RESUMO
OBJECTIVE: To evaluate the diagnostic yield, accuracy, and safety of frame-based stereotactic brain biopsy procedures. METHODS: A retrospective study of all pathologically diagnosed intracranial lesions, using frame-based stereotactic guided brain biopsy procedures performed at King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Kingdom of Saudi Arabia between 1993 and 2005 was conducted. Medical charts, radiological studies, and pathological slides were reviewed. RESULTS: A total of 120 consecutive patients who had frame-based stereotactic diagnostic biopsy procedures were identified. Data regarding procedural techniques, lesion locations, pathological diagnosis, and postoperative complications were collected. Patients` ages ranged from 3-72 years (mean +/- standard deviation: 39.4 +/- 20.3), 67 males and 53 females. Sites of biopsied lesions included: 49 thalamic, 29 deep frontal, 23 parietal, 9 temporal, and 10 others. Targeting accuracy was 99.2%. General anesthesia was used in 103 patients (85.8%). The rest was carried out under local anesthesia. Diagnostic yield was estimated at 96%. Most frequently encountered pathological diagnosis includes gliomas (63%), infections (16%), and lymphomas (7%). One mortality (0.8%), and 5 (4%) morbidities were encountered. CONCLUSION: Stereotactic brain biopsy is a relatively safe technique to obtain a tissue biopsy that represents the pathology of the lesion. Recent advances in stereotactic neurosurgical techniques have helped to improve the safety and diagnostic yield of such procedures.
RESUMO
OBJECTIVE: To obtain an appraisal for the use of methylprednisolone (MP) in the early management of acute spinal cord injury (SCI) in our health system and the attitude to its use. METHODS: A printed questionnaire on MP in acute SCI was distributed to all major spinal and neurosurgical centers in Riyadh, Kingdom of Saudi Arabia between October and November 2001. RESULTS: A total of 31 replies were collected for statistical analysis. There were 23 replies from doctors (74%) who see 5 or more cases of acute SCI per year. Sixteen doctors (53%) use MP in acute SCI (National Acute Spinal Cord Injury Studies [NASCIS] protocol) regularly, 11 (37%) use it occasionally and 3 (10%) never use it. The use of MP in acute SCI was suggested as a standard of care by 16%, recommended only by 48% and considered optional by 35%. In addition, a review of the literature on the results of the NASCIS I, II and III was conducted. CONCLUSION: Our results confirm the diversities in clinical practice regarding the use of MP in acute SCI. They also raise the issue of the need for specialized centers in spinal trauma with a unified protocol for treatment throughout the Kingdom.
