Abstract
Background and Study Aims Stereotactic biopsy is a versatile, minimally invasive technique to obtain tissue
safely from intracranial lesions for their histologic diagnosis and therapeutic management.
Our objective was to determine the anatomical, radiologic, and technical factors that
can affect the diagnostic yield of this technique. We suggest recommendations to improve
its use in clinical practice.
Methods This retrospective study evaluated 407 patients who underwent stereotactic biopsies
in the past 34 years. The surgical methodology changed through time, distinguished
by three distinct periods. Different stereotactic frames (Todd-Wells, CRW, Leksell),
neuroimaging tests, and planning programs were used. Using SPSS software v.23, we
analyzed a total of 50 variables for each case.
Results The series included 265 men (65.1%) and 142 women (34.9%) (average age 53.8 years).
The diagnostic yield was 90.4%, morbidity was 5.65% (n = 17), and mortality was 0.98% (n = 4). Intraoperative biopsy improved accuracy (p = 0.024). Biopsies of deep lesions (p = 0.043), without contrast enhancement (p = 0.004), edema (p = 0.036), extensive necrosis (p = 0.028), or a large cystic component (p = 0.023) resulted in a worse diagnostic yield. Neurosurgeons inexperienced in stereotactic
techniques obtained more nondiagnostic biopsies (p = 0.043). Experience was the clearest predictive factor of diagnostic yield (odds
ratio: 4.049).
Conclusions Increased experience in stereotactic techniques, use of the most suitable magnetic
resonance imaging sequences during biopsy planning, and intraoperative evaluation
of the sample before finalizing the collection are recommended features and ways to
improve the diagnostic yield of this technique.
Keywords stereotactic biopsy - diagnostic yield - stereotactic techniques - brain tumor
