Frame-based versus frameless stereotactic brain biopsies: A systematic review and meta-analysis

Area of Science:

• Neurosurgery
• Medical Technology
• Oncology

Background:

• Stereotactic brain biopsy techniques are rapidly evolving.
• Frameless stereotaxy emerged as an alternative to traditional frame-based systems.
• The study addresses the diagnostic yield and safety of frameless versus frame-based stereotactic brain biopsies.

Purpose of the Study:

• To compare the diagnostic yield of frameless and frame-based stereotactic brain biopsy techniques.
• To evaluate the safety profiles, including mortality and morbidity, of both stereotactic systems.
• To assess the frequency of repeat biopsies required for each technique.

Main Methods:

• A meta-analysis of English studies comparing frameless and frame-based stereotactic brain biopsies.
• Independent database searches were conducted to identify relevant studies.
• Pooled estimates and relative risks were calculated for diagnostic yield, mortality, morbidity, and repeat biopsy rates.

Main Results:

• Analysis included 3256 biopsies from 20 studies; no significant difference in diagnostic yield between frameless and frame-based systems.
• A statistically significant increase in asymptomatic intracranial hemorrhages was observed in the frameless group (RR 1.37, 95% CI 1.06-1.75).
• The overall quality of evidence for all outcomes was rated as very low.

Conclusions:

• Both frame-based and frameless stereotaxy are safe and effective for intracranial tumor biopsy, based on very low-quality evidence.
• No definitive preference between the two modalities can be established without further research.
• Future studies should investigate patient preference and cost-effectiveness to guide modality selection.