Abstract
Background The diagnostic accuracy of frameless stereotactic brain biopsy has been reported,
but there is limited literature focusing on the reasons for nondiagnostic cases. In
this study, we evaluate the diagnostic accuracy of frameless stereotactic brain biopsy,
compare it with the current international standard, and review the field for improvement.
Methods This is a retrospective analysis of consecutive, prospectively collected frameless
stereotactic brain biopsies from 2007 to 2020. We evaluated the diagnostic accuracy
of the frameless stereotactic brain biopsies using defined criteria. The biopsy result
was classified as conclusive, inconclusive, or negative, based on the pathologic,
radiologic, and clinical diagnosis concordance. For inconclusive or negative results,
we further evaluated the preoperative planning and postoperative imaging to review
the errors. A literature review for the diagnostic accuracy of frameless stereotactic
biopsy was performed for the validity of our results.
Results There were 106 patients with 109 biopsies performed from 2007 to 2020. The conclusive
diagnosis was reached in 103 (94.5%) procedures. An inconclusive diagnosis was noted
in four (3.7%) procedures and the biopsy was negative in two (1.9%) procedures. Symptomatic
hemorrhage occurred in one patient (0.9%). There was no mortality in our series. Registration
error (RE) and inaccurate targeting occurred in three trigonal lesions (2.8%), sampling
of the nonrepresentative part of the lesion occurred in two cases (1.8%), and one
biopsy (0.9%) for lymphoma was negative due to steroid treatment. The literature review
suggested that our diagnostic accuracy was comparable with the published literature.
Conclusion The frameless stereotactic biopsy is a safe procedure with high diagnostic accuracy
only if meticulous preoperative planning and careful intraoperative registration is
performed. The common pitfalls precluding a conclusive diagnosis are RE and biopsies
at nonrepresentative sites.
Keywords
frameless stereotaxy - histology - image-guided surgery - intracranial - neuronavigation
