Skip to main content
SpringerLink
Log in

Safety and efficacy of frameless and frame-based intracranial biopsy techniques

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Background. Frameless stereotaxy or neuronavigation has evolved into a feasible technology to acquire intracaranial biopsies with good accuracy and little mortality. However, few studies have evaluated the diagnostic yield, morbidity, and mortality of this technique as compared to the established standard of frame-based stereotactic brain biopsy. We report our experience of a large number of procedures performed with one or other technique.

Patients and methods. We retrospectively assessed 465 consecutive biopsies done over a ten-year time span; Data from 391 biopsies (227 frame-based and 164 frameless) were available for analysis. Patient demographics, peri-operative characteristics, and histological diagnosis were reviewed and then information was analysed to identify factors associated with the biopsy not yielding a diagnosis and of it being followed by death.

Results. On average, nine tissue samples were taken with either stereotaxy technique. Overall, the biopsy led to a diagnosis on 89.4% of occasions. No differences were found between the two biopsy procedures. In a multiple regression analysis, it was found that left-sided lesions were less likely to result in a non-diagnostic tissue sample (p = 0.023), and cerebellar lesions showed a high risk of negative histology (p = 0.006). Postoperative complications were seen after 12.1% of biopsies, including 15 symptomatic haemorrhages (3.8%). There was not a difference between the rates of complication after either a frame-based or a frameless biopsy. Overall, peri-operative complications (p = 0.030) and deep-seated lesions (p = 0.060) increased the risk of biopsy-related death. Symptomatic haemorrhages resulting in death (1.5% of all biopsies) were more frequently seen after biopsy of a fronto-temporally located lesion (p = 0.007) and in patients with a histologically confirmed lymphoma (p = 0.039).

Conclusions. The diagnostic yield, complication rates, and biopsy-related mortality did not differ between a frameless biopsy technique and the established frame-based technique. The site of the lesion and the occurrence of a peri-operative complication were associated with the likelihood of failure to achieve a diagnosis and with death after biopsy. We believe that using intraoperative frozen section or cytologic smear histology is essential during a stereotactic biopsy in order to increase the diagnostic yield and to limit the number of biopsy specimens that need to be taken.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • FV Aker T Hakan S Karadereler M Erkan (2005) ArticleTitleAccuracy and diagnostic yield of stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimens Neuropathology 25 207–213 Occurrence Handle16193837 Occurrence Handle10.1111/j.1440-1789.2005.00634.x

    Article  PubMed  Google Scholar 

  • M Bernstein AG Parrent (1994) ArticleTitleComplications of CT-guided stereotactic biopsy of intra-axial brain lesions J Neurosurg 81 165–168 Occurrence Handle8027795 Occurrence Handle1:STN:280:DyaK2czgtVeluw%3D%3D

    PubMed  CAS  Google Scholar 

  • RH Clarke VA Horsley (1906) ArticleTitleOn a method of investigating the deep ganglia and tracts of the central nervous system (cerebellum) Br Med J 2 1799–1800

    Google Scholar 

  • NL Dorward O Alberti JD Palmer ND Kitchen DG Thomas (1999) ArticleTitleAccuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note J Neurosurg 90 160–168 Occurrence Handle10413173 Occurrence Handle1:STN:280:DyaK1MzjvFGiug%3D%3D Occurrence Handle10.3171/jns.1999.90.1.0160

    Article  PubMed  CAS  Google Scholar 

  • NL Dorward TS Paleologos O Alberti DG Thomas (2002) ArticleTitleThe advantages of frameless stereotactic biopsy over frame-based biopsy Br J Neurosurg 16 110–118 Occurrence Handle12046728 Occurrence Handle10.1080/02688690220131705 Occurrence Handle1:STN:280:DC%2BD38zgsFOjtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • Ferreira MP, Ferreira NP, Pereira Filho Ade A, Pereira Filho Gde A, Franciscatto AC (2006) Stereotactic computed tomography-guided brain biopsy: diagnostic yield based on a series of 170 patients. Surg Neurol (65 Suppl 1): S1: 27–21: 32

  • R Grossman S Sadetzki R Spiegelmann Z Ram (2005) ArticleTitleHaemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies Acta Neurochir (Wien) 147 627–631 Occurrence Handle10.1007/s00701-005-0495-5 Occurrence Handle1:STN:280:DC%2BD2M3pt12msA%3D%3D

    Article  CAS  Google Scholar 

  • WA Hall (1998) ArticleTitleThe safety and efficacy of stereotactic biopsy for intracranial lesions Cancer 82 1749–1755 Occurrence Handle9576298 Occurrence Handle10.1002/(SICI)1097-0142(19980501)82:9<1756::AID-CNCR23>3.0.CO;2-2 Occurrence Handle1:STN:280:DyaK1c3jsFygsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • AO Heper E Erden A Savas K Ceyhan I Erden S Akyar Y Kanpolat (2005) ArticleTitleAn analysis of stereotactic biopsy of brain tumours and nonneoplastic lesions: a prospective clinicopathologic study Surg Neurol 2 IssueID64 Suppl S82–S88 Occurrence Handle10.1016/j.surneu.2005.07.055

    Article  Google Scholar 

  • VA Horsley RH Clarke (1908) ArticleTitleThe structure of the cerebellus examined by a new method Brain 31 45–124 Occurrence Handle10.1093/brain/31.1.45

    Article  Google Scholar 

  • EI Kandel YV Schavinsky (1972) ArticleTitleStereotaxic apparatus and operations in Russia in the 19th century J Neurosurg 37 407–411 Occurrence Handle4560951 Occurrence Handle1:STN:280:DyaE3s%2FgsVeqsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • JE Kim DG Kim SH Paek HW Jung (2003) ArticleTitleStereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment Acta Neurochir (Wien) 145 547–554 Occurrence Handle10.1007/s00701-003-0048-8 Occurrence Handle1:STN:280:DC%2BD3sznsVCgtg%3D%3D

    Article  CAS  Google Scholar 

  • D Kondziolka LD Lunsford (1999) ArticleTitleThe role of stereotactic biopsy in the management of gliomas J Neurooncol 42 205–213 Occurrence Handle10433104 Occurrence Handle10.1023/A:1006105415194 Occurrence Handle1:STN:280:DyaK1MzmtVCrtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • MD Krieger PT Chandrasoma CS Zee ML Apuzzo (1998) ArticleTitleRole of stereotactic biopsy in the diagnosis and management of brain tumours Semin Surg Oncol 14 13–25 Occurrence Handle9407627 Occurrence Handle10.1002/(SICI)1098-2388(199801/02)14:1<13::AID-SSU3>3.0.CO;2-5 Occurrence Handle1:STN:280:DyaK1c%2FntFGmsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • AV Kulkarni A Guha A Lozano M Bernstein (1998) ArticleTitleIncidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy J Neurosurg 89 31–35 Occurrence Handle9647169 Occurrence Handle1:STN:280:DyaK1czgvFertg%3D%3D Occurrence Handle10.3171/jns.1998.89.1.0031

    Article  PubMed  CAS  Google Scholar 

  • T Lee BG Kenny ER Hitchock PJ Teddy H Palividas W Harkness CH Meyer (1991) ArticleTitleSupratentorial masses: stereotactic or freehand biopsy? Br J Neurosurg 5 331–338 Occurrence Handle1786127 Occurrence Handle10.3109/02688699109002859

    Article  PubMed  Google Scholar 

  • L Leksell (1949) ArticleTitleA stereotaxic apparatus for intracerebral surgery Acta Chir Scand 99 229–233

    Google Scholar 

  • L Leksell D Leksell J Schwebel (1985) ArticleTitleStereotaxis and nuclear magnetic resonance J Neurol Neurosurg Psychiatry 48 14–18 Occurrence Handle3882889 Occurrence Handle1:STN:280:DyaL2M7jtlOhsQ%3D%3D

    PubMed  CAS  Google Scholar 

  • JC Maroon WO Bank BP Drayer AE Rosenbaum (1977) ArticleTitleIntracranial biopsy assisted by computerized tomography J Neurosurg 46 740–744 Occurrence Handle192856 Occurrence Handle1:STN:280:DyaE2s7msleisg%3D%3D

    PubMed  CAS  Google Scholar 

  • MJ McGirt GF Woodworth AL Coon JM Frazier E Amundson I Garonzik A Olivi JD Weingart (2005) ArticleTitleIndependent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases J Neurosurg 102 897–901 Occurrence Handle15926716

    PubMed  Google Scholar 

  • M Mosskin K Ericson T Hindmarsh H von Holst VP Collins M Bergstrom L Eriksson P Johnstrom (1989) ArticleTitlePositron emission tomography compared with magnetic resonance imaging and computed tomography in supratentorial gliomas using multiple stereotactic biopsies as reference Acta Radiol 30 225–232 Occurrence Handle2660886 Occurrence Handle1:STN:280:DyaL1M3oslWqsQ%3D%3D Occurrence Handle10.3109/02841858909174670

    Article  PubMed  CAS  Google Scholar 

  • KS O’Neill PV Dyer BA Bell PR Wilkins D Uttley HT Marsh (1992) ArticleTitleIs peroperative smear cytology necessary for CT-guided stereotaxic biopsy? Br J Neurosurg 6 421–427 Occurrence Handle1333227 Occurrence Handle10.3109/02688699208995030 Occurrence Handle1:STN:280:ByyD1c%2FotFY%3D

    Article  PubMed  CAS  Google Scholar 

  • TS Paleologos NL Dorward JP Wadley DG Thomas (2001) ArticleTitleClinical validation of true frameless stereotactic biopsy: analysis of the first 125 consecutive cases Neurosurgery 49 830–835 Occurrence Handle11564243 Occurrence Handle10.1097/00006123-200110000-00009 Occurrence Handle1:STN:280:DC%2BD3Mrhslyqsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • PD Sawin PW Hitchon KA Follett JC Torner (1998) ArticleTitleComputed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases Surg Neurol 49 640–649 Occurrence Handle9637625 Occurrence Handle10.1016/S0090-3019(97)00435-7 Occurrence Handle1:STN:280:DyaK1c3pvFOgug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • N Shastri-Hurst M Tsegaye DK Robson JS Lowe DC Macarthur (2006) ArticleTitleStereotactic brain biopsy: an audit of sampling reliability in a clinical case series Br J Neurosurg 20 222–226 Occurrence Handle16954072 Occurrence Handle10.1080/02688690600875507 Occurrence Handle1:STN:280:DC%2BD28rivFKltQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • JS Smith A Quinones-Hinojosa NM Barbaro MW McDermott (2005) ArticleTitleFrame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy J Neurooncol 73 173–179 Occurrence Handle15981109 Occurrence Handle10.1007/s11060-004-4208-3

    Article  PubMed  Google Scholar 

  • EA Spiegel HT Wycis M Marks ASJ Lee (1947) ArticleTitleStereotaxic apparatus for operations on the human brain Science 106 349–350 Occurrence Handle17777432 Occurrence Handle10.1126/science.106.2754.349

    Article  PubMed  Google Scholar 

  • J Tilgner M Herr C Ostertag B Volk (2005) ArticleTitleValidation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis – influence of clinical factors Neurosurgery 56 257–265 Occurrence Handle15670374 Occurrence Handle10.1227/01.NEU.0000148899.39020.87

    Article  PubMed  Google Scholar 

  • E Watanabe T Watanabe S Manaka Y Mayanagi K Takakura (1987) ArticleTitleThree-dimensional digitizer (neuronavigator): new equipment for computed tomography-guided stereotaxic surgery Surg Neurol 27 543–547 Occurrence Handle3554569 Occurrence Handle10.1016/0090-3019(87)90152-2 Occurrence Handle1:STN:280:DyaL2s3gs1GqtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • DY Wen WA Hall DA Miller EL Seljeskog RE Maxwell (1993) ArticleTitleTargeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques Neurosurgery 32 407–412 Occurrence Handle8455766 Occurrence Handle10.1097/00006123-199303000-00011 Occurrence Handle1:STN:280:DyaK3s3gsFWksA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • G Woodworth MJ McGirt A Samdani I Garonzik A Olivi JD Weingart (2005) ArticleTitleAccuracy of frameless and frame-based image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy and open resection specimen Neurol Res 27 358–362 Occurrence Handle15949232 Occurrence Handle10.1179/016164105X40057

    Article  PubMed  Google Scholar 

  • GF Woodworth MJ McGirt A Samdani I Garonzik A Olivi JD Weingart (2006) ArticleTitleFrameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique J Neurosurg 104 233–237 Occurrence Handle16509497

    PubMed  Google Scholar 

  • Zernov DN (1889) Encephalometer: device for determination of the location of brain parts of living humans. Proceedings of the society of physicomedicine, Moscow, vol. 2, pp 70–86

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands

    R. Dammers, I. K. Haitsma, J. W. Schouten, C. J. J. Avezaat & A. J. P. E. Vincent

  2. Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands

    J. M. Kros

Authors
  1. R. Dammers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. K. Haitsma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. W. Schouten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. M. Kros
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. J. J. Avezaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. J. P. E. Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Dammers.

Additional information

Correspondence: Ruben Dammers, M.D., Ph.D., Department of neurosurgery, Erasmus Medical Center, ‘s Gravendijkwal 230, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dammers, R., Haitsma, I., Schouten, J. et al. Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 150, 23–29 (2008). https://doi.org/10.1007/s00701-007-1473-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-007-1473-x

Search

Navigation