Ungar L, Nachum O, Zibly Z, Wohl A, Harel R, Attia M, Spiegelmann R, Zaubermann J, Feldman Z, Knoller N, Cohen ZR. Comparison of Frame-Based Versus Frameless Image-Guided Intracranial Stereotactic Brain Biopsy: A Retrospective Analysis of Safety and Efficacy.
World Neurosurg 2021;
164:e1-e7. [PMID:
34332151 DOI:
10.1016/j.wneu.2021.07.063]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND
A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless vs frame-based image-guided stereotactic techniques is unclear.
OBJECTIVE
To evaluate the safety and accuracy of frameless vs frame-based stereotactic brain biopsy techniques.
METHODS
A total of 278 patients (153 men, mean age 65.5 years) with intra-axial brain lesions underwent frame-based (n=148) or frameless image-guided stereotactic brain biopsy (n=130) using a minimally invasive twist drill technique during 2010-2016 at Sheba Medical Center. Demographic, imaging, and clinical data were retrospectively analyzed.
RESULTS
The diagnostic yield (>90%) did not differ significantly between groups. Overall morbidity (6.8% vs 8.5%), incidence of permanent neurologic deficits (2.1% vs 1.6%), mortality rate (0.7% vs 0.8%), and postoperative computed tomography-detected asymptomatic (14.2% vs 16.1%) and symptomatic (2.0% vs 1.6%) bleeding also did not differ significantly between the frame-based and frameless cohorts, respectively. The diagnostic yield and complication rates related to the biopsy technique were not significantly associated with sex; age; entry angle to the skull and skull thickness; lesion location or depth, or radiologic characteristics. Diagnostic yield was significantly associated with the mean lesion volume. Smaller lesions were less diagnostic than larger lesions in both techniques (p=0.043 frame-based and p=0.048 frameless).
CONCLUSION
The frameless biopsy technique is as efficient as the frame-based brain biopsy technique with a low complication rate. Lesion volume was the only predictive factor of diagnostic yield. The minimally invasive twist drill technique is safe and efficient.
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