Brain Biopsy

Definition

A brain biopsy is a surgery that removes a small piece of brain tissue for testing. The tissue may be removed by one of the following ways:

  • Stereotactic biopsy—A computer is used to help locate where the biopsy will be taken, so only a small hole will be needed
  • Burr hole—A small hole is made in the skull over the biopsy area
  • Craniotomy—A piece of skull is cut out and then put back in after the biopsy is taken

Reasons for Procedure

Brain biopsies are used to make a diagnosis so that treatment can be started. Some conditions that are diagnosed with this surgery include:

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a brain biopsy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Infection
  • Brain swelling
  • Damage to brain which may cause:
    • Changes in memory, behavior, thinking, or speech
    • Vision problems
    • Problems with balance
    • Bowel and bladder problems
    • Seizures
    • Paralysis or weakness
  • Reaction to the anesthesia
  • Heart attack
  • Blood clots

Smoking may increase the risk of complications.

Be sure to discuss these risks with your doctor before your biopsy.

What to Expect

Prior to Procedure

  • At the appointment before your surgery, you can expect:
    • A neurological exam—to find out how your nerves work, your mental status, and your motor and sensory abilities
    • An MRI scan , CT scan , or PET scan of the brain—images of your body that will help your doctor plan the surgery
    • Time set aside for questions:
      • Questions from your doctor—Do you have any new symptoms? What kind of help do you have at home?
      • Questions you should ask your doctor—What will my recovery be like? How soon will I know the biopsy results? When will I be able to return to work?
  • Arrange for a ride home from the hospital.
  • You will be asked to fast for 8-12 hours before surgery. Ask your doctor if you should take your morning medicines with a sip of water before your surgery.
  • Talk to your doctor about your medications. You may be asked to stop taking some medicines up to 1 week before the procedure.

Anesthesia

You may receive:

  • Local anesthesia and light sedation for stereotactic biopsies—blocks just the area where surgery is taking place; light sedation makes you sleepy during surgery
  • General anesthesia for craniotomies or burr holes—blocks pain and keeps you asleep during surgery; given through an IV

Description of the Procedure

After you are anesthetized and no longer feel any pain, an area of your head will be shaved and washed with an antiseptic.

Stereotactic Brain Biopsy

The skin on your scalp will be numbed. Next, a device that holds your head still will be placed on your head. Sometimes the device is not needed. A small incision and a small hole will be made in your skull. A thin needle will be inserted using a computer. The computer will help guide the needle to the exact spot. Using the needle, tissue will be removed from your brain. A dressing will then be applied.

Burr Hole

A CT or MRI scan might be used to help find the biopsy site. A hole will be drilled into part of your scull. A needle will be inserted into your brain to remove tissue. Staples or sutures may be used to close the incision. A dressing will then be applied.

Craniotomy

An incision will be made in your scalp. Part of the skull will then be removed. The sheets that cover your brain will be opened. A small sample of brain tissue will be removed. The sheets that cover your brain will be closed and stitched. The skull piece will be returned to its spot. Staples or stitches will be used to close the area. A dressing will be wrapped around your head.

Immediately After Procedure

After the surgery, you will be taken to the recovery room for observation. Your vital signs will be checked. When you are stable, you will be transferred to a hospital room or be allowed to go home.

How Long Will It Take?

1 to several hours, depending on the type of biopsy

How Much Will It Hurt?

You will not feel pain during surgery. After surgery, you will be given pain medication.

Average Hospital Stay

Depending on the type of biopsy, you may stay in the hospital for 1-2 days or go home the same day. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital
  • Your brain function will be checked frequently. This will include:
    • Pupil reactions
    • Mental status
    • Responsiveness
  • You may receive:
    • Medication to prevent seizures
    • Antibiotics to prevent bacterial infection
  • The dressing will be removed in 24-48 hours. A lighter dressing will be place on your head.

While in the hospital, you may be asked to:

  • Try not to strain or hold your breath. This can increase pressure on your brain.
  • Get out of bed and walk. This will help to prevent problems, like blood clots and pneumonia .
At Home

When you are at home, do the following for a smooth recovery:

  • Get plenty of rest.
  • Follow your doctor's instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Any changes in physical ability—balance, strength, or movement
  • Any changes in mental status—level of consciousness, memory, thinking, or responsiveness
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
  • Headache that does not go away
  • Changes in vision
  • Fainting
  • Signs of infection, including fever and chills
  • Nausea and/or vomiting that you cannot control with the medications you were given, or that continue for more than 2 days after leaving the hospital
  • Pain that you cannot control with the medications you have been given
  • Trouble controlling your bladder and/or bowels

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

  • New seizures
  • Shortness of breath, or chest pain
  • Loss of consciousness

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

Revision Information

  • American Brain Tumor Association

    http://www.abta.org

  • National Brain Tumor Society

    http://www.braintumor.org

  • Brain Tumor Foundation of Canada

    http://www.braintumour.ca

  • Canadian Cancer Society

    http://www.cancer.ca

  • About stereotactic brain biopsy. University of Florida Department of Neurosurgery website. Available at: http://www.neurosurgery.ufl.edu/clinical-specialties/stereotactic-brain-biopsy.shtml. Accessed December 5, 2014.

  • Your surgery guide: Information about your craniotomy or biopsy for a brain tumor. Cedars Sinai Medical Center website. Available at: http://www.braintumortreatment.com/What-to-Expect/The-Treatment-Experience/Your-Surgery-Guide.aspx. Accessed December 5, 2014.

  • 6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.