Frame-Based Stereotactic Biopsy - A Single Neurosurgeon Experience of 604 Diagnostic Procedures and Literature Review

To evaluate the surgical experience of the senior neurosurgeon to define the lesion, radiology, and technique-related factors that affect the diagnostic yield and complications, along with the literature review.

Documents were examined for consecutively performed frame-based stereotactic biopsies (SBs) from 1999 to 2021. Procedures that are aimed at nondiagnostic purposes were excluded, thus leaving 604 diagnostic procedures. Diagnostic yield, complication rates, and their relationship with clinical variables were investigated.

The diagnostic yield was 98%, with a symptomatic hemorrhage rate of 1.2%, a total morbidity rate of 4.8%, and a mortality rate of 0.83%. Larger tumors (odds ratio [OR]=1.350), experienced neurosurgeon (OR=1.339), and pathologist (OR=462.743), and prebiopsy examination with both computed tomography and magnetic resonance imaging (MRI) (OR=27.062) were associated with an increased diagnostic yield. None of the parameters were statistically significant for nonhemorrhagic morbidity, whereas the increasing number of specimens (OR=1.395) and glial tumors (OR=3.740) were associated with an increased hemorrhagic risk. Likewise, the increasing number of specimens (OR=2.497) along with the increasing age (OR=14.098) were associated with increased mortality risk.

Knowledge of stereotactic techniques and meticulous surgical planning is required to enhance the diagnostic yield and safety of SB. Considering the results of this largest, MRI-guided, single-neurosurgeon SB series, we advocate training neurosurgeons on stereotactic techniques, routine use of intraoperative pathological examination, and working with dedicated neuropathologists when possible.