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J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 031-038
DOI: 10.1055/s-0037-1602697
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Efficacy, Safety, and Duration of a Frameless Fiducial-Less Brain Biopsy versus Frame-based Stereotactic Biopsy: A Prospective Randomized Study

Miltiadis Georgiopoulos
1   Department of Neurosurgery, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
,
John Ellul
2   Department of Neurology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
,
Elisabeth Chroni
2   Department of Neurology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
,
Constantine Constantoyannis
1   Department of Neurosurgery, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
› Author Affiliations
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Publication History

13 November 2016

07 March 2017

Publication Date:
12 June 2017 (online)

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Abstract

Background/Objective We compared the efficacy, duration, safety, length of hospital stay of a frameless fiducial-less brain biopsy with those of the standard frame-based stereotactic biopsy.

Patients and Methods This prospective cohort study enrolled 56 adult patients: (1) for whom no conclusive diagnosis could be reached noninvasively; (2a) who had lesions involving deep-seated and eloquent areas, multifocal lesions, or lesions for which craniotomy and lesion removal was not indicated, or (2b) were poor candidates for craniotomy (> 80 years of age and/or with serious comorbidities). Frameless and frame-based biopsy were performed in 28 patients each

Results A diagnosis was not made in four cases (14.3%) of the frame-based biopsy group and in three cases (10.7%) of the frameless biopsy group, in spite of accurate targeting (p = 1.0). The mean duration of the whole procedure (preparatory steps outside the operating room [OR], inside the OR, surgery) was 111.3 minutes for the frame-based biopsy and 79.1 minutes for the frameless biopsy (p = 0.001). No statistically significant differences between the two methods were found concerning new neurologic symptoms, new abnormal findings in postoperative computed tomography (CT) and length of postoperative hospital stay (LOS). The smallest diameter of a successfully biopsied lesion was 15 mm for both groups.

Conclusions The frameless fiducial-less brain biopsy was equally efficacious and safe compared with the standard stereotactic frame-based biopsy. The overall duration of frameless biopsy is shorter than that of frame-based biopsy, mainly because the preparatory steps in frameless biopsy require less time. However, the overall time spent in the OR did not differ between the two groups. The LOS also did not differ significantly.

Keywords

brain - biopsy - image-guided - neuronavigation - stereotactic
 

  • References

  • 1 Yu X, Liu Z, Tian Z. , et al. Stereotactic biopsy for intracranial space-occupying lesions: clinical analysis of 550 cases. Stereotact Funct Neurosurg 2000; 75 (2–3): 103-108
    CrossrefPubMedGoogle Scholar
  • 2 Lozano A, Gildenberg P, Tasker R. Textbook of Stereotactic and Functional Neurosurgery. Berlin and Heidelberg, Germany: Springer; 2009
    Google Scholar
  • 3 Hall WA. The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 1998; 82 (09) 1749-1755
    CrossrefPubMedGoogle Scholar
  • 4 Heper AO, Erden E, Savas A. , et al. An analysis of stereotactic biopsy of brain tumors and nonneoplastic lesions: a prospective clinicopathologic study. Surg Neurol 2005; 64 (Suppl. 02) S82 –S88
    CrossrefPubMedGoogle Scholar
  • 5 Lu Y, Yeung CV, Radmanesh A. , et al. Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques. World Neurosurg 2015; 83 (03) 261-268
    CrossrefPubMedGoogle Scholar
  • 6 Shooman D, Belli A, Grundy PL. Image-guided frameless stereotactic biopsy without intraoperative neuropathological examination. J Neurosurg 2010; 113 (02) 170-178
    CrossrefPubMedGoogle Scholar
  • 7 Goldstein S, Gumerlock MK, Neuwelt EA. Comparison of CT-guided and stereotaxic cranial diagnostic needle biopsies. J Neurosurg 1987; 67 (03) 341-348
    CrossrefPubMedGoogle Scholar
  • 8 Matsumoto K, Tomita S, Higashi H. , et al. Image guided stereotactic biopsy for brain tumors: experience of 71 cases. [in Japanese]. No Shinkei Geka 1995; 23 (10) 897-903
    PubMedGoogle Scholar
  • 9 Dorward NL, Paleologos TS, Alberti O, Thomas DG. The advantages of frameless stereotactic biopsy over frame-based biopsy. Br J Neurosurg 2002; 16 (02) 110-118
    CrossrefPubMedGoogle Scholar
  • 10 Bale RJ, Laimer I, Martin A. , et al. Frameless stereotactic cannulation of the foramen ovale for ablative treatment of trigeminal neuralgia. Neurosurgery 2006; 59 (4, Suppl 2): ONS394-ONS401 ; discussion ONS402
    PubMedGoogle Scholar
  • 11 Georgiopoulos M, Ellul J, Chroni E, Constantoyannis C. Minimizing technical failure of percutaneous balloon compression for trigeminal neuralgia using neuronavigation. ISRN Neurol 2014; 2014: 630418
    CrossrefPubMedGoogle Scholar
  • 12 Smith JS, Quiñones-Hinojosa A, Barbaro NM, McDermott MW. Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol 2005; 73 (02) 173-179
    CrossrefPubMedGoogle Scholar
  • 13 Owen CM, Linskey ME. Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle. J Neurooncol 2009; 93 (01) 139-149
    CrossrefPubMedGoogle Scholar
  • 14 Amin DV, Lozanne K, Parry PV, Engh JA, Seelman K, Mintz A. Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation. J Neurosurg 2011; 114 (05) 1414-1420
    CrossrefPubMedGoogle Scholar
  • 15 Quiñones-Hinojosa A, Ware ML, Sanai N, McDermott MW. Assessment of image guided accuracy in a skull model: comparison of frameless stereotaxy techniques vs. frame-based localization. J Neurooncol 2006; 76 (01) 65-70
    CrossrefPubMedGoogle Scholar
  • 16 Woodworth GF, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD. Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique. J Neurosurg 2006; 104 (02) 233-237
    CrossrefPubMedGoogle Scholar
  • 17 IBM SPSS Statistics for Windows, RRID:rid_000042 [computer program]. Version 21.0. Armonk, NY: IBM Corp 2012
    PubMed
  • 18 Nishihara M, Takeda N, Harada T. , et al. Diagnostic yield and morbidity by neuronavigation-guided frameless stereotactic biopsy using magnetic resonance imaging and by frame-based computed tomography-guided stereotactic biopsy. Surg Neurol Int 2014; 5 (Suppl 8): S421-S426
    CrossrefPubMedGoogle Scholar
  • 19 Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJ, Vincent AJ. Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 2008; 150 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 20 Jain D, Sharma MC, Sarkar C, Deb P, Gupta D, Mahapatra AK. Correlation of diagnostic yield of stereotactic brain biopsy with number of biopsy bits and site of the lesion. Brain Tumor Pathol 2006; 23 (02) 71-75
    CrossrefPubMedGoogle Scholar
  • 21 Verploegh IS, Volovici V, Haitsma IK. , et al. Contemporary frameless intracranial biopsy techniques: might variation in safety and efficacy be expected?. Acta Neurochir (Wien) 2015; 157 (11) 2011-2016 ; discussion 2016
    CrossrefPubMedGoogle Scholar
  • 22 Gempt J, Buchmann N, Ryang YM. , et al. Frameless image-guided stereotaxy with real-time visual feedback for brain biopsy. Acta Neurochir (Wien) 2012; 154 (09) 1663-1667
    CrossrefPubMedGoogle Scholar
  • 23 Woodworth G, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD. Accuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen. Neurol Res 2005; 27 (04) 358-362
    CrossrefPubMedGoogle Scholar
  • 24 Chernov MF, Muragaki Y, Ochiai T. , et al. Spectroscopy-supported frame-based image-guided stereotactic biopsy of parenchymal brain lesions: comparative evaluation of diagnostic yield and diagnostic accuracy. Clin Neurol Neurosurg 2009; 111 (06) 527-535
    CrossrefPubMedGoogle Scholar
  • 25 Frati A, Pichierri A, Bastianello S. , et al. Frameless stereotactic cerebral biopsy: our experience in 296 cases. Stereotact Funct Neurosurg 2011; 89 (04) 234-245
    CrossrefPubMedGoogle Scholar
  • 26 Dammers R, Schouten JW, Haitsma IK, Vincent AJ, Kros JM, Dirven CM. Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre. Acta Neurochir (Wien) 2010; 152 (11) 1915-1921
    CrossrefPubMedGoogle Scholar
  • 27 Livermore LJ, Ma R, Bojanic S, Pereira EA. Yield and complications of frame-based and frameless stereotactic brain biopsy—the value of intra-operative histological analysis. Br J Neurosurg 2014; 28 (05) 637-644
    CrossrefPubMedGoogle Scholar
  • 28 Burkhardt JK, Neidert MC, Woernle CM, Bozinov O, Bernays RL. Intraoperative low-field MR-guided frameless stereotactic biopsy for intracerebral lesions. Acta Neurochir (Wien) 2013; 155 (04) 721-726
    CrossrefPubMedGoogle Scholar
  • 29 Skjøth-Rasmussen J, Jespersen B, Brennum J. The use of Brainsuite iCT for frame-based stereotactic procedures. Acta Neurochir (Wien) 2015; 157 (08) 1437-1440 ; discussion 1440
    CrossrefPubMedGoogle Scholar
  • 30 Jung TY, Jung S, Kim IY. , et al. Application of neuronavigation system to brain tumor surgery with clinical experience of 420 cases. Minim Invasive Neurosurg 2006; 49 (04) 210-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Pfisterer WK, Papadopoulos S, Drumm DA, Smith K, Preul MC. Fiducial versus nonfiducial neuronavigation registration assessment and considerations of accuracy. Neurosurgery 2008; 62 (3, Suppl 1): 201-207 ; discussion 207–208
    PubMedGoogle Scholar
  • 32 McGirt MJ, Woodworth GF, Coon AL. , et al. Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 2005; 102 (05) 897-901
    CrossrefPubMedGoogle Scholar
  • 33 Barnett GH, Miller DW, Weisenberger J. Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases. J Neurosurg 1999; 91 (04) 569-576
    CrossrefPubMedGoogle Scholar
  • 34 Air EL, Leach JL, Warnick RE, McPherson CM. Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 2009; 111 (04) 820-824
    CrossrefPubMedGoogle Scholar
  • 35 Wang X, Li L, Luo P. , et al. Neuronavigation-assisted trajectory planning for deep brain biopsy with susceptibility-weighted imaging. Acta Neurochir (Wien) 2016; 158 (07) 1355-1362
    CrossrefPubMedGoogle Scholar