Implementation of frameless stereotactic brain biopsy: a preliminary experience

Abstract

Introduction: Frameless stereotactic neuronavigation has proven to be a feasible technology to acquire brain biopsies with good accuracy and little morbidity and mortality.

Materials and methods: The present study reports our experience with intracranial biopsy procedures performed using BrainLAB® Varioguide frameless stereotactic brain biopsy systems. From March 2015 to February 2016, five patients aged from 37 to 54 years with supratentorial brain tumors underwent frameless stereotactic brain biopsy. The inclusion criteria for frameless stereotactic brain biopsy were: tumors localized in the eloquent brain area, deep-seated lesion or poor general condition with high risk for open surgery. All biopsies were performed using the frameless stereotaxy protocol under general anesthesia and head fixation in a three-point Mayfield clamp.

Results: In all patients, VarioGuide and multimodal neuronavigation were successfully integrated into the biopsy procedure. No VarioGuide-related adverse events were reported. The mean operative duration was 105 min.The overall diagnostic yield was 100 %. A discrepancy between smear results and conclusive diagnosis was detected in one case. The major reasons for the discrepancy were necrosis and improper quality of the preparations. Following each operation, a control headCT was routinely performed to confirm and document the proper targeting and to exclude postoperative intraparenchymal bleeding.Three cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were Associated with transitoryheadaches. No mortality and morbidity occurred postoperatively.

Conclusion: The frameless stereotactic biopsy with neuronavigation systems is an effective, safe and important technique for histological diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions.