Biopsy During Minimally Invasive Intracerebral Hemorrhage Clot Evacuation.

Biopsy During Minimally Invasive Intracerebral Hemorrhage Clot Evacuation.

World Neurosurg. 2018 Dec 24;:

Authors: Lieber AC, McNeill IT, Scaggiante J, Nistal DA, Fowkes M, Umphlett M, Pan J, Roussos P, Mobbs CV, Mocco J, Kellner CP

Abstract
BACKGROUND: The safety and efficacy of brain parenchyma biopsy during minimally invasive (MIS) intracerebral hemorrhage (ICH) clot evacuation has not been previously reported.
OBJECT: To establish the safety and diagnostic efficacy of brain biopsy during MIS ICH clot evacuation and to validate the Modified Boston Criteria as a predictor of Cerebral Amyloid Angiopathy (CAA) in this cohort.
METHODS: From October 2016 to March 2018, superficial and perihematomal biopsies were collected for 40 patients undergoing MIS ICH clot evacuation and analyzed by the pathology department to assess for various ICH etiologies. Additionally, the admission MRI or CT of each patient was analyzed and evaluated for the likelihood of a CAA etiology based on the Modified Boston Criteria. Student's T-test was used to analyze inter-group differences in continuous variables and a two-tailed Fisher exact test was used to determine inter-group differences of categorical variables with significance set at p<0.05.
RESULTS: Two of the 40 patients experienced a post-operative rebleed (5%). Four of the 40 patients had evidence of CAA on biopsy (10%). Patients with CAA on biopsy were older (p=0.005) and had a higher prevalence of parietal lobe (p=0.02) and occipital lobe hemorrhage (p=0.001). The Modified Boston Criteria had a sensitivity of 100% (95% CI: 39.6%-100%) and a specificity of 72.2% (95% CI: 54.6%-84.2%) for predicting CAA on biopsy.
CONCLUSIONS: Brain biopsy in MIS ICH clot evacuation is safe and allows for the diagnosis of various ICH etiologies.

PMID: 30590212 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2Subs7i