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Framed Stereotactic Brain BiopsyFrame placementThe patient should have adequate intravenous sedation but remain alertenough to participate and maintain an upright seated posture, which

greatly facilitates frame placement. If sedation is performed withoutmonitored anesthesia care, then pulse oximetry and oxygen deliveredby nasal cannula should be used. The authors do not routinely performany head shave for frame placement, although this is preferred by somesurgeons. An approximate entry point should be anticipated to avoidplacement of a pin-site or frame post too close to the desired incision.The frame should be assembled without pins in place, and placed onthe patients head in the approximate position. The posts can be rotatedinto a position that optimizes fixation by avoiding excessively medial orlateral location. The pins should be located at or below the greatest

circumference of the calvaria. This aids with fixation and places thelocalizing carbon fiber rods appropriately. nsuring that the frame is notpositioned too close to the bridge of the nose is also important.The anticipated pin sites can then be wiped with an alcohol or !etadinewipe and in"ected with local anesthetic. The pins are then placed in theframe posts, with attention to use the appropriate length pins. #ith the$%# frame, generally the shorter pair of pins are placed in the posteriorposts, while the longer pair of pins are placed in the anterior posts.Antibiotic ointment is applied to the pins, and the pins are advancedthrough the posts to each be flush with the s&in surface.

The authors generally prefer to secure one anterior pin and acontralateral posterior pin first, which then allows the frame to bebalanced relative to the horizon as desired. 'nce in satisfactoryposition, the remaining ( pins are advanced until each is rigidly secured.As the pins are advanced, giving more local anesthetic as needed maybe necessary. nsuring that the posts exert no pressure on the scalp isimportant while advancing the pins. )lacing * or ( radio-opaque fiducialmar&ers on the scalp near the planned incision can be useful. This canhelp tailor the incision, and, before the sterile stereotactic frame isattached to the base, it can help with approximating the s&in incision

and a smaller area of hair can be shaved if desired.Trajectory planning#ith the frame satisfactorily placed, the patient can then be ta&en for alocalizing $T scan or +%I. enerally, a contrast-enhanced head $Tscan is sufficient for identifying a target. #ith high-grade intrinsic braintumors, the area of thic&est enhancement is conventionally targeted./Atarget can also be selected such that slightly deeper or shallowersamples could be obtained along the same tra"ectory. #ith low-gradegliomas, a T(-weighted +%I may allow for better targeting. Thelocalizing $T scan is fused with the preoperative +%I, which provides

adequate accuracy. Advanced planning of an +%I-based tra"ectory withsubsequent fusion to a localizing $T scan reduces overall operative

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time.0/

The entry point should be planned to avoid entry into a dural bloodvessel, cortical blood vessel, or sulcus. 1epending on whether or notfuture attempts are resection are anticipated, the entry point could beplanned to be incorporated into the craniotomy incision. The tra"ectoryshould then be reviewed to ensure that the biopsy cannula will avoidunnecessarily traversing pial or ependymal surfaces. enerally, theshortest distance that ta&es these structures into consideration andavoids eloquent cortex is preferred.2eparate specimens can be obtained from a single tra"ectory by alteringthe depth of the biopsy cannula and also by rotating the aperture of theside-cutting biopsy cannula. Although even further samplingheterogeneity may be afforded by planning multiple tra"ectories, this isreported to increase the ris& of postoperative deficits in deeper lesions.3/

Biopsy'nce a tra"ectory is planned, the stereotactic coordinates should beconfirmed and transferred from the planning station into the operatingroom. 'nce the patient arrives in the operating room, he or she can bepositioned on the operating table and intravenous sedation resumed.The stereotactic frame should be assembled by a s&illed operating roomnurse or the surgeon. The stereotactic coordinates should be registeredonto the frame and verified.

#ith 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. Acustom drape, the Apuzzo 2tereotactic 1rape 4Integra 5ife2ciences,)lainsboro, 678 can be useful when using the $%# frame because ithas 9 perforations in the drape that exist where the sterile stereotacticring attaches to the nonsterile patient frame. 'nce the ring is placed,the tra"ectory should be verified, and any minor ad"ustments to the scalpincision can be made. 5ocal anesthetic is in"ected into the scalp forpatient comfort and hemostasis.The ( methods of trephination are twist-drill or bur hole. Twist-drill offersthe advantage of a small punctate s&in incision that can be made with a

:** or :*; scalpel and need measure no larger than a standard (.-mmdiameter twist-drill. This allows for less scalp bleeding, quic&er closure,improved cosmesis, and can also facilitate incorporation into acraniotomyif staged tumor resection is anticipated.In contrast, a bur hole can be made with a high-speed cranial perforatoror fluted matchstic& bur. The theoretical advantage of ma&ing a bur holeis that any dural or cortical blood vessels can be directly cauterized withbipolar 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 guidetube and reducer in the exact planned tra"ectory of the biopsy needle. If

a bur hole is made, the ring of the stereotactic arc can be temporarilyrotated out of the way to improve access.

http://emedicine.medscape.com/article/1890449-overviewhttp://emedicine.medscape.com/article/1890449-overview

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'nce the bur hole is made, the biopsy needle should be advanceddown the guide tube to confirm that no bony edges deflect its tra"ectory.'nce the dura is sharply opened, this should again be confirmed. Thebiopsy needle should be measured to the appropriate depth. Thestandard distance to the target should be borne in mind depending onthe exact configuration of reducers and guide tubes. The authors use adisposable 6ashold !iopsy 6eedle 4Integra %adionics, !urlington, +A8and measure the distance from the mid position of the side-cutting portto the depth stop. The biopsy needle has a 5uer loc& attachment inwhich a saline-filled syringe can be attached in order to apply slightnegative pressure.The system is flushed with saline, and the side-cutting port is closed.#hen the hub of the inner cannula of the needle is rotated *0 fiducial mar&s are typically

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necessary to accurately register the patient to an image set. The fiducialmar&ers should be placed a sufficient distance from each other so thatthey can be easily distinguishable from one another. ffort should alsobe made to avoid placing them in a single plane. $onfirming that theappropriately compatible fiducials are used depending on whether $Tscan or +%I is performed is also important.After the $T scan or +%I is obtained and the target is planned, thepatient is brought to the operating room and placed under anesthetic.enerally, pin-fixation is performed such that a rigid reference probecan be attached to the frame. An optical imaging system is used toregister the patient, and a reference probe to the preoperative imagesusing one of the registration methods mentioned above is used tomatch image space with physical space. If surface matching registrationis used with a laser, avoiding significant distortion of the scalp whenperforming pin-fixation is important. Among the 9 registration methods,no significant advantage exists regarding one method over another inregards to accuracy.*

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structures are encountered by the tra"ectory of the probe.Along the same lines, the distance to the target remains constant for agiven configuration of the biopsy set-up. #ith the 5e&sell system, theradius measures *3< mm. #ith the $%# system, the radius measures*B< mm. As guide tubes and reducing cannulas are introduced, theclinician needs to account for the distance to the target possiblyincreasing.#ith both frame systems, the trunnion rings can be flipped from thestandard left-right position to an anterior-posterior position in order toaccess lower temporal lesions. #hen rotating the trunnion rings,remember that the coordinates generated are no longer referenced tothe frame-space but to the patient-space and that the arc and ringangles will differ.

Complications

HemorrhageIn a consecutive series of ;

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determine the number of specimens to obtain.*9/

Increasing the number of specimens obtained has not been shown toincrease the diagnostic yield./ Fse of frameless stereotactic techniquehas not been shown to negatively affect diagnostic yield.*9, *>, *;, *B, */

Stereotactic Brain BiopsyJune 2015Stereotactic Brain Biopsyis a common procedure that allows a

neurosurgeon to diagnose a brain lesion. Performed in the

operating room, the procedure inoles the remoal of a small

piece of tissue, most commonly from the brain but could

include samples from the scalp, blood esselsor dura mater!the outermost membrane coering the brain". #ypically,

patients present with symptoms that re$uire a physician to

capture images of the brain. #hese images may reeal lesionsof uncertain causes. %n order to recommend treatment, a

doctor may re$uire a brain biopsyto obtain a specimen that a

pathologist can reiew for an official diagnosis. %n most cases,

the neurosurgeon will use stereotactic e$uipment to locali&e

the preferable site for the biopsy. #his allows the neurosurgeon

to map the brain in a three'dimensional coordinate system andselect the appropriate target coordinates for guiding the biopsy

needle.

Primary brain tumorsaffect almost (0,000 indiiduals eachyear and metastatic tumorsaffect almost 200,000. #he most

common primary brain tumors are gliomaand meningioma.

%maging studies such as an )*%!magnetic resonance imaging"

proide information about a tumor+s location, si&e andrelationship to surrounding structures. t times, it is

supplemented by )*S!magnetic resonance spectroscopy",

which proides information about the chemical composition of

the tumor. dditionally, diffusion-perfusion'weighted imagingproides information about the blood and water flow through a

tumor.

oweer, the most definitie method to ma/e a diagnosis, as

to the eact nature of a tumor, is by obtaining a tissue sample.#he decision as to whether a biopsy should be performed, as

opposed to attempting to completely remoe a tumor, is made

with consideration of numerous factors and is done carefully

by a neurosurgeon often in consultation with other neuro'oncology colleagues. %f its decided that a biopsy is the best

https://www.urmc.rochester.edu/neurosurgery/specialties/neurooncology/treatments/stereotactic-biopsy.aspxhttp://www.mayoclinic.com/health/brain-lesions/MY00847http://www.strokecenter.org/professionals/brain-anatomy/blood-vessels-of-the-brain/http://en.wikipedia.org/wiki/Dura_materhttp://www.healthline.com/health/brain-biopsy#Overview1http://www.nlm.nih.gov/medlineplus/ency/article/007222.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000769.htmhttp://www.abta.org/brain-tumor-information/types-of-tumors/glioma.htmlhttp://www.abta.org/brain-tumor-information/types-of-tumors/meningioma.htmlhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Nuclear_magnetic_resonance_spectroscopyhttp://en.wikipedia.org/wiki/Diffusion_MRIhttp://en.wikipedia.org/wiki/Perfusion_scanninghttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941711/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941711/https://www.urmc.rochester.edu/neurosurgery/specialties/neurooncology/treatments/stereotactic-biopsy.aspxhttp://www.mayoclinic.com/health/brain-lesions/MY00847http://www.strokecenter.org/professionals/brain-anatomy/blood-vessels-of-the-brain/http://en.wikipedia.org/wiki/Dura_materhttp://www.healthline.com/health/brain-biopsy#Overview1http://www.nlm.nih.gov/medlineplus/ency/article/007222.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000769.htmhttp://www.abta.org/brain-tumor-information/types-of-tumors/glioma.htmlhttp://www.abta.org/brain-tumor-information/types-of-tumors/meningioma.htmlhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Nuclear_magnetic_resonance_spectroscopyhttp://en.wikipedia.org/wiki/Diffusion_MRIhttp://en.wikipedia.org/wiki/Perfusion_scanninghttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941711/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941711/

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course of action to guide further treatment, then the safest

and most accurate route to access the tumor is performed.

#he same principle applies to metastatic brain tumors, wherethe primary malignancy is not /nown, or in a situation where a

neurosurgeon suspects an infectious process, and there isneed for tissue to confirm the diagnosis.

About Stereotactic SurgeryStereotaisis the process by which neurosurgeons use )*% or

3# imaging studies, targeted algorithms and a computer

wor/station to precisely locate and target a tumor, or other

lesion inside the brain. Preiously, this was done by placing ametal frame on a patients head. oweer, this has been

largely supplanted by a system that uses small fiducial

mar/ers, about the si&e of a nic/el, that are gently stuc/ todifferent parts of the scalp, proiding reference landmar/s.Systems that employ stereotais to facilitate neurosurgery

procedures are /nown as stereotactic naigation systems, and

since most of them use scalp fiducials rather than the old

frame, they are referred to as framelessstereotacticneuronaigation systems. #hey are used in the operating room

to facilitate neurosurgical procedures, such as a biopsy.

#here are seeral frameless stereotactic neuronaigation

systems aailable for use in neurosurgery procedures. #heyare manufactured by different biomedical engineering

companies and are named differently. #hey all hae

comparable accuracy and efficacy and use largely the same

principles to perform the tas/. 4eurosurgeons use the system

they are most familiar and comfortable with, and one that theycan trust for accuracy and reliability. stereotactic biopsy is

performed in the operating room and usually under general

anesthesia.

Techniquence the patient is asleep, the head is secured and the

fiducials on the scalp are registered by cameras into the

computeri&ed naigation system in the operating room.

minimal amount of hair is shaed and a small incision mar/edout. #his area is meticulously cleaned and draped in a sterile

fashion. n opening in the s/ull about the si&e of a $uarter is

made !burr hole" and the coering of the brain !the dura" is

opened. stereotactic biopsy needle, which is long and has asoft'nosed blunt tip, is introduced to the target using the

neuronaigation system in order to guide it and biopsysamples are obtained.

http://en.wikipedia.org/wiki/Stereotactic_surgeryhttp://en.wikipedia.org/wiki/Neuronavigationhttp://emedicine.medscape.com/article/2103850-technique#aw2aab6b4b2http://www.ncbi.nlm.nih.gov/pubmed/17041831http://en.wikipedia.org/wiki/Stereotactic_surgeryhttp://en.wikipedia.org/wiki/Neuronavigationhttp://emedicine.medscape.com/article/2103850-technique#aw2aab6b4b2http://www.ncbi.nlm.nih.gov/pubmed/17041831

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#hese are eamined in real'time by performing a fro&en

section analysis with a pathologist and then additional samples

are obtained for permanent pathology studies. #he final resultsta/e three to four days to allow for special stains to be

completed, which enhances the accuracy of the diagnosis.fter the incision is closed, a clean and dry dressing is applied,

which is typically remoed in two to three days. ospitali&ation

is short and, at most, re$uires an oernight stay. Somepatients are treated on an outpatient basis. #he sutures are

remoed in 10 to 16 days.

Indications

#he most common ailments that may be diagnosed by abiopsy are tumors, infection !e.g. abscess", inflammation!e.g.

encephalitis", demyelinating diseases!e.g. multiple sclerosis",

or perhaps a neurodegeneratie disease!e.g. l&heimersdisease". #he biopsy may help identify lesions that do notre$uire surgical treatment, or diagnose patients who are poor

surgical candidates so they can pursue other appropriate

therapies.

Benefits needle biopsy ma/es it possible for neurosurgeons to reach

the deepest recesses of the brain, allowing them to obtain a

specimen in order to ma/e a diagnosis in a relatiely safe

manner. ospitali&ation is short and, at most, re$uires anoernight stay. Some patients are treated on an outpatient

basis.

Risks

#he ris/sassociated with a stereotactic biopsy include

intracranial hemorrhage!approimately 17", infection !817",or the inability to obtain tissue to ma/e the diagnosis !17",

which may re$uire a repeat biopsy. 9or the most part, this is a

safe and useful procedure, performed by neurosurgeons with

e$uisite planning and care, and can proide aluableinformation, guiding further treatment. State'of'the'art

software and e$uipment assure a high leel of accuracy with

minimal ris/ to surrounding brain tissue.

Recovery9ollowing a brain biopsy, bandages may be placed oer the

incision sites and can be remoed the following day. Patients

may be obsered for a specified time after the treatment

before they go home, or they may be /ept in the hospitaloernight for obseration. Some people eperience minimal

tenderness around the incision site. )ost patients can returnto their usual actiities the following day.

http://www.nlm.nih.gov/medlineplus/ency/article/001310.htmhttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Inflammationhttp://www.mayoclinic.com/health/encephalitis/DS00226http://en.wikipedia.org/wiki/Demyelinating_diseasehttp://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/what-is-ms/index.aspxhttp://en.wikipedia.org/wiki/Neurodegenerationhttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://emedicine.medscape.com/article/2103850-technique#aw2aab6b4b4http://www.healthline.com/health/extradural-hemorrhage#Overview1http://www.nlm.nih.gov/medlineplus/ency/article/001310.htmhttp://en.wikipedia.org/wiki/Abscesshttp://en.wikipedia.org/wiki/Inflammationhttp://www.mayoclinic.com/health/encephalitis/DS00226http://en.wikipedia.org/wiki/Demyelinating_diseasehttp://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/what-is-ms/index.aspxhttp://en.wikipedia.org/wiki/Neurodegenerationhttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://www.alz.org/alzheimers_disease_what_is_alzheimers.asphttp://emedicine.medscape.com/article/2103850-technique#aw2aab6b4b4http://www.healthline.com/health/extradural-hemorrhage#Overview1

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Follow-up

#he neurosurgeon, generally in consultation with colleagues

from radiation oncology and medical oncology, will set upfollow'up care and treatment based on the results of the

biopsy. %f an infectioun is suspected, consultation withinfectious disease specialists is forthcoming.

tereotactic Brain Biopsy

About Stereotactic Brain BiopsyStereotactic neurosurgery involves mapping the brain in a three

dimensional coordinate system. With the help of MRI and CT scans and3D 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.

IndicationsThis 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.

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TechniqueOn 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 theleading centers in the country for stereotactic surgery. Please

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contactDr. FriedmanorDr. Footefor more information.

BiopsyA biopsy is a surgical procedure in which a small amount of tumor tissueis removed and sent to a lab for evaluation. The purpose of a biopsy isto establish a diagnosis in a patient who has a tumor.A biopsy can be performed as part of the surgery to remove a tumor, oras a separate procedure. In either case, the surgeon removes a smallamount of tumor tissue and sends it to a lab for a pathologist to review.Three types of biopsy are often performed in patients with brain tumorsG

H Needle Biopsy:A small cut is made and a small hole, called a

burr hole, is drilled in the s&ull. A narrow, hollow needle is insertedthrough the hole, and tumor tissue is removed from the core of theneedle. The surgeon then sends the tumor tissue to a pathologist forstudy and review.

H Stereotactic Biopsy:The same procedure as a needle biopsy,but performed with a computer-assisted guidance system that aids inthe location and diagnosis of the tumor. The computer, usinginformation from a $T or +%I scan, provides precise information abouta tumor@s location and its position relative to the many structures in thebrain. 2tereotactically guided equipment might be moved into the burr

hole to remove a sample of the tumor. The surgeon then sends thetumor sample to a pathologist for study and review. This is also called aclosed biopsy.

H Open Biopsy:The tissue sample is ta&en during an operationwhile the tumor is exposed. The surgeon then sends the sample to apathologist for study and review.If the results of your biopsy are not normal, you will be sent bac& to thedoctor for further tests and advice.It is important to note that the information provided here is basic and

does not ta&e the place of an in-person assessment by a physician. Ifyou have any questions about how brain tumors are diagnosed, pleasecontact your doctor.

Brain BiopsyDefinitionA brain biopsy is a surgery that removes a small piece of brain tissue fortesting. The tissue may be removed by one of the following waysG

H 2tereotactic biopsyA computer is used to help locate where the biopsy will

be ta&en, so only a small hole will be neededH !urr holeA small hole is made in the s&ull over the biopsy area

http://neurosurgery.ufl.edu/faculty-staff/our-faculty/william-a-friedman-md/http://neurosurgery.ufl.edu/faculty-staff/our-faculty/kelly-d-foote-md/http://neurosurgery.ufl.edu/faculty-staff/our-faculty/william-a-friedman-md/http://neurosurgery.ufl.edu/faculty-staff/our-faculty/kelly-d-foote-md/

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H $raniotomyA piece of s&ull is cut out and then put bac& in after the biopsy ista&en

Reasons for Procedure!rain biopsies are used to ma&e a diagnosis so that treatment can be started.2ome conditions that are diagnosed with this surgery includeG

J !rain cancerJ !rain tumors or growthsJ InfectionJ InflammationJ $reutzfeldt 7a&ob disease

Possile !omplications$omplications are rare, but no procedure is completely free of ris&. If you areplanning to have a brain biopsy, your doctor will review a list of possiblecomplications, which may includeG

J !leeding

J InfectionJ !rain swellingJ 1amage to brain which may causeG

K $hanges in memory, behavior, thin&ing, or speechK Eision problemsK )roblems with balanceK !owel and bladder problemsK 2eizuresK )aralysisor wea&ness

J %eaction to the anesthesiaJ eart attac&J !lood clots

2mo&ingmay increase the ris& of complications.!e sure to discuss these ris&s with your doctor before your biopsy.

"hat to #$pectPrior to Procedure

J At the appointment before your surgery, you can expectGK A neurological examto find out how your nerves wor&, your mental status,

and your motor and sensory abilitiesK An +%I scan, $T scan, or )T scanof the brainimages of your body that

will help your doctor plan the surgeryK Time set aside for questionsG

Luestions from your doctor1o you have any new symptomsM #hat &ind ofhelp do you have at homeMLuestions you should as& your doctor#hat will my recovery be li&eM owsoon will I &now the biopsy resultsM #hen will I be able to return to wor&M

J Arrange for a ride home from the hospital.J Nou will be as&ed to fast for 0-*( hours before surgery. As& your doctor if you

should ta&e your morning medicines with a sip of water before your surgery.J Tal& to your doctor about your medications. Nou may be as&ed to stop ta&ing

some medicines up to * wee& before the procedure.

%nesthesiaNou may receiveG

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J 5ocal anesthesia and light sedation for stereotactic biopsiesbloc&s "ust thearea where surgery is ta&ing placeO light sedation ma&es you sleepy duringsurgery

J eneral anesthesiafor craniotomies or burr holesbloc&s pain and &eepsyou asleep during surgeryO given through an IE

Description of the ProcedureAfter you are anesthetized and no longer feel any pain, an area of your headwill be shaved and washed with an antiseptic.2tereotactic !rain !iopsyThe s&in on your scalp will be numbed. 6ext, a device that holds your headstill will be placed on your head. 2ometimes the device is not needed. A smallincision and a small hole will be made in your s&ull. A thin needle will beinserted using a computer. The computer will help guide the needle to theexact spot. Fsing the needle, tissue will be removed from your brain. Adressing will then be applied.

!urr oleA $T or +%I scan might be used to help find the biopsy site. A hole will bedrilled into part of your scull. A needle will be inserted into your brain toremove tissue. 2taples or sutures may be used to close the incision. Adressing will then be applied.$raniotomyAn incision will be made in your scalp. )art of the s&ull will then be removed.The sheets that cover your brain will be opened. A small sample of braintissue will be removed. The sheets that cover your brain will be closed andstitched. The s&ull piece will be returned to its spot. 2taples or stitches will beused to close the area. A dressing will be wrapped around your head.

&mmediately %fter ProcedureAfter the surgery, you will be ta&en to the recovery room for observation. Nourvital signs will be chec&ed. #hen you are stable, you will be transferred to ahospital room or be allowed to go home.

Ho' (ong "ill &t Ta)e** to several hours, depending on the type of biopsy

Ho' +uch "ill &t Hurt*Nou will not feel pain during surgery. After surgery, you will be given painmedication.

%,erage Hospital Stay1epending on the type of biopsy, you may stay in the hospital for *-( days orgo home the same day. Nour doctor may choose to &eep you longer ifcomplications arise.

Post-procedure !areAt the ospital

J Nour brain function will be chec&ed frequently. This will includeGK )upil reactionsK +ental statusK %esponsiveness

J Nou may receiveG

K +edication to prevent seizuresK Antibiotics to prevent bacterial infection

http://www.genesishcc.com/helpful-resources/health-library/health-library-resource?chunkid=102887&lang=English&db=hlthttp://www.genesishcc.com/helpful-resources/health-library/health-library-resource?chunkid=102887&lang=English&db=hlt

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J The dressing will be removed in (>->0 hours. A lighter dressing will be placeon your head.#hile in the hospital, you may be as&ed toG

J Try not to strain or hold your breath. This can increase pressure on your brain.J et out of bed and wal&. This will help to prevent problems, li&e blood clots

and pneumonia.At ome#hen you are at home, do the following for a smooth recoveryG

J et plenty of rest.J ?ollow your doctorPs instructions.

!all .our DoctorAfter you leave the hospital, contact your doctor if any of the following occursG

J Any changes in physical abilitybalance, strength, or movementJ Any changes in mental statuslevel of consciousness, memory, thin&ing, or

responsiveness

J %edness, swelling, increasing pain, a lot of bleeding, or any discharge fromthe incision siteJ eadache that does not go awayJ $hanges in visionJ ?aintingJ 2igns of infection, including fever and chillsJ 6ausea andDor vomiting that you cannot control with the medications you

were given, or that continue for more than ( days after leaving the hospitalJ )ain that you cannot control with the medications you have been givenJ Trouble controlling your bladder andDor bowels

If any of the following occurs, someone should call for medical help for youG

J 6ew seizuresJ 2hortness of breath, or chest painJ 5oss of consciousness

In case of an emergency, call for emergency medical services right away.

R#SO/R!#SAmerican !rain Tumor AssociationhttpGDDwww.abta.org6ational !rain Tumor 2ocietyhttpGDDwww.braintumor.org

!%N%D&%N R#SO/R!#S

!rain Tumor ?oundation of $anadahttpGDDwww.braintumour.ca$anadian $ancer 2ocietyhttpGDDwww.cancer.ca

ReferencesAbout stereotactic brain biopsy. Fniversity of ?lorida 1epartment of6eurosurgery website. Available atGhttpGDDwww.httpGDDneurosurgery.ufl.eduDresidencyDabout-usDclinical-specialtiesDstereotactic-brain-biopsyD. Accessed 6ovember *(, (

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xperienceDNour-2urgery-uide.aspx. Accessed 6ovember *(, (-*;>.e0.

Re,ision &nformationJ %eviewerG +ichael #oods, +1J %eview 1ateG **D(