Post-operative complication after stereotactic biopsy

Cancer involving the central nervous system ranks second as the most common malignancy seen in infancy through adolescence. Stereotactic biopsy for histopathological diagnosis has become a standard component of the neurosurgical armamentarium. Post- operative care for this procedure has its own challenges. We report a case of a 9-year-old female patient with history of deviation of the face to the left side for 3 years, minimal drooling of saliva and weakness of the right hand for 2.5 years, dysphagia for solids and liquids since 3 weeks. On examination, she had right fourth, sixth and eighth nerve palsy, with right lower motor neuron facial palsy (seventh) and right side paresis of SCM (eleventh). On investigation, she was foud to have a well-defined enhancing lesion about 1.8 cm × 1.3 cm involving right side of medulla extending to pons. She was posted for stereotactic biopsy under general anaesthesia. The procedure was uneventful. The patient was reversed and extubated. Post-operatively she was unable to swallow secretions and cough adequately resulting in aspiration and laryngospasm/bronchospasm, for which she was reintubated and ventilated. She was extubated on the 6^th day and discharged after 4 days. Stereotactic biopsy is a relatively safe procedure but studies have shown complications such as post-operative development of new cranial nerve palsies and worsening of existing deficits which could have occurred in our case. At discharge, although the existent cranial nerve palsies persisted, she was able to swallow and expel secretions as she did before surgery. Thus, it is imperative that we need to be updated about the post-operative complications of certain recently developed procedures and plan accordingly.

No conflict of interest has been declared by the author(s).