Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique

Restricted access

Object

The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques.

Methods

A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling.

Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity.

Conclusions

With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.

Abbreviation used in this paper: MR = magnetic resonance.

Article Information

Address reprint requests to: Graeme F. Woodworth, M.D., Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Harvey 8-161, Baltimore, Maryland 21287. email: gw@jhmi.edu.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    Alberti ODorward NLKitchen NDThomas DG: Neuronavigation—impact on operating time. Stereotact Funct Neurosurg 68:44481997

  • 2

    Apuzzo MLChandrasoma PTCohen DZee CSZelman V: Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20:9309371987

    • Search Google Scholar
    • Export Citation
  • 3

    Apuzzo MLChandrasoma PTZelman VGiannotta SLWeiss MH: Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15:5025081984

    • Search Google Scholar
    • Export Citation
  • 4

    Boethius JCollins VPEdner GLewander RZajicek J: Stereotactic biopsies and computer tomography in gliomas. Acta Neurochir (Wien) 40:2232321978

    • Search Google Scholar
    • Export Citation
  • 5

    Callovini GMSherkat SRinaldi ASantucci NGazzeri G: Stereotactic-guided microsurgical removal of lesions without cortical appearance planned by three-dimensional CT reconstruction: limits and advantages of the frame-based technique. Minim Invasive Neurosurg 41:1871931998

    • Search Google Scholar
    • Export Citation
  • 6

    Chandrasoma PTSmith MMApuzzo ML: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:1601651989

    • Search Google Scholar
    • Export Citation
  • 7

    Dorward NLPaleologos TSAlberti OThomas DG: The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 16:1101182002

    • Search Google Scholar
    • Export Citation
  • 8

    Field MWitham TFFlickinger JCKondziolka DLunsford LD: Comprehensive assessment of hemorrhage risks and outcomes after stereotactic brain biopsy. J Neurosurg 94:5455512001

    • Search Google Scholar
    • Export Citation
  • 9

    Hall WA: The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:174917551998

  • 10

    Heilbrun MP: Computed tomography-guided stereotactic systems. Clin Neurosurg 31:5645811983

  • 11

    Jackson RJFuller GNAbi-Said DLang FFGokaslan ZLShi WM: Limitations of stereotactic biopsy in the initial management of gliomas. Neuro-oncol 3:1932002001

    • Search Google Scholar
    • Export Citation
  • 12

    Kelly PJEarnest F IVKall BAGoerss SJScheithauer B: Surgical options for patients with deep-seated brain tumors: computer-assisted stereotactic biopsy. Mayo Clin Proc 60:2232291985

    • Search Google Scholar
    • Export Citation
  • 13

    McGirt MJBulsara KRCummings TJNew KCLittle KMFriedman HS: Prognostic value of magnetic resonance imaging-guided stereotactic biopsy in the evaluation of recurrent malignant astrocytoma compared with a lesion due to radiation effect. J Neurosurg 98:14202003

    • Search Google Scholar
    • Export Citation
  • 14

    Ostertag CBMennel HDKiessling M: Stereotactic biopsy of brain tumors. Surg Neurol 14:2752831980

  • 15

    Sawin PDHitchon PWFollett KATorner JC: Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases. Surg Neurol 49:6406491998

    • Search Google Scholar
    • Export Citation
  • 16

    Wild AMXuereb JHMarks PVGleave JR: Computerized tomographic stereotaxy in the management of 200 consecutive intracranial mass lesions. Analysis of indications, benefits and outcome. Br J Neurosurg 4:4074151990

    • Search Google Scholar
    • Export Citation

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 291 291 38
Full Text Views 248 248 16
PDF Downloads 140 140 6
EPUB Downloads 0 0 0

PubMed

Google Scholar