS was 80 (30-100). Pathological diagnosis was conclusive in 96.6% revealing neoplastic lesions in 90.5 % (high-grade glioma 62.8%, lymphoma 17.6%, metastasis 5.4%, low-grade glioma 2.0% and other tumors 2.7%) and non-neoplastic lesions in 6.1%. Median CHA2DS2-VASc Score was 4 (1-9); 41.2% received anticoagulation and duration of inpatient-stay was 9.5 (2-30) days. Procedure-related mortality was 0%, transient morbidity was seen in 18 patients (7.4%) and permanent morbidity in four patients (2.7%; aggravation of preoperative symptoms (n=3); decreased level of consciousness (n=1)). Adjuvant disease specific therapy was initiated in 112/148 (75.7%) patients. Complication rate was only influenced by age ≥ 75 (p=0.027). Decision against disease-specific therapy was influenced by age ≥ 75 (p=0.028) as well as pre- and postoperative KPS <70 (p= 0.038 and p<0.0001 respectively).

Conclusions: These data demonstrate that stereotactic biopsy in elderly patients is feasible, safe and supports treatment decision-making. Younger patients (< 75 years) with independent status (KPS ≥ 70) showed a significantly higher probability of receiving adjuvant disease-specific therapy and lower complication rates, while with increasing age indication for SB should be made on a case-by-case basis.