Infection following a stereotactic brain biopsy: myth or reality? Retrospective study between 2009 and 2023.

Abstract

Introduction: Stereotactic brain biopsy is a routine diagnostic tool for evaluating brain lesions. Although postoperative hemorrhage, epilepsy, and cerebral edema are recognized complications, surgical site infections are rare but still reported. Despite being classified as "clean surgery," the absence of standardized antibiotic prophylaxis remains a topic of discussion. This study aimed to quantify the incidence of postbiopsy infections (PBI) and assess their impact on patient outcomes.

Materials: We conducted a monocentric retrospective study between 2009 et 2023 in order to determine the incidence of post-biopsy infections (PBI+) and compare them with those who were infection-free (PBI-). All patients having a stereotactic brain biopsy were included.

Results: Over a 15-year period, 2,312 patients underwent stereotactic brain biopsy. Post-biopsy infections occurred in 11 patients (0.47%), predominantly involving Staphylococcus (36%). There were no significant differences between the PBI + and PBI - groups in terms of demographic or lesion characteristics. However, PBI + patients had longer ICU stays (21 days, p = 0.01) and longer hospital stays (11 days versus 1 day, p = 0.01). There was no significant difference in mortality.

Conclusions: Infectious complications following stereotactic brain biopsy are rare and do not significantly affect morbidity or mortality. These findings support the continued omission of routine antibiotic prophylaxis and highlight the importance of rigorous sterile techniques and further research to identify high-risk patients.