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
Further Information

Publication History

13 November 2016

07 March 2017

Publication Date:
12 June 2017 (online)

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.

 
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