Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain...

For 50 years, frame-based stereotactic brain biopsy has been the "gold standard" for its high diagnostic yield and safety, especially for complex or deep-seated lesions. Over the past decade, frameless and robotic alternatives have emerged. This report evaluates and compares the outcomes, diagnostic yield, and safety of these methods.

Major databases were screened for studies reporting data on diagnostic yield, postoperative hemorrhage, neurological deficits, and mortality after frame-based, robot-assisted or neuronavigation-assisted frameless biopsies. Meta-analysis with random-effect modeling was performed to compare diagnostic yield, operative duration, length of stay, complications, and mortality.

A total of 92 studies were included with 9801 patients in the frame-based group, 2665 in the robot-assisted group, and 1862 in the frameless group. Pooled diagnostic yield rates were 97% (96%-98%, I 2 = 49%) in robot-assisted, 95% (94%-96%, I 2 = 74%) in frame-based, and 94% (91%-96%, I 2 = 55%) frameless groups with a statistically significant difference ( P < .01, I 2 = 71%). The mean total operative duration including anesthesia, system setup, patient registration, trajectory planning, and skin incision to closure was significantly shorter in the robot-assisted group (76.6 vs 132.7 vs 97.3 minutes, P < .01). The duration from skin incision to closure was comparable between the groups (robot-assisted: 37.8 mins, frame-based: 42.6 minutes, frameless: 58.2 minutes; P = .23). Pooled rates of symptomatic hemorrhage (0.005% vs 0.009% vs 0.007, P = .71, I 2 = 34%), asymptomatic hemorrhage (4% vs 3% vs 3%, P = .64, I 2 = 93%), transient neurological deficit (3% vs 2% vs 2%, P = .5, I 2 = 72%), permanent neurological deficit (0.001% vs 0.001% vs 0.0002, P = .78, I 2 = 47%), and mortality (0% vs 0.001% vs 0.006%, P < .01, I 2 = 10%) were similar between groups. Deaths were mainly due to postprocedural hemorrhage (robotic: 46%, frame-based: 48%, frameless: 72%).

Robot-assisted biopsy is not inferior in diagnostic yield and safety to the gold standard frame-based and neuronavigation-assisted frameless biopsy methods.