Temporal artery biopsy

[suracon]

This Friday 24 Feb. I am to have a left sided temporal artery biopsy and would like to know how many or if anyone had facial nerve damage after the procedure?

[PMRpro Ambassador]

This paper: jmedicalcasereports.biomedc...

says:

"Complications are few and infrequent; however, facial nerve injury has been reported, leaving an untoward cosmetic outcome. This case report is to the best of our knowledge only the fourth one presented in the available literature so far regarding facial nerve injury from superficial temporal artery biopsy."

Which suggests it is very uncommon and it isn't something I've heard anyone say has happened to them.

In seeking informed consent for a procedure they have to tell you everything that MIGHT conceivably happen - or you wouldn't have been "informed". This lady in the article made a full recovery by the way.

However - if you are very concerned, do ask the rheumatologist if it will change the way he treats you. TAB is only positive in about half of patients and while finding the evidence is 100% confirmation of you having GCA, not finding any does NOT mean you don't have GCA. It just means they didn't see the evidence. There are several reasons for that including the fact that the lesions skip areas of the blood vessels, it may not be affecting the temporal artery, the patient has already been on pred for some time, the operator and pathologist were not suitably experienced etc.

[Woodiesmum]

I had a biopsy and no problems xx good luck and hope all goes well xx

[EdithWales]

I had one almost three years ago and like you was very reluctant even more so because I watched the U Tube video, don't do if, I am a nurse.

I went to see the Ophthalmologist with GP husband one side and scary solicitor daughter the other, the former chatted aimlessly about nothing but my daughter and I bombarded him with questions about the risk of facial paralysis. He had never experienced one and when asked if he would have it done himself confirmed he would.

Having made such a fuss I was amazed at the procedure, as others have also said it was no worse than the dentist, in my case it was better.

I had some bruising but nothing else and an almost invisible tiny scar. More importantly he found the Giant Cells, I had been on steroids for 3 weeks and sometimes it's too late but mine were very much there which confirmed GCA.

There is a risk to anything but as others have said it is extremely rare.

Good luck and let us know how you get on

[Woodiesmum in reply to EdithWales]

I wish I had a different surgeon as when I got new rheumy he said the size of sample was too small and would never have shown up x but also a studen t did it which I know they have to learn but I wasn't amused x

But no other problems apart from never watch o on YouTube lol my hubby did and told me how easy it was lol I could have thumped him lol but we had to laugh xx

[Carrollee]

Hi. Had TAB done nearly two years ago at John Radcliffe hospital Oxford. They use vascular surgeons, no problems at all and he took out parts of two separate arteries. No GCA found but have been treated due to symptoms. Also have PMR. All the best cc

[daw50]

I had a temporal artery biopsy without complications. The procedure was very quick and is done under local anesthetic. Good luck with yours.

[enan-illuc]

I had a left side temporal artery biopsy last August (2016). I had no complications or problems. Good luck with your procedure.

[Akino]

I had left sided biopsy on 26 th in January this year. The procedure was about 20 minutes, no bleeding, no pain afterwards, no stitch removal, I could shower and wash my hair after two days. Today the scare is still slightly swollen, but not much. Not tender. No complications!

Wish you luck for tomorrow.

[casse]

Had mine December 2014, no problems. Was diagnosed in 24 hours with GCA. I think you will be fine, I was put under some people are awake not sure which type you were having. Good luck to you.

[suracon]

Thank you everyone for your responses. Really helped me get over my nerves! Had my biopsy done last Friday. As one person said - no worse than going to the dentist, in fact I think having an injection in the gum from the dentist is far worse. I was told it would take 10 days for results of the biopsy which is odd. I have also found out that one could have CGA without it showing up in the biopsy!! It seems that an IMR scan is the more thorough way of identifying CGA which makes me wonder why that is not the chosen course. I shall ask the consultant at my next visit.

[PMRpro Ambassador in reply to suracon]

MRI was assessed as not being useful for GCA in the temporal artery some years ago - but that may be because the technology available at the time wasn't up to it.

Enhanced MRI using a contrast substance has been said to be useful - but for the temporal artery I understand there is the problem that the uptake of the tracer is much higher by the brain and that swamps the signal from the artery.

TAB is available everywhere. There is now an ultrasound technique but it is only available where someone is trained to do it.

[jgantic]

This might be a dumb question, but does the temporal artery biopsy -- after removing the sample -- result in a less prominent prominent artery on the side of the forehead? Are the ends of the artery tied-off, or is blow flow able to continue through the artery after the sample section is removed? Thanks!

[PMRpro Ambassador in reply to jgantic]

No, the ends are tied off, not anastomosed. The blood flow is taken over by what is called collateral circulation - other vessels in the area, like using side roads instead of the motorway.

[jgantic]

Thank you for the quick reply. Does the redistributed blood flow result in other veins in the area becoming more prominent - i.e. bulging? I am experiencing pain in that area due to bulging arteries, and a biopsy is being suggested. So just curious as to the potential side effects / benefits to undergoing the procedure (in addition to test results from the sample artery section removed during the biopsy).

Thanks!

[PMRpro Ambassador in reply to jgantic]

It's not veins you are worried about - it is arteries. GCA only affects arteries and not even all arteries are at risk. The temporal artery is at the surface - that's why you see it and why that is the one that is biopsied. The others are deeper.

Don't get things the wrong way round - the pain isn't due to the artery bulging, it is possibly due to inflammation in the artery wall and that makes it swollen and it becomes more obvious.

If your doctor suspects you may have GCA then the biopsy MAY confirm it. It is positive in about half of patients. When it is positive it is 100% confirmation you have GCA. When it is negative it only means they didn't find the enlarged cells they were looking for and then the doctor has to rely on the symptoms and experience.

There are no benefits to undergoing the procedure unless the biopsy is positive - then you have a certain answer to your diagnosis. Side effects are just the same as any superficial surgical intervention - soreness and a small scar to heal. It may be more painful for some than others - depends on the patient and on the surgeon.

Your doctor should have discussed this and explained why they want to do it. And how the result will influence how they manage your symptoms.