Temporal Artery Biopsy: Complications

Introduction:

Giant cell arteritis, or temporal arteritis, is an inflammatory condition that affects large to medium-sized arteries, primarily in the head and neck regions, particularly those on the sides of the forehead. It is classified as an autoimmune disorder wherein the body's immune system erroneously targets and damages tissues. This condition predominantly impacts individuals who are aged 50 and above. Symptoms may include:

• Severe headaches at the back and sides of the head.

• Tenderness of the scalp.

• Jaw pain.

• Vision problems.

A prompt and accurate diagnosis involving blood tests, medical imaging, or a biopsy is crucial for effectively addressing this condition. A temporal artery biopsy is a definitive benchmark for uncovering the enigma of giant cell arteritis.

What Is Temporal Artery Biopsy?

Temporal artery biopsy is a medical procedure used to diagnose the condition of giant cell arteritis. Understanding the various parts of the head is crucial for performing a successful temporal artery biopsy. The superficial temporal artery originates from a more significant artery located in the neck. This artery ascends in front of the tragus and emits its branches. The bifurcation of one of its branches, the anterior auricular artery, varies among individuals. In approximately 73 percent of people, the bifurcation is situated high; in 20 percent, it is in the middle; and in about 7 percent, it is low and close to the tragus. Damage risks during the procedure are more significant when the bifurcation is lower.

The Temporoparietal fascia is a thin layer beneath the scalp, within which the superficial temporal artery is positioned. The facial nerve is also located near this layer. Some experts recommend extracting a sample from the primary branch of the superficial temporal artery before its division into smaller branches, but this may entail the removal of a significant portion of the artery. Others propose obtaining a sample from the smaller branches of the artery. There are also suggestions for obtaining a biopsy sample from the parietal branch.

What Are the Indications of Temporal Artery Biopsy?

Indications for a temporal artery biopsy encompass:

• Clinical Suspicion of Giant Cell Arteritis: Symptoms may encompass jaw pain, headache, vision problems, or scalp tenderness. When these symptoms are coupled with the patient's age exceeding 50, the doctor may recommend a temporal artery biopsy.

• Concern for Vision Complications: Giant cell arteritis has the potential to result in severe vision complications, including possible blindness (either permanent or temporary). Vision-related symptoms can raise suspicions of giant cell arteritis.

• Elevated Inflammatory Markers: Blood tests such as C-reactive protein and erythrocyte sedimentation rate tend to be elevated in cases of giant cell arteritis.

While no single symptom can definitively predict this condition, a temporal artery biopsy can possess a predictive value of over 90 percent. However, if the patient requires corticosteroids, healthcare providers should not delay administering them until the biopsy is performed, as these medications can reduce the likelihood of complications.

What Potential Issues Can Arise From a Temporal Artery Biopsy?

Temporal artery biopsy is generally considered a safe procedure, but there are specific situations in which it should be contraindicated:

• Uncontrolled Bleeding: If an individual takes anticoagulants or has a bleeding disorder, the procedure is contraindicated due to the risk of excessive bleeding post-procedure.

• Localized Infection: If an active infection is present near the biopsy site, the procedure should be contraindicated to prevent the spread of infection and potential hindrance to the healing process.

• Uncooperative Patient: Performing a biopsy safely can be challenging when dealing with a severely mentally ill patient or someone with cognitive impairment.

• Anesthesia Allergy: If the person is allergic to anesthesia, the procedure is contraindicated due to the potential risk of adverse reactions.

• Recent Trauma: Recent trauma near the biopsy site can impede the healing process, making the procedure contraindicated in such cases.

• Corticosteroid Medications: Different opinions exist regarding the impact of long-term corticosteroid use on biopsy results. While some believe it can affect the results, others argue that it does not have an impact.

• Contralateral Biopsy: If an individual has already undergone a temporal artery biopsy with negative results, performing a biopsy on the other side should be avoided. This is because a positive result on the contralateral side is observed in only 2 to 3 percent of individuals.

What Are the Complications of Temporal Artery Biopsy?

Temporal artery biopsy is generally considered a safe procedure, but it can also entail certain complications, including:

• Nerve Injury: The temporal branch of the facial nerve, responsible for controlling eyebrow expressions, is situated near the biopsy site. Injury to this nerve can lead to changes in sensation or muscle weakness. In some cases, facial nerve injury can affect facial movements. Utilizing ultrasound can aid in accurately identifying the optimal location to minimize this risk.

• Bleeding: There is a potential for bleeding, ranging from minor to significant, necessitating medical attention.

• Infection: Infections can trigger inflammation, resulting in redness, pain, swelling, and the potential for other complications.

• Scarring: Scarring is minimal due to the relatively small biopsy size, though it can still occur.

• Hematoma: Hematoma, characterized by the accumulation of blood beneath the skin, is a possible outcome.

• Allergic Reactions: Rarely, patients allergic to anesthesia may experience allergic reactions.

• Localized Pain or Discomfort: Some patients may experience pain at the biopsy site following the procedure.

• Wound Opening: Wound edges separating can impede healing and elevate the risk of infections.

• False Negative: In about 5 to 10 percent of cases, a false negative result can occur, indicating the absence of a problem when one exists. Surgeons must exercise careful site selection and tissue handling to ensure accurate results.

• Other Complications: Aside from swelling, infection, or wound opening, other uncommon issues like stroke, scalp necrosis, or tongue necrosis can arise. To mitigate these risks, some experts recommend palpating the artery's pulse or utilizing ultrasound to identify major blood vessels adjacent to the biopsy site.

Conclusion:

Temporal artery biopsy is a valuable tool for diagnosing giant cell arteritis; however, it is crucial to recognize its potential complications. While it is generally safe, there are associated risks that both healthcare providers and patients should be aware of. The likelihood of encountering these complications can be minimized through cautious patient selection, precise surgical technique, and proper post-operative care.